Acne 911

Acne will always be awful. It may be a rite of passage into adulthood, but it brings anxiety and shame at a time when a teen-ager's self-esteem is at its most delicate.

But teen-age breakouts made the news in a good way recently, with the announcement that Justin Bieber has become the latest spokesperson for Proactive. He joins Avril Lavigne, Katy Perry and other stars who proudly admit they get zits (in return for compensation, of course).

While your kid may not believe it, acne is not life-threatening — but some of the more invasive treatments may be. Antibiotics prescribed for acne have been linked to inflammatory bowel disease. And actor James Marshall is suing the makers of Accutane, claiming it caused bowel problems that ultimately led to the removal of his colon, ruining his career. (It's now off the market, but the generic version, isotretinoin, is still used.)

We asked Alyson Levine, a dermatologist specializing in treating teenage acne in Chappaqua, New York, about how to support your spotty teen with treatment and love.

Is it usually the teen who asks to see a dermatologist or a mom who brings him or her in?

Often, kids aren't going to be the ones to mention it — even if they are worrying. In my practice, I've found that often moms don't know how to recognize early acne.

We thought it was pretty obvious.

Acne comes in many different forms. That's why many moms and kids don't recognize that they're suffering from acne.

It can begin simply with one or two blackheads. This is the point when you should recognize that this is teen acne coming on. The time to start treatment is early. You can treat it more quickly and more effectively, so it's more likely you'll have success from basic products and regimens.

What are the best treatments?

Start with simple treatments. Look for over-the-counter, proven products, and look for something that contains benzoyl peroxide.

There are so many products out there containing benzoyl peroxide, and some of them are really pricey. Are the most expensive products any better?

Benzoyl peroxide can be very harsh and not well-tolerated. It can be challenging to find one that is well tolerated. Some can be very drying, or cause your skin to be itchy, blotch or burning.

We thought that was a sign that the product is working.

Every day, I see teens and adults who think that products are working if they're burning. That's not true at all. It would be better to use a product that's effective but not irritating.

Are there any other common acne treatment mistakes?

Don't spot treat or treat just one zit. If you look better after a few days or weeks of treatment, that doesn't mean you're cured. It means the products are working. Keep treating the whole face or, inevitably, acne will flare again.

How can I support my teen's treatment?

It's hard for a teen to get into good habits, to understand what to use and when to use it. Even if we have an effective product, getting them to use it can be a major challenge. Create a regimen, laying out steps A, B and C. If you're working with an over-the counter product, they often come with such a regimen. Your teen may only need one product, so the regimen may be as simple as, "Wash your face in the morning, dry it and put on sunscreen. Before bed, wash and apply the product." 

How do we know when to ask for help?

Sometimes the over-the-counter product is not going to be god enough. Some forms may be treatment resistant or get more severe. At that point, you should see a dermatologist. Some of the things we commonly use are prescription topical that may contain benzyl peroxide, retinoids or topical antibiotics. We also commonly use oral antibiotic pills and hormone therapies.

How should we bring this up with a teen-ager in a way that isn't negative or shaming?

Don't minimize what your teen is feeling. It can be devastating. Their self-esteem goes down, they can become depressed or socially isolated.  Bringing it up gently is the best way, and in a way that empowers the teen. Let him know he doesn't need to suffer, there are very effective things they can do.

Do you typically see more resistance from boys?

Yes, I see a lot of resistance from young teen boys. This is where a product that has a prescribed regimen can help. Take baby steps and educate them on why and how to use the product. Once they do take these small steps and start to see results, they're encouraged. The good news is, there's so much we can do.