Transcription:
Understanding Acne: When to Seek Help from a Pediatric Dermatologist

Deborah Howell: Acne is a condition most teens will face in their lives. It can be a stressful time for many teenagers, but helping your teen learn how to manage their acne can help decrease anxiety and long-term effects. It's also equally important to know when to seek the help of a dermatologist.

Here with us today is Chief of Pediatric Dermatology at Lebonheur Children's Hospital, Dr. Teresa Wright, to share more information about acne and how to treat it. Welcome to you, Dr. Wright.

Dr. Teresa Wright: Thank you. Thank you for having me today.

Deborah Howell: Lovely to have you. So, let's start from the top. What exactly is acne?

Dr. Teresa Wright: Technically, acne is considered a disorder of sebaceous glands, which are the oil glands in the skin. And we don't really understand exactly what causes acne or why some individuals are more prone to it than others. But we do know that there are four main features kind of involved in the development of acne.

First thing is that as hormones become more active as kids head into puberty, that stimulates production of oil in the skin. And the other thing that happens is that there's a buildup of dead skin cells that leads to clogged pores. The clogged pores can then lead to inflammation, which causes the red sore bumps. And then, the fourth thing is there is normal bacteria on the skin that plays a role in that inflammatory process.

Deborah Howell: Okay. And at what age is acne most common?

Dr. Teresa Wright: It's going to be most common in pre-adolescents and adolescents. So just as kids kind of round the corner into puberty, we'll start to see development of some early acne lesions, usually some clogged pores, some blackheads that you see on the skin, and then throughout adolescence, and certainly some people struggle with acne into their adult years as well.

Deborah Howell: I remember my parents say, "Don't worry. When you're 21, it'll all magically go away."

Dr. Teresa Wright: Yeah. That would be nice if that were true. That's not true for everybody. But certainly, a lot of teenagers struggle and it does often improve as they become young adults.

Deborah Howell: Now, is baby acne the same as teen acne?

Dr. Teresa Wright: So, baby acne is not exactly the same. And when most people say baby acne, they're actually referring to neonatal acne in kids under a year of age. We actually separate that into neonatal acne and infantile acne. Neonatal acne will usually show up around a month of age or certainly within the first few weeks of life. It's usually pretty mild. It definitely looks like your typical little red pimples and sometimes pustules, but it tends to clear up on its own. Infantile acne usually shows up a little later between three and six months of age, and it can be somewhat more severe and more persistent. It will often also have a significant number of blackheads. It can occasionally even lead to deeper cysts and can even cause scarring. So, that one usually needs to be treated a little more aggressively and a little more likely treat adolescents with acne.

Deborah Howell: And what are the most common types of acne for teens?

Dr. Teresa Wright: The way I think about it, there's really one type of acne, you know, one big category, but there are different kind of skin lesions. So, there are clogged pore lesions which are not inflamed, so that's going to be blackheads and what we, as dermatologists, call whiteheads. I think lay people tend to call pus bumps whiteheads, we call those pustules. So when we say whiteheads, we're talking about a closed over blackhead. So, those are also called open and closed comedones. And then there're inflammatory lesions, so red inflammatory papules and pustules. And then for more severe acne, there's gonna be nodules and cysts.

I do think I've been hearing more from teenagers coming in about this concept of fungal acne. I think that's been on a lot of social media platforms. And what people are really referring to when they talk about fungal acne is something that we call pityrosporum folliculitis, which is actually a different condition, but it can be associated with acne because it's caused by a yeast on the skin that likes the oils on the skin, which tend to be there and playing a role in the acne as well. So, some teenager s may have a component of pityrosporum folliculitis, which is being called fungal acne, but it's not actually the same as the regular acne.

Deborah Howell: Let's get now to the treatments, because that's the good part. What are the best treatments for each type of acne?

Dr. Teresa Wright: So, the most important thing is getting rid of clogged pores because all of acne lesions start with a clogged pore. You get a buildup of dead skin cells, which clogs the pore, causes the blackhead or whitehead and traps dirt and oil and bacteria, which leads to inflammation. So when I see kids who just have some comedones, some clogged pores, blackheads, we start with a medicine targeted to get rid of those. But even if they have more inflammatory lesions, pustules, nodules, it's still important that we really target those underlying clogged pores. If there are more inflamed lesions, the red papules, pustules, then that's when we use things that are more antibacterial and anti-inflammatory, so that might be topical antibiotics or sometimes oral antibiotics.

Deborah Howell: Okay. Yeah, I remember when we were growing up, it was always Clearasil, those little pads.

Dr. Teresa Wright: Clearasil has benzoyl peroxide in it. And benzoyl peroxide is a very mild comedolytic, meaning it can bust up those comedones and the clogged pores, and also has some antibacterial properties. So, it can be helpful for relatively mild acne.

Deborah Howell: And I do remember once when my friend in high school said, "I'm going to the doctor today." I'm like, "Oh, I'm so sorry. What's wrong with you?" She goes, "I have a pimple." I mean, at what point do you really need to go to the doctor for acne?

Dr. Teresa Wright: Well, I think certainly if the acne is more moderate to severe, if there are signs of scarring. So if you have significant inflammatory lesions, then you can end up with some pitted scars, which can be permanent and those are more difficult to treat. So, we do focus on prevention in kids who have more severe acne. So, that's when I would probably go. I mean, if you've tried over-the-counter washes and maybe over-the-counter cream with salicylic acid or benzoyl peroxide and the acne is really not improving, then that's when it's probably time to at least start with your pediatrician or family practice physician, whoever your primary care physician is. And then if they feel like it's beyond their ability to help, then they can refer to dermatology.

Deborah Howell: And when they do come to you, I wonder if you, you know, settle their minds like, "This is normal. You know, most kids your age do have this"?

Dr. Teresa Wright: Yeah, that really pretty much all teenagers have some degree of acne. It's just, for some, it's very mild. And then, for some, it's more severe and has more effects on their self-esteem and confidence.

Deborah Howell: So, what tips can you give to help a teen maintain clear skin?

Dr. Teresa Wright: So, I think number one thing is wash your face. So many times parents come in and they'll say, "Doctor, will you please just tell him or her that they need to wash their face?" So, yes, yeah, your parents know what they're talking about and you should wash your face. So, just washing the face after sports where you're getting hot and sweaty and definitely before bed, just with a plain mild cleanser. And we always recommend things that are fragrance-free and dye-free, just because those are ingredients that can often cause irritation.

The other thing is you want to avoid thick and greasy products on the skin that may contribute to clogging pores. So if you're wearing makeup, you want to look for things that specifically say that they are oil-free or that they are non-comedogenic, meaning they do not promote formation of comedones or those blackheads. So, that's really important.

And then, the third thing I think about is being mindful about what you put in your hair. So if you use a lot of hair products and your hair is laying across your forehead, sometimes hair product can be a culprit in causing clogged pores and aggravating acne. Also, kids who wear like visors or baseball caps a lot, where they're on the skin of the forehead and they may be getting all sweaty underneath there, that can sometimes promote formation of acne too. So, important to keep that stuff in mind.

Deborah Howell: And what are some other things that teens shouldn't do?

Dr. Teresa Wright: The number one thing that they should not do is pick at their skin. So, really avoiding picking at pimples, scratching them off or squeezing pimples is really important because that can just cause more inflammation and deeper inflammation, which promotes scarring. So, I always say, I know it's really tempting and certainly some people are just more prone to picking than others, but trying to keep hands off is really, really important. And if they have a big pustule, that they just feel like they absolutely must remove that purulent material from there. They really need to wash their hands well, be very gentle in handling the skin and clean the area really well. But in general, I really, really, encourage them to avoid that. So, I discourage them from picking behaviors because it's really just a bad habit.

Deborah Howell: Absolutely. But I know what you say when it's just so tempting.

Dr. Teresa Wright: And a lot of times I know they're going to do it anyway. So then, I tell them, "Okay, here's how you can do it safely if you absolutely must, but I would prefer that you don't."

Deborah Howell: Okay. Maybe a warm washcloth?

Dr. Teresa Wright: Yeah. Like a warm soapy washcloth to wash the area, and then just very gently just removing what's right at the surface and then cleaning that area again really well.

Deborah Howell: Yeah, only if you must.

Dr. Teresa Wright: Only if you must, yeah, because picking should really be avoided.

Deborah Howell: Okay. Well, Dr. Wright, thank you so much for talking us today about acne and helping us to understand more about it and how to treat it. This is The Peds Pod by Lebonheur Children's Hospital. I'm Deborah Howell. Thanks for listening and have yourself a great day.