Child / Adolescent Health

Article: "Acne Treatment Advice"

Article: "Bright Student Bored in School"

Question: My 14-year-old daughter has recently developed significant acne on her face. She has tried the over-the-counter benzoyl peroxide treatments, but that just made her skin red and dry. She is trying a new cleanser that a friend recommended, and washes her face three or four times a day. I told her that I don't think it's good to wash her face so much, but whenever I offer advice, she gets upset and says that I'm being too critical. What do you suggest?

Answer:

There are really two issues in your question. The first relates to the science of acne. It flares in the adolescent age group because of the hormonal changes that occur in that time. It is not caused by dirty skin, though there is a type of bacteria that likely plays a role in the severity of acne, and that is why some teenagers are helped by antibiotics. The first step in treatment usually is benzoyl peroxide and /or retinoic acid cream. Washing the face frequently is generally not helpful as you suggest, and this leads us to the second issue. Teenagers can be very self conscious, and advice from parents (who they are struggling to be independent from) can be interpreted as criticism. To address both issues, I would recommend making an appointment for your daughter to see her primary physician. Her physician can assess how severe her acne is, explain the cause and treatment of acne directly to your daughter, and set up a management plan that they can jointly agree on. You can be supportive by taking her to the appointment and helping her to get whatever medications are needed.

Question: How can I get rid of acne?

Answer:
While more than three-quarters of all teenagers have some visible acne, most never visit a doctor for treatment. Acne is so common that doctors and even parents tend to overlook it as a health issue. They forget how important appearance is for all of us, but particularly for self-conscious, frustrated teens. Acne is a common condition of the skin that presents itself as different kinds of bumps, including whiteheads, blackheads, pimples, and cysts. It develops where hair follicles or pores in the skin become clogged, which most frequently happens on the face, neck, shoulders, upper back, and chest.

Hormonal changes during puberty stimulate oil glands to overproduce oil, contributing to acne in many teenagers. For teens who don't get results using over-the-counter acne medications, treatment should be individualized and begun as early as possible. This is important in trying to minimize the inflammation and subsequent scarring that can result, if poorly treated. To keep your pores from getting clogged, wash your face with a mild soap and warm water at least twice a day and after you have been exercising or sweating a lot. Avoid scrubbing your face hard with a washcloth because this only irritates your skin and makes the acne worse. Avoid the temptation to pick at or play with acne, as this can create tiny scars on the face.

Diet has not been scientifically proven to make acne worse; for example, large amounts of chocolate have no effect. Most teenagers don't need to see a dermatologist (skin specialist) for treatment. The many medicines that are available in various strengths work in different ways, so your primary-care doctor can recommend the best treatment option for you. The ideal way to control acne is to know what it is, understand that it is treatable, follow a simple treatment plan, and keep in touch about it with your doctor. Also, remember to be patient: it takes time for acne to improve.

Question: I'm 16 years old and I've been getting acne on and off throughout my teenage years. My acne is not like other people's acne -- I have little dots on my face. They are like clogged pores and I get a lot of them, sometimes with whiteheads. What kind of treatment should I use?

Answer:
There are two types of acne -- large, red, pus-filled bumps or small blackheads or whiteheads. Acne is caused by overactive oil glands. When excess oil is made and released, tiny hair follicles on your face become clogged. When this happens, the clogged follicles trap bacteria, which then cause acne to develop. Unfortunately, you cannot completely prevent acne, but you can certainly help decrease how frequently and how severely your skin breaks out.

Most cases of acne can be controlled and cleared up, either by over-the-counter products or prescriptions from a doctor. To treat your acne, I would first recommend trying some over-the-counter acne products first. You may need to try a few to find what works best for you. If you have tried these products without enough improvement, I would talk with your doctor. She will be able to prescribe a medication that will help clear up your acne. If scarring seems to be occurring, you may want to consider visiting a dermatologist (skin doctor).

In the meantime, you can do some things to try to prevent future breakouts. Be sure to keep your face clean by washing your face twice a day with a mild soap. Wash more frequently if you have been sweating from exercise or the heat. Instead of a wash cloth, use your hands to wash your face to avoid over scrubbing and irritating your skin. When choosing cleansing products, lotions, and aftershaves, be sure the container says non-comedogenic or non-acnegenic. This means that the product tends not to clog pores. Avoid alcohol-based cleansers that can dry your skin and irritate your acne. Oil-based cleansers are not recommended because they, too, will clog your pores. Keep your hands away from your face because the hands can be very oily and contain a lot of bacteria. Most importantly, do not pop or squeeze your whiteheads. This will only worsen your acne and could lead to permanent scars.

Acne is common at your age and definitely can be treated. Remember to keep your face clean and use some anti-acne products. If the amount of improvement is not what you expected, speak more with your pediatricia.

Question: I have a daughter who is 11 years of age and African-American. She is going through puberty and experiencing severe acne, which causes her embarrassment. I would like to know what products are available to her. Any help you could give would be greatly appreciated.

Answer:
Most children have some difficulty with acne during their pubertal years. Acne develops during this time because the hormones that increase with puberty also cause an increase in the oils and other substances that are produced by the skin. It also promotes the growth of certain bacteria which are the main cause of acne.

In order to lessen the development of acne, it is important to cleanse the skin regularly, to keep it free of these oils and to diminish some of the bacteria. This does not mean washing the face multiple times a day, as that is not good for the skin either. Rather, your daughter should wash her face twice a day with a good soap or cleansing solution. I recommend glycerin type soaps, such as Neutrogena Facial Bar.

Be careful about the products that are used in your daughter's hair. Pomades and gels often seep onto the skin, and can promote the development of more acne, especially on the forehead and temples. Also, pull back your daughter's bangs so they don't touch the skin.

For children who have a lot of bumps, I usually recommend a benzoyl peroxide gel or cream to use a once a day. This helps to break down the acne bumps that are there, and help the skin heal. Benzoyl peroxide can be very drying though, so start out slowly, with a 5 percent concentration, rather than 10 percent. These are available in drug stores without a prescription.

If your daughter's acne does not improve with these measures, have her see her primary physician to discuss other treatments. Depending on the type and severity of acne, other products can be prescribed, such as retinoic acid cream, and antibiotics. It would also be important to make sure there are no associated medical conditions in patients who have very severe acne.

Bright Student Bored in School

Question: My fourth-grader finds school boring and dislikes it. He's an A student and has to put little or no effort towards getting these grades. The only bright spot to his day is an advanced reading class where there are more activities and hands-on assignments. I'm familiar with the teachers in fifth grade -- my daughters have had some of them -- and the majority of them are strictly by-the-book. I feel my son needs more hands-on learning with a variety of techniques, but I don't know how to go about trying to get this. In our school district, you're not allowed to request any teacher. What should I do?

Answer:
It's quite significant that your son is not bored when he is in a more challenging classroom setting. Is he so bright that he is a good candidate for advancing to sixth grade next year? At the very least, he should definitely be in an advanced reading class again in fifth grade as well as an advanced math class, if appropriate.

When school starts again, wait a few weeks to find out if your son will be placed in some classes that challenge him. Also, is there a gifted program at the school in which he could take part? You may discover that the curriculum in fifth grade turns out to be sufficiently challenging to keep him from being bored. If not, you need to request a conference with his teacher and a counselor to discuss what can be done to challenge your son.

The responsibility for challenging bright students does not just belong to schools. Parents must also provide stimulating experiences. This summer, why don't you try to help your son find a hobby or interest that really intrigues him. Then, he could devote considerable time to learning more about this topic, whether it is collecting stamps or studying rocks. When he returns to school, he could use and build upon this recently gained knowledge in his classes.

Don't jump to the conclusion that the teacher your son will have next year is not going to be a good match for his learning style. Just because a teacher is not a good choice for one child in a family does not necessarily mean that the teacher will be a poor choice for another.