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Carrie Coughlin, MD (Guest): Hi, I’m Dr. Carrie Coughlin, a dermatologist at Washington University and a mom doc at St. Louis Children’s Hospital.

Melanie Cole, MS (Host): If you’re a parent, you know how devastating it can be for your children to develop acne and pimples. They don’t want to go to school and they're embarrassed, but really a lot of their friends have the same thing going on. So, when is it important to take them to a dermatologist? This is Mom Docs, the podcast from St. Louis Children’s Hospital. I’m Melanie Cole and today we’re talking about acne. Dr. Coughlin I’m so glad to have you here. What is acne? What is the difference between the occasional pimple and acne?

Dr. Coughlin: Acne is an inflammatory skin condition that involves the oil glands, a lot of times on the face, and can have several different appearances. You can start out with black heads and white heads, then you can get red bumps, pustules and they can be on the face, but they can also be chest, back, sometimes even extending down onto the arms if you have a lot of it. Acne depends a little bit on age. Kids who are younger, kind of the pre-adolescents age group, will have more of the black heads and white heads and then as you progress through puberty and are an adolescent can have more of the inflammatory component. Everybody’s different. So there are some folks that just have one or two acne bumps along the way or every now and again will get them, and there’s other folks that have a lot all at one time.

Host: Do we know what causes it and why is it so hard to get rid of?

Dr. Coughlin: Well, there is definitely a hormonal contribution in some people. So, that’s where some girls around the time of their periods, you’ll really notice some flaring. Or some guys as they’re going through puberty, you’ll notice a development of more. There are other medicine causes. So sometimes when people are on medicines like prednisone, steroids, they can get acne. Then there’s that whole kind of process with the oil glands on the face where they get a little bit inflamed and then they get clogged up and then you can get your acne bumps.

Host: Are there things, Dr. Coughlin, that make acne worse? I know even in my own daughter, she’s like “Oh, I can’t have chocolate now,” and stress, and sugar. There’re so many things. Is that a myth or is that true?

Dr. Coughlin: When thinking about diet’s relation to acne, there’s good data that skim milk can contribute to acne, but we have to balance that with the fact that of course we want people consuming milk and other things that have protein and calcium. For some people, chocolate can certainly make their acne worse, and for some people it has no effect. So, there’s not as great data on that and other sugary foods. I would say, in general, one of the things that we promote is healthy choices and healthy eating. So, the same things that you would prefer for folks to be when you’re trying to think about how to be healthy overall are good choices for people with acne as well.

Host: What about stress? Does that contribute?

Dr. Coughlin: It can. I think that can also contribute to changes in your hormones. So that can certainly contribute to acne.

Host: I think the million-dollar question, Dr. Coughlin, that every parent wants to know since time began and every kid wants to know, are they supposed to pop those pimples? Is that bad for them? Is that okay to do? What should they do?

Dr. Coughlin: Ideally you don’t pop pimples because sometimes that can mean that you are digging at the skin and then can create some open areas or sores, and that can contribute to scaring. If spots are very inflamed and painful and it seems like having them be opened up would make it be less painful, you could try doing something like a warm compress. But even those ones that are the kind of pustules or the white heads, ideally, you leave them be. You treat them with the facewashes, topical medicine, potentially oral medicines if your doctor has recommended those, and let those do their job.

Host: Thank you for that answer. I hope every parent heard you. So, now let’s talk about treatments. Do you first look to topical treatments or oral medications you mentioned there? Tell us what treatments are available and which ones do you start with?

Dr. Coughlin: It depends what your acne type is as to the treatments that we recommend. The vast majority of folks are going to start out with the white heads and black heads and maybe start out with a few and then continue to collect more. There are several over the counter options that can be helpful for this, what we call comedonal acne, and a comedo is an acne bump. There are options like salicylic acid washes, benzoyl peroxide washes, that can be used for face, chest, and back. Then there are other over the counter treatments. Spot treatments with benzoyl peroxide or even now medicine called Differin, which the active ingredient is adapalene. That is a lower strength retinoid type medicine, and that is now available over the counter.

If those aren’t working or there’s a significant inflammatory component, meaning there are a lot of red bumps or pustules, then you might need to move on to treatment with a physician. That can be sometimes with a primary doctor or a dermatologist depending on how much acne you have, your access, and your physician’s comfort level in terms of treating. The prescription treatments can include stronger topical retinoid treatments, sometimes topical antibiotic treatments, and then oral medicine including antibiotics. Which we use a little bit for the antibiotic properties, but more so even for the anti-inflammatory properties. Then on to the medicine called isotretinoin, which is commonly known as Accutane, though that brand isn’t made anymore for pretty resistant acne.

Host: So, you mentioned antibiotics and many parents are concerned if their child has to be on antibiotics for any reason these days. What about antibiotics for acne? Is this a concern if they have to be on them for months at a time?

Dr. Coughlin: Well, the American Academy of Dermatology has guidelines in terms of treatment with oral antibiotics. The recommended length of treatment is ideally no more than three months. Now, there are going to be some people who do great with a month and then don’t need to continue. Other folks who are going to still have inflammatory acne bumps after three months and potentially not be candidates for other sorts of treatment. So, you really have to take the individual patient into consideration when thinking about the length of therapy. Do I prefer to not have people on long term antibiotics? Definitely. Sometimes we don’t have the same choices that we would like to have for all folks, and then have to be willing to talk with family, talk with patients, to make that decision together.

Host: Does it clear up on its own as they grow older? When can we expect those acne breakouts and even pimples to stop? Do they ever?

Dr. Coughlin: It depends who you are. So, there are, definitely I would say males tend to more than females have better luck with their acne clearing up. The hormonal components that are seen in women can sometimes continue on and last for longer and be troublesome into college years, work years, adult life and not necessarily stop when the teenage years are over.

Host: So, now we’d like your best advice. Dr. Coughlin, for kids and acne as far as prevention for our kidos. Do you have some good skin care advice? Cosmetics, face washes, staying out of the sun. What do you recommend they use when they’re doing their face at night, or in the morning, or in the shower? What do you want them to do to keep nice clear skin?

Dr. Coughlin: For acne prone skin, I definitely recommend products that are made for the face, and they will say that on their label. They’ll also use words like noncomedogenic, so non-acne forming, or oil free. Ideally, kids will wash their face twice a day. If they don’t have acne, they can do that with a nonmedicated wash. If they do have acne or are starting to get a few bumps here or there, then using medicated wash makes since. Then if the skin is dry, we recommend using a moisturizer. Again, one that is made for the face. Particularly when thinking about coming up close to summer here, we do like sun screen. There are plenty that are made for the face or moisturizers made for the face that have SPF in them. So those are ways that you can be using the products that you like but still preventing or not contributing to the formation of acne. Thicker things like ointments or creams that are made for the body are not good for acne prone sin because they can contribute to acne.

Host: Can a child have both really dry skin and acne? ‘Cause I know that my daughter looks to things like, not even only—You mentioned the thicker creams, but Aquaphor when she has this really dry skin. Is that a bad idea?

Dr. Coughlin: It’s tricky, so folks with eczema, and eczema folks tend to have dry skin, itchy skin, can form acne as well. It’s trickery to treat because you do need to moisturize the skin, but you can’t use the same thick things that you would on the body on the face when you’re trying to treat acne as well. So, we actually don’t recommend using things like petrolatum or Aquaphor on the face if you have acne or are acne prone because those can contribute to it. What you’d be looking for is an over the counter moisturizer made for the face. There are ones that are thicker and lighter. If you have eczema prone skin or very dry skin, you may aim for ones that are kind of thicker creams, but still made for the face that you could tolerate, and it would help your dry skin but not make your acne worse.

Host: It’s such great information and I hope the parents listening will share this with their acne prone adolescents. Do you have some final thoughts? What would you like the take home message about acne, which is so prevalent in some people, what would you like them to know?

Dr. Coughlin: The treatment target really depends on what your child is experiencing. If your child is bothered by their acne then, yes, aim for treating it. See a doctor if you need to. If your child is not bothered by their acne, I would try to follow their cues and be lower key in terms of it. My goals are my patient’s goals. If my patients are happy with where they are, I’m happy with where they are. The main thing in terms of treatment is consistency. So, a lot of the topical medicines work quit well if you use them every other night or every night, but if it’s a once a week application it’s not going to be helpful enough.

Host: Thank you so much for clarifying really what it is and whether or not the kids should be popping their pimples and how hormones can actually be related to it. Thank you for giving us such great advice. If you found this podcast informative, please share on your social media and be sure to check out all the other helpful podcasts in our library. Head on over to our website at stlouischildrens.org to get connected with one of our providers. This is Mom Docs with St. Louis Children’s Hospital and until next time I’m Melanie Cole.