Acne in Adolescence

Almost all teens get acne. It happens when an oily substance called sebum clogs pores.

According to the Academy of Dermatologists (AAD), acne is the most common skin condition in the United States and 85% of young people between the ages of 12 and 24 will experience at least minor acne outbreak. Most teens will get acne sometime during their teenage years because puberty is the time when there are many hormonal changes.

Although parents and most doctors consider acne to be a disease of puberty, increasingly, comedonal acne is now seen in children under the age of 10 years. The reasons for this include that children are maturing earlier. The belief that acne is caused by poor hygiene, excessive consumption of fatty foods and chocolate has not been validated by extensive research.

Pimples usually pop up on the face, neck, back, chest, and shoulders. Acne is so common that it’s considered a normal part of puberty. But knowing that doesn’t always make it easier when you’re looking at a big pimple on your face in the mirror. So what is acne, and what can you do about it?

Why Do Some People Get Acne and Others Don’t?

It is not clear why some people are more prone to acne than others.

The exact cause of acne is not known, but hormones called androgens can play a role. Androgens increase in both boys and girls during puberty. Androgens make the skin’s oil glands get larger and make more sebum. Androgens also can increase because of hormonal changes related to pregnancy or starting or stopping birth control pills.

Genetics may also matter. If your parents had acne, you may have inherited that tendency.

Some medications (for example, androgens taken as medicine, epilepsy medication, lithium, and prednisone) can cause acne.

Cosmetics that have a greasy consistency may also clog pores. Water-based products are less likely to cause acne than oil-based makeup.

Pathophysiology of inflammatory acne.

Four main factors are involved in the development of acne:

  1. Abnormal follicular keratinocyte hyperproliferation, leading to the formation of a follicular plug
  2. Increased sebum production within sebaceous follicles
  3. Proliferation of microorganisms (eg Propionibacterium acnes) in the retained sebum
  4. Inflammation

There is a strong genetic element in many patients. All acne, including comedonal acne, has an inflammatory basis.

How to classify acne?

  • Acne lesions are clinically classified as comedones, pustules, nodules, cysts and scars. 
  • Comedones are the distinguishing features between acne rosacea and acne vulgaris. They are keratin-filled plugs that can be described as open or closed. 
  • Open comedones are commonly referred to as blackheads; the black appearance is due to oxidation of keratin plugs. 
  • Closed comedones are whiteheads. 
  • Pustules occur when follicular inflammation is such that large collections of neutrophils collect. 
  • Cysts are follicular-lined keratin-filled structures that dilate. 
  • Nodules occur when there is further inflammation. These are clinically red, tender, palpable lesions. This is where the follicular structures have ruptured. Scarring can be the final outcome once healed.


Many variations of scarring occur in acne. These include 

  • ice‑pick (narrow and deep), 
  • hypertrophic (heaped and smooth) and 
  • atrophic scars (flat and slightly depressed) with a thinner epidermal surface. 

Finally, keloids and hypertrophic scars extend well beyond the site of original inflammation. These occur in the more severe forms of acne and once present they are permanent.

How to treat acne?

Treatment should be individualized and will be based on severity of acne and response to therapy. You should talk to your doctors about which option is best for you. Some over-the-counter topical options include products that contain benzoyl peroxide or salicylic acid. Some people will need prescription strength medications including topical products, oral antibiotics or other medications. For some moderate to severe cases, your doctor may recommend evaluation by a dermatologist. Each product works slightly differently. Products come in soaps, cleansing pads, creams, gels, or lotions.

Try to avoid things that can irritate or bother your skin and cause acne, such as:

  • Squeezing pimples and picking at your skin
  • Tight headbands, helmets or wool hats
  • Greasy lotions, hair products, and oily makeup
  • Grease-filled air — if you work in this type of environment, be sure to wash your face when you get home.
  • When you’re emotionally stressed your body makes extra hormones that can cause breakouts. Studies have shown that some people who have acne often have a breakout when they are stressed

There are still many misconceptions about acne. In nearly all teenage patients, it is not caused by abnormal hormone levels but rather changes to the hormonal levels due to puberty. Acne isn’t a serious health risk, though severe acne can cause permanent scars. Acne can also damage self-esteem.

Taking good care of your skin will help. If you’ve tried over the counter medicine for a while without good results, or you notice scars or dark areas on your skin from your acne, ask your primary care provider about treatment including a possible referral to a dermatologist (skin doctor).

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