Acne is the most common skin problem that teenagers face. Just about nine out of ten of them have to deal with pimples or acne at some time. That’s right, nearly 90 percent of kids have to deal with at least an occasional breakout of pimples.

I give you the lowdown on teenage acne. I help you spot teenage acne in all its glory. I help you deal with the emotional scars of acne. And I remind you (or tell you for the first time if you haven’t heard it before) that you don’t have to accept acne as a rite of passage. You can do something about it.

Identifying Teenage Acne

We dermatologists generally refer to the acne that you get as a teenager as acne vulgaris. Yeah, it sounds horrible, but vulgaris is the Latin word for “common,” not “obnoxious” or “repugnant.”

And as you saw in the stats I just tossed around, common is a good choice of words! (Some adults also suffer from acne vulgaris that sticks around after the teen years turn to the 20s and beyond. But most adults usually have a somewhat different type of acne.)

In teenagers, acne is one of the signals that your body is going through a tremendous upheaval called puberty. Teenage acne often begins around the ages of 10 to 13. It may start before puberty in both sexes, but teenage girls tend to start getting acne at a younger age than boys; however, boys tend to have the more severe cases.

Studies have shown that puberty is occurring at an earlier age these days, and so is acne. Most teenagers grow out of it when they reach 19 or 20; however, don’t be surprised if your acne persists into your early 20s and even into later adulthood.

But just because acne is common and almost every teen suffers through it doesn’t mean you can’t do anything about it. You don’t have to just wait for it to go away.

That’s what I’m here for — to help you knock out those pimples, whiteheads, and blackheads. With so many excellent acne treatments available today, treating your acne will prevent (or at least greatly lessen) the scarring that often results from untreated acne.

Not that many teens have real problems (like scars or serious emotional problems) from acne, but if you do, there are a bunch of things that can be done to help you with those issues as well.

Teen skin

Teenagers’ faces are all different. Your skin may be dark or light complexioned. You may have dry skin, oily skin, combination skin, sensitive skin, or be “thick-skinned” (I’m talking blowtorch-resistant, here). I can’t generalize, but there are a couple of tendencies that make your skin different from that of adults:

• More oiliness and less sensitivity: Teen skin tends to be a little oilier, and that’s probably a good thing because many treatments that are effective for teenage acne can be somewhat irritating to the more sensitive skin that commonly affects adults. The extra oil serves as a waterproof barrier between you and the outside world and protects your skin from irritation.

• Easier to heal: Your skin tends to be more “forgiving” and to heal more completely after experiencing acne. This is especially important when it comes to avoiding permanent scars and those dark spots that tend to appear in people of color when their acne lesions heal.

Teen acne

Good ol’ acne vulgaris, teenage acne. If you have it, you have an idea what it looks like. But there may be more in store. So, without further delay, here are the main features of teen acne:

• Centered on the T-zone: Typically, teenage acne tends to flare up on the forehead, nose, and chin. Take a look at Figure below to see a picture of this T-zone. Sometimes however, acne can have a mind of its own and it can pop up anywhere on your face or trunk.

• Blackheads and whiteheads: We dermatologists call these two unwelcome visitors comedones. Actually we call blackheads open comedones and whiteheads closed comedones. These black and white bumps are largely the upshot of teen acne and aren’t so common in adults.

• Inflammatory lesions: These acne lesions are called papules, pustules, nodules, and cysts. These are the red, pus-filled, lumpy, inflamed, and sometimes sore, painful zits.

Tracking acne

In its full glory, teenage acne generally looks like a mixture of blackheads and whiteheads (comedonal acne) with papules and pustules (inflammatory acne) and macules (healing lesions). Awesome! Here’s how teenage acne can look in different kids. Maybe you’ll find your type in one of the following descriptions:

• Initially, the main lesions may be whiteheads and blackheads. Often they start out in a nice, embarrassing, central location — the nose and forehead. This part of the T-zone is where your skin tends to be most oily and, therefore, likely to develop acne.

As time goes on, you may discover a zit (also called pimples or papules; the red stuff) here and there, and an additional blackhead or whitehead now and then. There’s a good chance that they will come and go. At this point, we’re still in the “it’s no big thing” stage.

This type of acne is a rite of passage that almost all of us go through. If you’re lucky, this will just pass by itself or you can help it clear up with some inexpensive over-the-counter stuff that you can buy at your local drugstore.

• Sometimes, however, the going can get a little rougher: The whiteheads and blackheads want to hang around a lot longer and sometimes a population spurt of inflammatory papules and pustules really start making their presence felt.

They can be seen in the center of the face but may also be scattered all over the place including your neck, chest, and back. If you have dark skin, you may not see all of this red stuff because your acne may look brown or even darker on your skin.

As individual acne lesions heal, macules (dark red or purple spots) form and linger until the lesion heals completely. The macules may look brown or almost black in color if you are very dark-complexioned.

• In some teens, especially those who have inherited a tendency to develop scarring acne, acne nodules may appear. They can get quite large, lumpy, and painful. They’re inflamed lesions that are situated deeper than ordinary papules and pustules and can, if they go untreated, leave deep or thickened scars. This is called nodular acne.

Fortunately, even if acne reaches this point, dermatologists can treat it very effectively in many people with oral antibiotics and, if necessary, with an oral retinoid, known as isotretinoin, or Accutane. Besides these strong medicines, we have many new tricks up our sleeves, such as lasers and special lights to treat your acne.

The Causes Of Teenage Acne

You may think you have teenage acne as some sort of punishment for a crime you didn’t even know you committed. Actually though, you’re breaking out for two main reasons. The first is that, as you mature, your hormones are telling your oil glands to produce too much oil, and your body isn’t handling the oil very well.

Another reason you’re breaking out? Well, you may be able to go ahead and blame your parents or other ancestors for this one. Heredity plays a huge role in whether you end up with acne. In this section, I go over both topics to give you a better idea of why you’re breaking out.

Hormones gone wild

By the time you hit puberty, it may seem like all you hear about is hormones and how they’re to blame for every problem you have, from shyness to a low paying job to acne. In the case of acne, what people are telling you is the truth.

Hormones are to blame! Hormones are the chemical messengers that provide the signals that regulate many of your body’s functions and that are responsible for the changes you experience during puberty. They’re also responsible for bringing your acne to the forefront.

The most important hormones when it comes to acne are your androgens. Androgens are really a group of closely related hormones. The androgen testosterone is the main “male” hormone. Besides bringing on puberty-related changes, it’s also central to our acne story.

Androgens are a natural part of development for both boys and girls, but boys tend to produce more of them, especially testosterone, which is why boys have bigger bodies and stubbly beards. The higher level of testosterone in boys is considered to be the reason that they tend to get more severe breakouts of acne than do girls.

As in males, androgens also are necessary for the development of acne in females. Estrogen and progesterone are female hormones that play the primary role in puberty.

These female hormones play less important roles in the evolution of teenage acne than do androgens, but their influence on acne’s ups and downs, as well as their part in its treatment, is significant.

During puberty, the levels of androgens in both boys and girls starts to climb and begins to stimulate your oil glands to grow and produce more sebum. If you develop acne, you probably don’t have higher amounts of these androgens; it’s more likely that you have a higher sensitivity to them.

And how’s this for an entry in the “perfect timing” category: Just when you guys begin to shave, up pop those bumps that get in the way of your razor. Now you have the added problem of having to shave over and around those papules and pustules. It’s like an obstacle course!

The heredity factor

That’s right. You may be able to thank your mom, dad, aunts, uncles, and grandparents for the current state of your face. Check in with your parents and their siblings to see whether they’ve had acne too and how severe it was. If acne runs in your family (or even hides — it may be lurking under shirts and blouses!), you’re more likely to have it too.

Feel free to drop them a thank-you note. If both of your parents had acne, you’re even more likely to have it. In fact, identical twins tend to share acne problems just like they share looks. And they got their acne genes from their parents, who inherited them from their parents, and so on, probably back to the Stone Age.

Why is acne hereditary? Well, for the same reason anything is inherited from your parents: for instance, the color of your skin, eyes, and hair. Scientists are still trying to pinpoint the exact genetic cause or causes of acne. We do know that you inherited something from your parents that tells your body:

• How much oil to produce
• How big or small your oil glands are
• How sensitive your oil glands are to androgens
• How easily your pores get clogged
• How quickly your skin cells replace themselves
• How quickly your immune system reacts to the acne-producing bacteria, P. acnes.

All these instructions are just swimming in your gene pool. And sometimes, what finally emerges is often just a matter of luck! If you were adopted, you inherited the acne tendency from your biological family.

Acknowledging The Emotional

Acne can be difficult to deal with at any age. But for teens, the appearance of acne can be especially trying. Who has time to deal with this stuff?

At a time in your life when you’re working on your homework, social life, dating, trying out for the school play, and getting a job (among all the other activities and events in life), developing acne can seem like a major bump in the road.

You’ve got better things to do with your time. But there’s a lot that you can do to control acne without letting your life get out of control. Maybe you feel totally alone. Maybe you just want to stay in your room, pull the covers over your head, curl up into a little ball, and hide away forever.

Maybe you feel worthless and you want to give up. Guess what! I don’t think I’ve ever met a teenager — even those without acne — who doesn’t feel that way at some time or other. It’s natural! Even adults get that way sometimes. You may feel uncomfortable talking about acne.

Acne can be embarrassing, but I’m sure there are people to talk to if you give it a shot. If you try talking to trusted friends, your doctor, or your parents or other family members, I think you’ll be surprised by how helpful they are! Close to 90 percent of teens face acne at some point in their lives, which means that 90 percent of adults also know how it feels.