Acne—How to Treat and Control It

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Almost all teens get pimples, zits, or acne. Whether your case is mild or severe, there are things you can do to keep it under control. Read on to find out how.

Causes of Acne

During puberty, your skin gets oilier. This can cause pimples. There are many myths about what causes acne, but there are really only 3 main causes.

  • Hormones. You get more of them during puberty. Certain hormones, called androgens, trigger the oil glands on the face, back, shoulders, and upper chest to begin producing more oil. This can cause acne in some people. Some girls get more pimples before and during their periods. This is caused by changes in the levels of hormones.

  • Bacteria. Bacteria called Propionibacterium acnes can be part of the cause of acne.

  • Plugged oil ducts. Small whiteheads or blackheads can form when the oil ducts in your skin get plugged with oil and skin cells. They can turn into the hard and bumpy pimples of acne.

What Doesn't Cause Acne

Don't let people tell you it's your fault. It's not. Acne is not caused by

  • Dirt. That black stuff in a blackhead is not dirt. A chemical reaction in the oil duct turns it black. No matter how much you wash your face, you can still get acne.

  • Contact with people. You can't catch acne from or give acne to another person.

  • Food. Even though soft drinks, chocolate, and greasy foods aren't really good for you, they don't cause acne directly. There is some information suggesting a diet high in sugar and starch may worsen acne, however. Some supplements such as whey protein may also worsen acne.

What to Do and Not Do

If you have acne, here are some tips on what to do and not do.

  • Do wash your face twice a day. In general, milder soaps and cleansers are better for your skin. If you play sports or work up a sweat, wash your face right afterward.

  • Do wash or change your pillowcase 1 to 2 times per week. Residue from hair products and oils can worsen acne.

  • Do eat a well-balanced diet.

  • Do learn how to handle stress. Sometimes stress and anxiety can cause pimples. Try to keep your stress down by getting enough sleep and having time to relax.

  • Do ask your doctor about medicines. If you have to take a prescription medicine, ask your doctor if it can cause pimples. Also ask your doctor what medicines would be best to treat your acne.

  • Don't pop or pinch your zits. All this does is break open the lining of the oil ducts and make them redder and more swollen. This can also cause scars.

  • Don't scrub your skin too hard—it irritates the skin. Other things that can irritate the skin are headbands, hats, chin straps, and other protective pads like football players use.

  • Don't use greasy makeup or oily hair products. These can block oil ducts and make acne worse.

Types of Medicines

There's no cure for acne, but there are over-the-counter and prescription medicines to help keep your acne under control. Also, acne usually clears up as you get older.

NOTE: Check with your doctor before using any medicine. It is important to follow the directions. Also, you should try any new acne regimen for 3 months before giving up because it will take that long to see the maximal benefits.

Over-the-counter Medicines

Medicine bought in stores off the shelf is called over-the-counter or OTC medicine. There are 2 types of OTC medicines for acne: benzoyl peroxide and adapalene.

  • Benzoyl peroxide. Benzoyl peroxide wash, lotion, or gel is an effective acne treatment you can get without a prescription. It helps kill bacteria in the skin, unplug oil ducts, and heal pimples. There are a lot of different brands and different strengths (2.25% up to 10%).

    The gel may dry out your skin and make it redder than the wash or lotion. If that happens to you, you can try the wash or lotion.

    Benzoyl peroxide can be used as a wash in the morning or applied to the face after washing with a gentle cleanser. If using benzoyl peroxide as a wash, make sure you completely rinse it off before using a hand towel or getting dressed, as it may bleach cloth such as towels, clothing, and pillowcases.

  • Adapalene. Adapalene is a topical medicine that is now available without a prescription. It is a very effective medicine for acne, especially when used in combination with benzoyl peroxide. It should be used nightly. This medicine may dry your skin out and make it red at first. Adapalene should be applied once a day at night after washing with a gentle cleanser.

Prescription Medicine

Medicine the doctor orders from a pharmacy is called prescription medicine. There are 3 types of prescription medicines to treat acne: retinoid, antibiotics, and isotretinoin.

  • Retinoid. If OTC medicines do not get your zits under control, your doctor may prescribe a stronger retinoid to be used on the skin (like Retin-A and other brand names). This comes in a cream or gel and helps unplug oil ducts. It must be used exactly as directed. Make sure to use sunscreen and try to stay out of the sun (including tanning salons) when taking this medicine. Retinoids can cause your skin to peel and turn red.

  • Antibiotics. Antibiotics, in cream, lotion, solution, or gel form, may be used for "inflammatory" acne. Antibiotics in pill form may be used if the treatments used on the skin don't help.

  • Isotretinoin. This is a pill that is used for more severe forms of acne and acne that has not improved with other conventional acne treatments. It must never be taken just before or during pregnancy. There is a danger of severe or even fatal deformities to unborn babies. Patients who take this medicine must be carefully supervised by a doctor knowledgeable about its usage, such as a pediatric dermatologist or other expert in treating acne. Isotretinoin should be used cautiously (and only with careful monitoring by a dermatologist and psychiatrist) in patients with a history of depression. Don't be surprised if your doctor requires a negative pregnancy test result, some blood tests, and a signed consent form before prescribing isotretinoin.

    NOTE: Birth control pills can be useful for treating young women with acne. However, taking birth control pills and other medicines may make both less effective. If you are on the pill, talk with your doctor about how it might affect your acne.

How to Apply Topical Medicine

Apply a thin layer to the entire area where pimples may occur. Don't just dab it on top of your pimples. A pea-sized amount should be used to cover the entire face. You can use a "5-dot" method where a small dot-sized amount is applied to the forehead, each cheek, nose, and chin. Avoid the skin around your eyes.


Here are things to keep in mind no matter what treatment you use.

  • Be patient. Give each treatment enough time to work. It may take 3 to 6 weeks or longer before you see a change and 12 weeks for maximum improvement.

  • Be faithful. Follow your treatment program every day. Don't stop and start each time your skin changes. Not using it regularly is the most common reason why treatments fail.

  • Follow directions. Not using it correctly can result in treatment failure or troublesome side effects.

  • Only use your medicine. Doctors prescribe medicine specifically for particular patients. What's good for a friend may not be good for you.

  • Don't overdo it. Too much scrubbing makes skin worse. Too much benzoyl peroxide or topical retinoid cream can make your face red and scaly. Too much oral antibiotic may cause side effects.

  • Don't worry about what other people think. It's no fun having acne, and some people may say hurtful things about it.

  • Try not to let it bother you. Most teens get some acne at some point. Acne usually clears up as you get older. Remember that acne is temporary and there are a lot of ways to keep it under control.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. Products are mentioned for informational purposes only and do not imply an endorsement by the American Academy of Pediatrics.


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