Preteen Acne: When Puberty Smacks You in the Face

Editor’s Note: From time to time we like to invite local experts from the community to answer questions about parenting and raising kids in Huntsville and North Alabama. Today we asked Dr. Bo Rivera, head dermatologist at Southeastern Skin Cancer & Dermatology, to address reader questions about preteen acne.

Q: Are there certain foods to avoid that trigger hormonal acne?

A: There isn’t strong evidence that specific foods are a definite cause (for everyone as a whole). Some studies do show that it could help to avoid foods with a high glycemic index such as bread, rice, pasta and high sugar foods. Weaker data shows that there might be some impact from skim milk (other percent milks do not show this possibility though) but this needs more study. Overall genetics, medications (such as birth control or others), incorrect over-the-counter products, stress and normal hormonal fluctuations (pregnancy, menopause, cycles) play a larger role than food. This applies to both “regular” and hormonal acne. We have multiple options available to treat acne, including hormone-specific acne, if that appears to be a patient’s primary diagnosis. In summary, eating a healthy, well-rounded diet is good for your health and might help your acne. Even though no single food causes acne, if you notice an association of acne flares with a particular food then do a trial of avoidance for a while to see if it makes a difference.

Q: At what point do you seek help from a Dermatologist? When it’s all over their face or when over the counter remedies aren’t working?

A: Any time that you have a question or concern about your skin. Our available options are numerous and there is definitely one that fits whatever category or stage you might be in at the time. Also we can customize the regimen for how complicated or simple you need or how aggressive or conservative you would like to start. There are prescription medications approved for as young as 8 years old. Both my personal and our practice philosophy for acne (and skin cancers, wrinkles, etc.) is that prevention and early intervention are key. Even though we routinely address severe acne it is always easier when we can be involved in guidance or treatment before complications arise. You want to seek attention right away if there are severely inflamed or large acne spots or if any appear to be scarring. Scars can be treated but can also be permanent so we really want to prevent that if possible. Over-the-counter products can certainly be appropriate in many instances and we will recommend that to some patients but know that if you aren’t getting results within a couple of months, there are better options available from your dermatologist.

Q: If you pop them will it scar or is that a myth? My preteen had a blackhead that she didn’t want me to mess with. It eventually grew a huge whitehead and started turning yellow like infected. I popped it and it bled so much. How can I manage this differently in the future?


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A: Not all popped acne will scar but it is definitely one cause. Usually the lesions that scar are the ones that have become very inflamed or large – probably the ones that people want to squeeze or manipulate anyway. Gentle massage, not harsh scrubbing, might help loosen some plugs to prevent them from continuing to enlarge but you don’t want to aggressively squeeze. Sometimes this can rupture the acne under the skin which can create more inflammation and problems. As I said above, the best management is sometimes prevention. If someone is already to the point of getting these larger whiteheads (our medical term is closed comedones) then they need to be on a regular regimen. An example such as this case could improve with over-the-counter products but it sounds like mild prescription options might be more appropriate.

Q: How can a concerned parent encourage an unconcerned preteen boy to treat their acne? I can spend lots of money on products but how can I get him to use them? Any tips or scripts for parents?

A: There have been studies that show that even though kids, particularly boys, say that they are not concerned to parents that they really do want treatment. Peer influence has a big effect. If they feel that none of their friends are being treated or that it isn’t “cool” to use acne products or it’s like “being a girl” by using products on your face, then they will resist even if interested. Letting them know that their friends are being treated or casually mentioning how much improvement you’ve seen in a friend sometime helps, maybe asking them why Susie’s acne has gotten so much better. Also just getting them to talk with someone who isn’t a parent for a neutral discussion can help. If you can make a bargain with them that they don’t have to treat the acne but at least speak with a dermatologist, then that might help. We can talk directly to them and figure out what they want or are willing to do and create a program WITH them and not FOR them. Usually the improvement sells itself and once the results start they want to continue the improvement. Every kid is different though so we do just as you do by trying to find the right trigger to positively influence them in their decisions.

Q: I’ve been hearing a lot about oils. Is this a better option than moisturizers?


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A: This is a bit harder question because it is a bit broader than it seems. It depends on which oils that people are talking about. For dry skin, creams, ointments or lotions are all good options. Some of these do contain various oils that aid in hydration and repair. If it is a facial (or body) moisturizer for acne-prone skin then it needs to be oil-free. Also, using oil only as your choice of moisture in acne patients is not ideal. Most likely by all of the recent buzz and people doing multi-level marketing from home, you might be referring to all of the essential oil craze. At times these can be very benign and cause no problem (and also no benefit) but we do quite often see contact or irritant reactions or worsening of an initial medical skin condition from these products. Most of these home sales products tout photos that are not truly representative even though they claim miraculous results. A lot of it is riding the wave of people wanting to use “natural” products. Many botanical or naturally derived products can be very beneficial but natural or organic doesn’t mean that it will help more or is a better choice. We do carry some more natural products and have filtered through what is beneficial from a scientific study perspective versus casual “guarantees” as we chose those products. A common recommendation from dermatologists is to find an oil-free, non-comedogenic moisturizer if dealing with acne and for dry skin there are similar moisturizers that can contain beneficial oils (ones less likely to cause dermatitis) but usually not just an oil by itself.

Q: What about “safe” products – products that are environmentally friendly and contain no hormone disrupting chemicals for young growing kids?

This question depends on whether or not you are referring to over-the-counter products, cosmeceuticals or prescriptions and also to what level you consider environmentally friendly. Some people don’t want anything produced by pharmaceutical companies because they might not respect the environment. Or others want a seal of approval from their chosen internet research website (even though it might not be scientific). There are non-prescription cosmecueticals that focus on environmentally friendly production and use more natural ingredients. We will often choose this recommendation for patients who are more comfortable with that as an initial therapy. We have several lines in our office as options.

As far as “safe”, the prescriptions that we utilize have been through FDA testing and have been shown to be safe (unless noted in certain instances or medical conditions). Most data that is out there about hormone-disrupting chemicals are in animals and in very extreme doses or via ingestion rather than topical so it’s a leap to claim that they can cause problems in normal, limited, topical use in humans. There are some groups out there that circulate poor, misleading information and recommend “safe” or “eco-friendly” products for compensation so we often have to discuss the true scientific data available and what risks or benefits a medication has. This is a long discussion so I’m not sure that I’ve even scratched the surface but we feel that the products that we choose are safe and effective and I use them on myself and my family.


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Q: My daughter has had pretty large blackheads on her nose since she was 4, and they’ve only gotten worse. We don’t mess with them or treat them in any way, but should I be doing something? It’s getting more noticeable both to her and others as time goes on.

If the blackheads (open comedones) aren’t causing a problem and are not cosmetically a concern then you don’t have to address them from a medical standpoint. If worsening as you state then you might want to consider treatment. As we’ve discussed above, it’s often easier to intervene early rather than late. Depending on what we would find on exam and the route that you prefer we could use over-the-counter options or prescriptions (some approved to age 8). A common start that we suggest over-the-counter is either benzoyl peroxide or salicylic acid washes or creams. Recently, Differin 0.1% has been approved for OTC and that is a very good option. Four is a bit young for true acne so there are other conditions that might not be acne and we do occasionally see that – they are not typically dangerous, but just to be aware that sometimes “acne” does not respond because it’s something a little different that might need a different therapy.

ABOUT THE EXPERT: Dr. Albert E. “Bo” Rivera is a licensed physician and surgeon at Southeastern Skin Cancer & Dermatology, board-certified diplomat of the American Osteopathic College of Dermatology, a fellowship-trained member of the American College of Mohs Surgeons as well as member of several dermatology and medical specialty organizations such as the American Society for Dermatologic Surgery, American Society for Mohs Surgery, American Academy of Dermatology, Skin Cancer Foundation and the Madison County Medical Society. Dr. Rivera also enjoys time with his wife, Stephanie, a daughter who was born in 2015 and their Labradoodle.

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