McKesson Clinical Reference Systems: Pediatric Advisor 2002.1
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What is acne?

Acne is a skin condition that occurs when the oil glands in your skin are clogged and become inflamed or infected. More than 90% of teenagers have some acne.

With acne you will probably have:

• whiteheads, which are closed plugged oil glands
• blackheads, which are open plugged oil glands (the oil turns black when it is exposed to air)
• red bumps, which are inflamed oil glands (the larger red bumps are quite painful).

Acne usually appears on your face, neck, and shoulders.

What causes acne?

Acne is due to an overactivity and plugging of the oil glands. The main cause of acne is an increased levels of hormones during adolescence.

Acne is not caused by diet. A person who has acne does not have to avoid eating fried foods, chocolate, or any other food.

Acne is not caused by sexual activity. It is not caused by dirt or by not washing your face often enough.

How long does it last?

Acne usually lasts until age 20 or even 25. Do not worry about scarring. It is rare for acne to leave any scars.

How is it treated?

There is no medicine at this time that will cure acne. However, good skin care can keep acne under control and at a mild level.

Basic treatment for all acne

• Wash your skin twice a day and after exercise. The most important time to wash is bedtime. Use a mild soap such as Dove.
• Shampoo your hair daily. Long hair can make acne worse by rubbing against your skin.
• Avoid picking and squeezing. Picking stops acne from healing. Squeezing causes bleeding into the skin and blotches that last a month.
• Avoid scrubbing your skin or using abrasive soaps. Hard scrubbing of the skin is harmful because it irritates the openings of the oil glands and can cause them to be more tightly closed.
• Avoid putting any oily or greasy substances on your face. Oily and greasy substances make acne worse by blocking oil glands. If you must use cover-up cosmetics, use water-based cosmetics and wash them off at bedtime.
• Avoid hair tonics or hair creams (especially greasy ones). When you sweat, these substances will spread to your face and aggravate the acne.
• If you are using acne medicine, don't stop using the medicine too soon. It takes 8 weeks to see a good response.

Treatment for whiteheads

Whiteheads should be treated with the following:

• Benzoyl peroxide 5% lotion or gel

  This lotion helps to open pimples and unplug blackheads. It also kills bacteria. It is available without a prescription. Ask your pharmacist to recommend a brand.

  Apply the lotion once a day at bedtime. Redheads and blonds should apply it every other day for the first 2 weeks.

  An amount of lotion the size of a pea should be enough to cover most of your face. If your skin becomes red or peels, you are using too much of the medicine or applying it too often. Try using less of it or applying it less often. You may need to use this lotion for several years.

  Caution: Benzoyl peroxide bleaches clothing, carpets, etc. Apply it only at bedtime and put it on sparingly.

• Pimple opening

  In general, it is better not to "pop" pimples, but most teenagers do it anyway. Therefore, do it safely. Never open a pimple before it has come to a head. Wash your face and hands first. Use a sterile needle (sterilized by alcohol or a flame). Nick the surface of the yellow pimple with the tip of the needle. The pus should run out without squeezing. Wipe away the pus and wash the area with soap and water.

  Scarring will not result from opening small pimples, but it can result from squeezing boils or other large, red, tender bumps.

Treatment for blackheads

Blackheads should be treated with the following:

• Benzoyl peroxide 5% lotion or gel

  This lotion is also excellent for removing thickened skin that blocks the openings to oil glands. Use the lotion as described above for whiteheads.

• Blackhead extractor

  Blackheads that are a cosmetic problem can sometimes be removed with a blackhead extractor. This instrument costs about a dollar and is available at any drugstore. By placing the hole in the end of the small metal spoon directly over the blackhead, you can apply uniform pressure that does not hurt normal skin. This method is much more efficient than anything you can do with your fingers. Soak your face with a warm washcloth before you try to remove blackheads. If the blackhead does not come out the first time, leave it alone.

Treatment for red bumps

Large red bumps mean the infection has spread beyond the oil gland. If you have several red bumps, you probably also need an antibiotic. Antibiotics come as solutions for the skin or as pills. Your antibiotic is _________________________. Use it ________ times a day every day.

When should I call my health care provider?

Call during office hours if:

• The acne has not improved after you have treated it with benzoyl peroxide for 2 months.
• It looks infected (large, red, tender bumps).
• You have other concerns or questions.