Acne In Teenagers

Key points about acne in teenagers

• acne is very common in rangatahi (young people)
• it is often related to hormonal changes
• creams and other treatments from your pharmacy may help, but there are treatments from your doctor if these don’t work
• acne treatments usually take several weeks or months to work
• acne usually clears after several years, but can last longer for some people
• see a health professional if your teen has bad acne, scarring or their acne goes on for a long time

What is acne? 

Acne is a common skin condition. It happens when hair follicles (pores) get blocked with oil and dead skin cells. This can lead to blackheads, whiteheads, pimples or deeper cysts under the skin. It often starts in the teenage years but can happen at any age.

Although acne is common it can affect a teen’s confidence. Teens with acne may have low mood and avoid social situations.

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The illustration shows a young person with acne across the face.
A circle highlights the cheek and connects to two close-up illustrations of the skin:

• The first close-up, labelled Normal, shows a cross-section of healthy skin with a clear hair follicle.
• The second close-up, labelled Acne, shows a red, swollen bump where the follicle is blocked. The text reads: Red, swollen bump from a blocked hair follicle.

At the top right is the KidsHealth logo with the website: kidshealth.org.nz.

A bit about the skin

Under the skin are lots of small structures. This includes:

• hair follicles – where hairs grow from
• sebaceous glands – make natural oils that travel up the follicle to the surface

These sit just below the surface layer of the skin.

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The illustration is titled Under the skin. It shows a cross-section of the skin with labels pointing to:

• Hair – a strand growing above the skin surface.
• Skin surface – the outer layer of skin.
• Sebaceous gland – a small gland attached to the hair follicle.
• Hair follicle – the root of the hair below the skin.

At the top right is the KidsHealth logo with the website: kidshealth.org.nz.

Causes of acne

During puberty, testosterone levels rise. This makes the skin’s oil (sebaceous) glands more active and they produce more oil. These glands connect to hair follicles on the face, neck, chest, and back.

When too much oil builds up, pores can block, bacteria grow, and the follicle wall can break. Oil, bacteria, and dead skin cells then spill into nearby skin.

This can lead to:

• whiteheads
• blackheads
• pimples
• deeper cysts

Types of acne

Whiteheads

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The illustration is titled Whitehead.

• It shows a cross-section of the skin with a hair follicle, sebaceous gland, and skin surface.
• A blocked pore is shown near the skin surface, labelled Whitehead.
• The blocked pore appears as a small bump with trapped material under the skin.

At the top right is the KidsHealth logo with the website: kidshealth.org.nz.

Round, white spots. They form when plugs of oil and dead skin cells block the follicle.

Blackheads

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The illustration is titled Blackhead.

• It shows a cross-section of the skin with a hair follicle, sebaceous gland, and skin surface.
• A blocked pore is shown at the skin surface, labelled Blackhead.
• The blocked pore is open to the air, which makes the trapped material appear darker.

At the top right is the KidsHealth logo with the website: kidshealth.org.nz.

Round, dark spots. They form when plugs of oil and dead skin reach the skin's surface and meet the air. 

Pimples

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The illustration is titled Pimple.

• It shows a cross-section of the skin with the hair, skin surface, sebaceous gland, and hair follicle visible.
• A blocked pore is labelled Pimple. The pore is inflamed and filled with yellow pus, pushing up toward the skin surface.

At the top right is the KidsHealth logo with the website: kidshealth.org.nz.

Red, swollen bumps. They form when the plugged follicle walls break near the skin's surface.

Deep cysts

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The illustration is titled Deep cyst.

• It shows a cross-section of the skin with the hair, skin surface, sebaceous gland, and hair follicle visible.
• A large lump beneath the skin is labelled Deep cyst.
• The cyst forms from a blocked pore and sebaceous gland, causing swelling and pus to build up deep inside the skin layers.

At the top right is the KidsHealth logo with the website: kidshealth.org.nz.

Red, pus-filled spots. They form when plugged follicle walls break deep within the skin.

Managing mild acne

If your teen has acne, take them to a health professional to discuss treatment options. They may recommend treatments that go on the skin (topical treatments). Some are also available from your pharmacy without a prescription.

Acne treatments don’t do much for pimples that are already there — they help prevent new ones from forming. This means treatments can take weeks or even months to work. 

It's best to test any new cream or lotion on a small patch of skin first (patch testing). If there is no irritation, your teen can use it on affected areas. Follow the specific product directions.

Face washes and cleansers

Face washes can help reduce greasiness. Some acne washes contain an antiseptic, antibacterial ingredient, or mild salicylic acid. These can help remove oil and dead skin cells that block pores.

Avoid harsh scrubs or over-washing. This can dry out the skin and make acne worse.

If you are using another acne treatment you may need to change to a gentle cleanser so the skin doesn’t get too dry.

Benzoyl peroxide

Benzoyl peroxide comes as a cream, gel, or wash. It reduces bacteria on the skin. It also helps the top layer of skin peel off, unblocking the pores. It can help if your teen has a lot of blackheads, but it may irritate their skin. If irritation happens, use a lower strength or only use it every second night. 

Avoid putting it near the eyes or mouth. And be aware that benzoyl peroxide can bleach clothing and hair. 

Retinoid gels or creams

Retinoid treatments (such as tretinoin or adapalene) help unblock pores and reduce blackheads. They work by speeding up the shedding and renewal of skin cells.

These treatments can make the skin dry and irritated, especially in the first few weeks. Your teen should only use a small amount — a pea-sized dab spread thinly over the face once a day.

It can take weeks to see improvement. Your teen’s acne can sometimes look worse before it gets better. Your teen will need to use sunscreen daily, as retinoids make the skin more sensitive to sunlight.

People who are pregnant or could become pregnant should not use retinoids.

Azelaic acid cream

Azelaic acid helps clear blocked pores and reduces redness and bacteria on the skin. It’s usually used twice a day. If the skin becomes irritated, your teen can use a smaller amount or switch to only using it once a day.

Managing severe acne

Early treatment for severe acne may help prevent scarring. 

Mild treatments alone will not work for severe acne. If mild treatments haven’t helped after 3 months, take your teen to a health professional.

Also take your teen to a health professional if their acne is: 

• made up of large, sore lumps under the skin (cysts)
• painful
• on the chest or back
• leaving scars or dark marks
• causing them distress, low mood or loss of confidence

Mild treatments alone will not work for severe acne. Your doctor can discuss other options.

Treatments for severe acne

Oral antibiotics

Your health professional may prescribe oral antibiotics if topical treatments haven’t worked. These help reduce bacteria and inflammation inside the skin.

They are usually taken for 3 months to 6 months, depending on how bad the acne is. Topical retinoids or benzoyl peroxide should be used at the same time as the oral antibiotics. 

Not all antibiotics are suitable for everyone. Your health professional will discuss which options are safe for your teen.

Oral retinoids

Your health professional may prescribe your teen isotretinoin for severe acne. This medicine works by shrinking oil glands, reducing bacteria, and preventing blocked pores.

Because isotretinoin can cause side effects, a health professional will monitor treatment closely. A dermatologist (skin specialist) may do this.

Common side effects include dry skin, nosebleeds, and increased sensitivity to sunlight.

People who are pregnant or could become pregnant must not take isotretinoin. It can cause serious birth defects. Your health professional will explain the safety steps and monitoring required.

Hormone treatments

If hormonal changes and menstruation (periods) seem to impact your teen’s acne, hormone medicine might help. This includes the combined oral contraceptive pill or spironolactone. These can reduce the effect of androgen hormones on the skin’s oil glands.

Your health professional can advise whether this is suitable for your teen.

Light treatments

Some dermatologists offer treatments such as blue-light therapy or laser therapy for acne. These can reduce bacteria and skin inflammation. 

Helping your teenager manage their acne 

There’s no instant or permanent cure for acne. Regular treatment can help control acne. Managing acne well can prevent scars and can improve confidence. Below are some suggestions to help your teen care for their skin.

Hygiene

Dirt does not cause acne. Blackheads look dark because of dried oil and skin cells in the pore opening.

Encourage your teen to wash their face no more than twice a day. Use a gentle, pH-balanced, soap-free cleanser and warm water.

Washing too often or scrubbing hard can irritate the skin and make acne worse. Shampoo hair regularly, especially if it’s oily or touches the forehead.

Makeup

Some makeup can make acne worse. Choose products labelled non-comedogenic or non-acnegenic, which means they won’t block pores.

Remind your teen to remove makeup every night using a gentle cleanser and warm water.

Non-prescription creams

Over-the-counter acne creams and gels can help mild acne. But using too many products can irritate the skin and make acne worse. Use only one new product at a time and follow directions carefully. Ask your pharmacist which single product might be best to start with.

Don't squeeze

Squeezing or picking pimples can push bacteria deeper into the skin. That can cause more redness, swelling, and possible scarring. It can also spread bacteria to nearby pores.

Shaving

If your teen shaves, suggest they try both an electric razor and a safety razor to see which feels best. If using a safety razor, soften the hair first with warm water and cleanser. Encourage your teen to shave gently. Use a sharp blade, and only when necessary to avoid irritation.

Diet

Food doesn’t generally cause acne. But eating a balanced diet helps skin health. Some people notice their acne improves when they eat less processed or sugary foods. Research doesn’t support strict diets or cutting out major food groups.

Sunlight

Sunlight can seem to help in the short term, but too much sun can make acne worse over time. It also increases the risk of skin aging and skin cancer.

Encourage your teen to use sun protection daily. This is important if they’re using treatments that make the skin more sensitive to sunlight. Choose an SPF 50 + product which is designed for use on the face so that it doesn’t block pores.