Guide to Acne Development and Treatment Using Over-the-Counter Products

Up to 90% of adolescents develop acne
Acne usually starts around ages 7-12 years old and resolves by 30 years old
Typically the most severe acne for boys is during adolescence, but for girls may be later
There is a big range in acne severity, from very mild to very severe

Acne is a problem of the skin cells, nearby sebaceous glands (that make the body’s natural body oils aka sebum), and C. acnes bacteria (found on the surface of all skin)
When skin cells do not shed properly and there is increased production of sebum, black heads (open comedones) and white heads (closed comedones) develop from the accumulation of the skin cells’ keratin and the sebum
C. acnes feasts on the trapped sebum. The body’s immune system reacts by sending out white blood cells to attack this hungry bacteria
The white blood cells form pus, which leads to the development of pustules surrounded by redness/inflammation

Teens have increased levels of the hormones called androgens and testosterone
These hormones stimulate the sebaceous glands to produce more sebum/oil, which is more food for the C. acnes bacteria

Left: Non-inflammatory acne with closed comedones (“white heads”) and open comedones (“black heads”)

Right: Inflammatory acne with pustules and surrounding inflammation

Wash your face twice a day with a gentle cleanser (Cetaphil, CeraVe, Neutrogena, etc.)- do not scrub the skin aggressively
Keep skin moisturized by applying an oil-free moisturizer after washing your face
Wear broad-spectrum sunscreen- some moisturizers even contain SPF
Choose make-up that is “non-comedogenic,” or avoid wearing make-up completely

Work by reducing inflammation and breaking down white heads and back heads
Adapalene 0.1% (Differin®) is the only retinoid available without a prescription
Use these products for non-inflammatory and inflammatory acne
How to use: Apply a thin layer of adapalene after washing your face at night
Warning: can increase the risk of sunburn, so it’s best to use this product at night

Works by killing the acne causing bacteria (C. acnes)
Available in many strengths (2.5%-10%)- start with 2.5% and increase as needed
Add this product to your skin care regimen if you have inflammatory acne
How to use: Apply a thin layer of benzoyl peroxide after washing face in the morning and/or at night. You can apply this simultaneously with adapalene.
Warning: can bleach clothes and pillow cases, so may want to apply carefully in the morning or use white pillow cases
Available in the form of lotions and creams (best for dryer skin) as well as gels (best for oily skin)

Use a thin layer of the product- a pea-sized amount should cover the entire face
Don't just apply the product to the pimples, apply it to the entire face
Skin irritation, dryness, and flaking are common with use of these products. If this occurs, use the product every 2-3 days instead of daily.
Salicylic acid products can be added to improve your skin care regimen, or substituted for adapelene if too much dryness is occuring.
If you have acne on your body, try benzoyl peroxide washes to cover large areas of skin.
Patience is important- usually improvement can be noticed after 2 weeks of treatment, but maximum effects aren’t apparent until after 2 months
Try not to pick at your acne, this can lead to more inflammation and scar formation.

If your acne is severe or not significantly better with over-the-counter treatments
If there is scarring or cyst formation from your acne
If there is a lot of acne on your body, not just your face
For females, if your acne is much worse around the time of your periods
Anytime you have additional questions or concerns

More information about acne for teens and parents can be found at healthychildren.org.

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