This post is sponsored by CHOC Children’s

The teen years can be difficult. From social issues to heartbreaks to school stress, it’s a lot to handle. And then you add the roller-coaster of shifting hormones . . . it’s no wonder teens can struggle with self-esteem. Acne can be another frustrating hallmark of this phase of life and can affect self-confidence for many kids. I talked with Dr. Priya Mody, a pediatrician from CHOC Children’s, to hear an expert opinion on how to help our kids deal with problematic skin issues.

Simply put, teens are more prone to acne than their younger siblings or their parents. Acne occurs when the hair follicles are plugged with an oil called sebum.

“Hormones, that teenagers can have in excess during puberty, increase that oil production, which means more acne,” Dr. Mody explains. “That’s why girls tend to get it around their period, and boys tend to get it when they start going through growth spurts when they’re around 14, 15, and 16 years old.”

I asked Dr. Mody about the best products for kids to use. She explained that many times, kids come in to her office after they have already tried over-the-counter medications. “There’s a lot of different options out there, so sometimes it is confusing for the parents and kids,” she says. “Washes that contain benzoyl peroxide or salicylic acid tend to be the best because they kill bacteria and remove the dead skin that clogged the pores. There are also on-the-spot treatments that contain these same ingredients, that you can apply to decrease inflammation and prevent pimples from coming back.”

In terms of which active ingredient to choose (benzoyl peroxide or salicylic acid), Dr. Mody suggests that it’s a matter of trial and error. “Unfortunately for kids, an over-the-counter product that works for one teen, doesn’t necessarily work for another. I typically tell them to start with one and if it doesn’t work, go to the other. I don’t usually give specific brand names, but instead,  looking for a nice light wash that the kids can use to wash their faces in the morning and at night or after sports. I like that salicylic acid doesn’t dry out the skin, but it takes longer to take effect. Kids often want something that’s quicker, and benzoyl peroxide tends to work better, but it can be drying.”

Dr. Mody warns that many acne treatments can dry out the skin, so it’s important to find a good oil-free moisturizer. “After you put on any acne treatment, apply an oil-free moisturizer on top of it to prevent dry skin. If your body thinks your skin is too dry, it produces more oil, and then the acne can get worse.” The point is not to dry the skin out completely, she explains. It’s to get that bacteria off and then keep it moisturized.

I also asked about toners or pre-moistened pads with medication on it that seem to be heavily marketed to teens. Dr. Mody recommends caution with these because sometimes kids can think that the more they scrub their face, the better their acne will be. “Sometimes it’ll make it worse because it dries out the skin more and actually irritates the skin,” she says. “I recommended they do one or the other. If it is a light toner, then that’s fine, but they have to just lightly dab their face with it. Sometimes with cleansing pads, kids just start scrubbing and scrubbing, their face gets more inflamed, their skin dries out, and then that will make the acne worse.” She also warns that toners and pads are not a quick substitute for washing the face, although they can be great in a pinch in situations like after gym class or sports. “Sometimes maybe that’s all they can do. They can have them in their backpack and just kind of clean off the oil on their face. But when they get home, they should wash their face again.”

I was interested to hear her advice on that tricky combo of eczema and acne that plagues some teens. She acknowledged this can be more difficult to treat because they already have dry skin. “Teens with eczema already have dry skin, and acne medication can worsen the eczema. There is an over-the-counter option called Differin that has adapalene, and it tends to not dry out the skin as much as a lot of other topical retinoids or benzoyl peroxide.” She also emphasized that kids with eczema need to make sure they are wearing sun protection to prevent further drying of their skin.

In terms of how to know it’s time for a prescription acne medication, Dr. Mody says that usually happens after they have tried several different  over-the-counter options and nothing has worked.

“Kids will tell you, ‘Oh, I’ve done Proactiv. I’ve done Clearasil. I’ve done Neutrogena,” and then by that time they’re frustrated. That’s when we do prescriptions. There are combinations out there with benzoyl peroxide and then a topical antibiotic cream, like clindamycin or erythromycin. Sometimes those combo creams work well because it’ll kill bacteria pretty quickly.” In harder cases, Dr. Mody will look at retinoids like Retin-A, or oral antibiotic for really problematic issues like cystic acne.

She stresses that the important thing is to let the kids know that it’s going to take time. It can be discouraging for kids who have already tried a lot of options to be patient. As teens are prone to do, they want instant results.

“When they come back in and say, ‘This didn’t work,’ I ask them, ‘Why didn’t it work?’ and they say, “I tried it for a week.” I have to remind them to allow the medication time to take effect. You have to keep it up for six weeks. You have to be persistent. Sometimes, acne may get worse before it gets better.” It can be discouraging for kids who have already tried a lot of options to be patient. As teens are prone to do, they want instant results.

In terms of more holistic approaches to acne, Dr. Mody suggests taking 30 to 40 milligrams of zinc per day. She also recommends tea tree oil just for spot treatment, and even apple cider vinegar diluted at a one to three ratio with water as an anti-inflammatory wash. She also suggests paying attention to diet. “There have been studies suggesting that carbohydrates, refined sugars, and some milk products have been shown to increase inflammation, which could worsen acne,” she says.

Acne doesn’t always warrants a trip to a dermatologist. Dr. Mody encourages parents to first discuss treatment options with their child’s pediatrician or primary care physician. “Sometimes I bring it up before my patients do,” says Dr. Mody. “A teenager’s  self-esteem can be really affected by acne. Kids or teens with moderate to severe acne can be depressed or have low self-esteem or anxiety. Fixing the acne can improve their self-esteem and sometimes their depression.

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