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More than 85 percent of teens have zits. “It’s a side effect of puberty,” says Shannon Humphrey, a clinical instructor in the Department of Dermatology and Skin Science at the University of British Columbia in Vancouver. Acne flares when hair follicles become clogged with oil, bacteria and dead skin cells. “Surging hormones increase oil production and make skin cells stickier so that pores become clogged,” she says.
Although genetics play a role, no one knows for sure why some kids coast through their teens with pristine skin while others have breakouts as soon as they hit puberty. “Teen acne usually begins with blackheads and whiteheads by the hairline and inside the ears,” says Fiorillo. “After about six months, bumps appear on the forehead, then over the face, chest or back.”
Acne can surface anytime after age eight and usually clears by the time teens reach their 20s — small consolation for a 13-year-old with spots. “Acne can have a huge psychological impact,” says Humphrey. “It can destroy a kid’s self-confidence and cripple their social life.” Unfortunately, you can’t just wash it away. “Acne isn’t a hygiene issue,” says Weinstein. “I see kids who are meticulous about skin care with horrible acne and others who have probably never used a washcloth and have never had a breakout.” Since over-cleansing can make acne worse by increasing inflammation, Weinstein recommends washing twice a day with mild cleansers. Only use cleansers medicated with benzoyl peroxide or salicylic acid if prescribed by a doctor.
Topical treatments are the first step to tackling periodic breakouts, while more persistent zits might require oral antibiotics to help fight bacteria and inflammation. Girls also have the option of taking oral contraceptives to reduce excess sebum. For severe acne, a dermatologist may prescribe isotretinoin (a.k.a. Accutane). Derived from vitamin A, this potent drug can be controversial because of potential side effects, including depression.
One of the most important things is not to pick at pimples — not only can it lead to scarring, but touching acne-prone skin spreads bacteria and increases the risk of breakouts. As for masking problem skin with makeup, it’s best to reserve camouflage for special occasions, Fiorillo says. “Look for oil-free, non-comedogenic products and use them sparingly because they can still clog pores and make acne worse.”
A version of this article appeared in our April 2012 issue with the headline: Acne Through the Ages (p. 44).