by the Pediatrics Team at Boulder Medical Center
Serving families in Boulder, Longmont, Louisville, and beyond
Acne is one of the most common skin conditions affecting children and teens, with nearly 90% of adolescents experiencing breakouts. While it often begins between ages 10 and 13, acne can persist well into adulthood. Many teens and preteens don’t bring up acne to their parents or doctor, believing it’s something they must endure.
The good news is that acne is highly treatable, and pediatric providers at Boulder Medical Center are here to help. From personalized skincare guidance to prescription treatments, our team offers trusted, effective solutions for every stage of acne.
First, a few notes:
- Note #1: In this article, the terms “male” and “female” relate to the sex one is assigned at birth (or the physical traits one was born with). In addition, gender identity matters when it comes to acne treatment. Your doctor needs to know your child’s gender identity to prescribe the best treatment.
- Note #2: The products and medications mentioned in this article are included solely for informational purposes, and the authors have no financial affiliations with any brands.
- Note #3: The information provided in this blog is for general informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider regarding a medical condition. Never disregard or delay seeking professional medical advice because of something you have read on this blog. If you think you may have a medical emergency, call 911 immediately.
What Causes Acne?
Acne forms when the pilosebaceous unit pores become clogged due to oil production, dead skin cells, and bacteria. Three main factors contribute to this process: hormones, skin cell buildup, and bacteria.
Hormones
Hormonal changes stimulate oil (sebum) production in the skin. Testosterone, present in both males and females, is a major contributor. Stress and menstrual cycles can also lead to hormone fluctuations, triggering breakouts. Hormone-aware treatments may be beneficial for patients whose acne follows a cyclical or stress-related pattern.
Slow Skin Cell Turnover
This condition can cause dead skin cells to create a keratin plug in the pilosebaceous unit. It helps to imagine a blocked oil well. The oil can’t reach the skin’s surface, so it accumulates deep in the pilosebaceous unit and can form whiteheads. Or, oil can build up pressure and explode like a volcano. If the plug explodes deep down, cysts can form. If it pops toward the top, you get a pus-filled bump on the skin’s surface (the classic pimple). A blackhead is created when the oil comes to the surface and oxidizes, causing the color to darken. Over-the-counter pore strips will remove a blackhead’s dark color for a couple of days, but the oil re-oxidizes, so this is not a great long-term solution (but it might be handy before prom). Many acne medications work by increasing skin cell turnover to prevent plugs from forming in the first place.
Bacteria
A common skin bacterium called Propionibacterium acnes (P. acnes) contributes to inflammation and worsens acne. Many medications aim to reduce this bacteria on the skin.
Does Diet Affect Acne?
While chocolate was once blamed, modern research shows high-glycemic diets and excess sugar are more likely to trigger breakouts. These foods can increase inflammation, making acne worse. To support clear skin, teens and preteens are encouraged to:
- Limit sugary snacks and drinks
- Eat fruits, vegetables, and lean proteins
- Choose slow-digesting carbs like whole grains, lentils, and sweet potatoes
Daily Skincare for Teen Acne: Step-by-Step Guide
Morning Routine
- Cleanse. When you enter a drug store aisle, you will see many facial cleansers targeting acne. These products may have benzoyl peroxide or salicylic acid. Unfortunately, these skin cleansers only stay on your face for about 5 seconds before rinsing and will not do much to help your skin. Instead, try a gentle skin cleanser like Cerave, Cetaphil liquid cleansers, or Dove soap with no fragrance. If your face is not too oily in the morning, using a cleanser may be unnecessary. You can splash your face with water to wake up.
- Apply treatment. If prescribed or recommended, apply medication as directed.
- Moisturize. If your skin is dry. Although everyone has different skin conditions, skin is typically quite oily during our teens, and we may not need a moisturizer. However, some acne medicines can make your skin dry. Or maybe you live in a dry climate like Colorado and need extra moisture. You may need to experiment. I recommend a non-comedogenic moisturizer, meaning the product will not clog your pores. Here are some non-comedogenic moisturizers:
- Cerave PM Facial Moisturizing Lotion
- Cerave Moisturizing Cream
- Cerave Ultralight Moisturizing Face Gel
- Cetaphil Moisturizing Cream
- Paula’s Choice Clear Oil Free Moisturizer
- Other: If you want to try something natural, a few drops of hempseed or argan oil are considered non-comedogenic.
- Apply sunscreen (at least SPF 30). The earlier you start using a daily face sunscreen, the better. It prevents skin cancer, wrinkles, and dark spots later in life. In addition, most acne medications make your skin more sensitive to the sun, so sunscreen is essential. A zinc-based, non-comedogenic sunscreen is ideal for teens with acne. Zinc is safer for our bodies and the environment. Ideas for products are:
- Cerave Hydrating Mineral Sunscreen SPF 30 Sheer Tint
- Cerave Hydrating Mineral Sunscreen for Face SPF 50
- Cetaphil Sun 30 Sheer Mineral Sunscreen
- Cetaphil Sun 50 Sheer Mineral Sunscreen
- Differin oil-absorbing moisturizer
- Eucerin Sensitive Tinted Mineral Face Sunscreen SPF 35
- Tower 28 SPF 30: comes in lots of different tints and has excellent natural ingredients
- Neutrogena Sheer Zinc Face SPF 50
- SkinCeuticals Physical Fusion UV Defense SPF 50 Mineral Sunscreen
Evening
- Cleanse again to remove oil, dirt, and bacteria
- Apply acne treatment as indicated by your regimen
- Moisturize if needed to balance dryness or irritation
The Basics of Acne Treatment
Acne creams and gels are formulated to help prevent future breakouts, not to treat existing pimples. To be effective, these products must be used consistently and applied to the entire face, not just on individual blemishes. Spot treatment alone won’t stop new pimples from forming, but regular, full-face application can significantly reduce future breakouts over time.
Sadly, there is no instant gratification with any acne treatment. Most treatments take 2-3 months to work. Be patient—it is worth it! However, if home treatments don’t work, talk to your doctor about trying something stronger or different.
Mild Acne
Benzoyl Peroxide
An over-the-counter benzoyl peroxide product (2.5%, 5%, or 10%) can be a good starting point for those with just a few pimples or blackheads. Despite the varying strengths, studies show they are generally equally effective. Benzoyl peroxide is available in both creams and gels—gels tend to work better for oily skin, while creams are more suitable for dry skin. This medication breaks down dead skin cells and offers natural antibacterial properties against P. acnes bacteria. It’s important to note that benzoyl peroxide can bleach clothing and bedding, so white pillowcases and sleepwear are recommended. If dryness or irritation occurs, it may help to apply it every other night or incorporate a non-comedogenic moisturizer to reduce side effects while maintaining effectiveness.
Azaleic Acid
Azelaic acid (15–20% cream or gel) is a well-tolerated, naturally derived option for treating mild to moderate acne. Higher-strength formulations typically require a prescription. As a breakdown product of whole grains like wheat, azelaic acid is already present in small amounts in the body. It offers antibacterial benefits like benzoyl peroxide, but individuals with sensitive skin may better tolerate it.
Topical Retinoids
If acne is more severe or benzoyl peroxide alone is ineffective, a topical retinoid may be recommended. Retinoids are highly effective acne treatments that increase skin cell turnover and prevent clogged pores.
The most well-known retinoid is tretinoin (brand name Retin-A), which is available by prescription. It has three strengths: 0.025%, 0.05%, and 0.1%. Starting with a lower strength is often advised to help the skin adjust and reduce the risk of dryness or irritation.
Adapalene is another retinoid available over the counter. While it may not be as effective, it can be a valuable part of an acne care routine when combined with benzoyl peroxide. To avoid irritation and maximize results, these products should be applied at different times—benzoyl peroxide in the morning and Adapalene or tretinoin at night. If dryness occurs, using the retinoid every other night or mixing it with a non-comedogenic moisturizer can help.
It’s important to apply only a small, pea-sized amount of retinoid to the entire face and to avoid sensitive areas such as the corners of the eyes, nose, and mouth. Applying too much—especially in the beginning—is a common mistake that can lead to excessive dryness and irritation.
Some prescription combination treatments simplify the routine by blending a retinoid with benzoyl peroxide in a single formula:
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- Twyneo: benzoyl peroxide 3% + tretinoin 0.1%
- Epiduo Forte: benzoyl peroxide 2.5% + Adapalene 0.3%
These formulations are designed to be used together safely. If using separate products, continue applying benzoyl peroxide in the morning and the retinoid at night to avoid interactions.
For acne on the back, chest, or more resistant areas, more potent prescription retinoids may be considered:
-
- Tazarotene (Tazorac) is a potent option, especially effective for body acne.
- Trifarotene (Aklief) is a newer retinoid approved for use on the face, chest, and back. It is generally well tolerated and may be less irritating than Tazorac.
Moderate to Severe Acne
Medical providers generally use fewer antibiotics to treat acne to avoid antibiotic resistance. However, topical antibiotics (in addition to benzoyl peroxide) can help with acne. These include clindamycin, minocycline, sulfacetamide, and dapsone. Dapsone can be effective for susceptible skin that can’t tolerate retinoids.
For many red and pus-filled bumps, an oral antibiotic pill (like doxycycline or minocycline) can be used along with a retinoid at low doses for no more than 2-3 months. Once the skin is improving, you can transition back to just creams. If the acne worsens again when you come off the antibiotic, either hormonal medications or Isotretinoin (formerly brand name Accutane) may be effective next steps.
Hormone therapies can work well for a specific type of acne called papular acne — lots of red bumps. Some of these are creams, and some are pills. Both males and females can use the creams, but only females can use the pills.
Creams include Clascoterone (brand name Winlevi), which decreases sebum production. It works very well, but unfortunately, it can be very expensive. Spironolactone cream is a similar, less expensive product, but only specialty or compounding pharmacies can dispense it.
Oral hormones (pills) can only be taken by females. These include spironolactone, which can be effective for girls who may have irregular periods and acne (or PCOS). This is a diuretic, meaning it makes you urinate more frequently, so you need to stay well-hydrated while taking it. It can also increase potassium levels, so eat bananas and other high-potassium foods in moderation. The majority of girls who take this have a significant improvement. One-third of the girls who take it completely clear their acne.
Another hormone therapy is oral contraceptive pills. The one that works best for acne is Drospirenone: Ethinyl Estradiol tablets (brand name Yaz or Yasmin).
Treatments for Severe Acne
If you have very deep and large cysts, the above therapies will probably not be effective. You may need to see a dermatologist who may prescribe Isotretinoin (formerly Accutane). This highly effective medication is a pill to be taken for five months.
Isotretinoin can have some rare but severe side effects, so it has to be monitored closely. It would be best to get blood tests before starting (and while taking it) to monitor for side effects. Females need to get regular pregnancy tests and be on two types of birth control if they are sexually active, because Isotretinoin can cause severe congenital disabilities in the fetus of a pregnant person.
Side effects of Isotretinoin include major sun sensitivity, so daily sunscreen is essential. It usually causes dry, chapped skin of the lips and nose that requires frequent chapstick application. It sometimes causes dryness of the skin around the anus and even rectal bleeding. A rare but severe side effect is pancreatitis. Some individuals can have emotional side effects and report a worsened mood, but the vast majority feel much better emotionally because the acne goes away so quickly.
This article covered the basics of acne treatment and details on medications for mild, moderate, and severe acne. Do not suffer in silence if you have acne! It is a well-understood skin condition that is very treatable!
References
- Ashton R, et al. Acne Vulgaris in the Pediatric Patient. Pediatr Rev. 1019: 40 (11): 577-589
- Zaenglein AL, et al. Guidelines of care for managing acne vulgaris [published correction appears J. Am Acad Dermatol. 2020 Jun: 82 (6): 1576]. J Am Aced Dermatol. 2016: 74 (5): 945-73.e33
- Peds Rap podcast Pediatric Acne Part 1 and Part 2 with Parul Bhatia, MD, and Karen Sherwood, MD