Although acne is a common dermatologic condition among adults, it is still most often associated with the teen years. Even the slightest case of acne can seem earth-shattering to a young person who is coping with myriad social, emotional, and physical changes.
If a sufficient length of time has gone by and they do not improve,
I'll boost up the adapalene and benzoyl peroxide to twice a day. If they have popular lesions, I might switch the antibiotic, too.
Differences between Teen and Adult Skin
o Teenage skin tends to be oilier than adult skin because the surge of hormones during adolescence accelerates the production of sebum.
o Dehydroepiandrosterone sulfate, testosterone, and dehydrotestosterone stimulate the sebaceous gland during adolescence, which is why oily skin is a special concern of teenagers.
o The constant flux of hormones results in acne that can rapidly change in degree of intensity.
o Hormonal changes influence the quality of the patient's acne, which in turn affects response to therapy.
o Teenagers are more susceptible to acne mechanica, because of friction from sports equipment.
Tailoring Therapy
o A patient who presents with mild, comedonal acne may respond well to first-line acne treatments, such as topical retinoid with benzoyl peroxide and an oral antibiotic, but hormonal shifts could interfere with this therapy's effectiveness.
o Dr Jan Hornets recommends waiting for a minimum of 6 weeks before altering any acne therapy, and then doing so by changing the dosage or type of only one medication at a time.
o His first-line therapy is a topical retinoid, such as adapalene (Differin®), during the day and benzoyl peroxide at night.
o If acne is more severe or fails to improve, he recommends using adapalene and benzoyl peroxide simultaneously twice a day.
o When used together, benzoyl peroxide should be applied first, with adapalene on top, since this retinoid does not destabilize in sunlight.
What Teens Prefer in Acne Therapy
o Ease of use is primary.
o A combination of a topical retinoid and benzoyl peroxide is Dr Jan Hornets's first-line choice for this age group.
o Gels are preferable to lotions; they help absorb excess sebum, and their texture is more acceptable to teenage boys.
o Adding an oral antibiotic to standard topical treatment can help speed up improvement. The antibiotic should be discontinued once the skin clears.
o For teens on isotretinoin, both doses can be given simultaneously to minimize confusion and missed doses.
Hormonal Therapy in Teenagers
o Teenage girls who request oral contraceptives from their dermatologist should be referred to a gynecologist if they have not yet consulted one.
o Girls whose acne flares before the start of their menstrual cycle are ideal candidates for hormonal therapy.
Avoiding Bad Habits
o Noncompliance is the worst habit among teenagers, though most will adhere to therapy.
o Sun exposure may be a problem if the teen is using an older topical retinoid, such as Retin-A. Switching to adapalene, which is not photosensitive, may be a better choice.
o Sugar and junk food do not appear to exacerbate acne.
Hyperpigmentation and Scarring
o Teenagers need to understand that picking at acne causes scars and that scars are permanent.
o In dark-skinned patients, even those who do not manipulate their lesions may develop areas of hyperpigmentation.
o Hyperpigmentation can be treated with a combination of a topical retinoid and hydroquinone.
Self-Treatment
o Teens are particularly susceptible to acne remedies offered on TV, over the counter, or in health food stores.
o If the teen prefers, most of these remedies can be continued even while on conventional therapy.
Developing Rapport
o It is paramount that the patients trust the dermatologist to be sensitive and confidential.
o Information gleaned from interviews with teenagers should not be shared with parents.
o Expressing interest in the teen as an individual helps establish a good relationship.
