If a sufficient length of time has gone by and they do not improve, I'll boost up the adapalene and benzoyl peroxide to twice a day.
If they have popular lesions, I might switch the antibiotic, too.
Differences between Teen and Adult Skin - Teenage skin tends to be oilier than adult skin because the surge of hormones during adolescence accelerates the production of sebum.
- Dehydroepiandrosterone sulfate, testosterone, and dehydrotestosterone stimulate the sebaceous gland during adolescence, which is why oily skin is a special concern of teenagers.
- The constant flux of hormones results in acne that can rapidly change in degree of intensity.
- Hormonal changes influence the quality of the patient's acne, which in turn affects response to therapy.
- Teenagers are more susceptible to acne mechanica, because of friction from sports equipment.
Tailoring Therapy - A patient who presents with mild, comedonal acne may respond well to first-line acne treatments, such as topical retinoid with benzoyl peroxide and an oral antibiotic, but hormonal shifts could interfere with this therapy's effectiveness.
- Dr Jan Hornets recommends waiting for a minimum of 6 weeks before altering any acne therapy, and then doing so by changing the dosage or type of only one medication at a time.
- His first-line therapy is a topical retinoid, such as adapalene (Differin®), during the day and benzoyl peroxide at night.
- If acne is more severe or fails to improve, he recommends using adapalene and benzoyl peroxide simultaneously twice a day.
- When used together, benzoyl peroxide should be applied first, with adapalene on top, since this retinoid does not destabilize in sunlight.
What Teens Prefer in Acne Therapy - Ease of use is primary.
- A combination of a topical retinoid and benzoyl peroxide is Dr Jan Hornets's first-line choice for this age group.
- Gels are preferable to lotions; they help absorb excess sebum, and their texture is more acceptable to teenage boys.
- Adding an oral antibiotic to standard topical treatment can help speed up improvement.
The antibiotic should be discontinued once the skin clears.
- For teens on isotretinoin, both doses can be given simultaneously to minimize confusion and missed doses.
Hormonal Therapy in Teenagers - Teenage girls who request oral contraceptives from their dermatologist should be referred to a gynecologist if they have not yet consulted one.
- Girls whose acne flares before the start of their menstrual cycle are ideal candidates for hormonal therapy.
Avoiding Bad Habits - Noncompliance is the worst habit among teenagers, though most will adhere to therapy.
- Sun exposure may be a problem if the teen is using an older topical retinoid, such as Retin-A.
Switching to adapalene, which is not photosensitive, may be a better choice.
- Sugar and junk food do not appear to exacerbate acne.
Hyperpigmentation and Scarring - Teenagers need to understand that picking at acne causes scars and that scars are permanent.
- In dark-skinned patients, even those who do not manipulate their lesions may develop areas of hyperpigmentation.
- Hyperpigmentation can be treated with a combination of a topical retinoid and hydroquinone.
Self-Treatment - Teens are particularly susceptible to acne remedies offered on TV, over the counter, or in health food stores.
- If the teen prefers, most of these remedies can be continued even while on conventional therapy.
Developing Rapport - It is paramount that the patients trust the dermatologist to be sensitive and confidential.
- Information gleaned from interviews with teenagers should not be shared with parents.
- Expressing interest in the teen as an individual helps establish a good relationship.