Acne in teenage girls can be painful and unsightly at best – but for some teen girls, acne can contribute to low self-esteem, with some feeling so upset and embarrassed, they try their best to avoid the outside world.
According to the American Academy of Dermatology, researchers found that people with acne can also develop depression, anxiety, a poor self-image, a decreased quality of life, and a feeling of being alone.
Fortunately, there are many methods that can potentially help. This article takes a look at the best acne treatments for teenage girls, including topical therapies, oral therapies, oral contraceptives, and in-office procedures. We’ve gathered input from three Board Certified Dermatologists, who offer their expertise about these methods, as well as ideal candidates.
Keep in mind that this article is not intended as medical advice. Before you try any of the methods highlighted in this article, talk to your doctor, or Board Certified Dermatologist, first.
What Are the Causes of Acne in Teen Girls?
Acne is very common in teenage girls, with up to 85% getting acne at some point, according to Dr. Paul Yamauchi, Ph.D, a dermatologist in private practice at the Dermatology Institute and Skin Care Center in Santa Monica, California.
When girls reach teenage years, certain kinds of hormones called androgens are increased that result in oil glands becoming overactive producing too much oil called sebum, explained Dr. Yamauchi, who is also the founder of the Clinical Science Institute in Southern California; and is a Clinical Assistant Professor of Dermatology at the David Geffen School of Medicine at UCLA.
“This causes the pores to become blocked forming a pimple,” he said, adding that increased sebum production causes an overgrowth of a bacteria called Propionibacterium acnes – also known as “P.acnes” – that leads to inflammation.
Acne in teenage girls can be due to many different reasons, including fluctuating hormones, stress, genetics, and bacteria on the skin, said Dr. Matthew J. Elias, a Board Certified Dermatologist at Elias Dermatology, which has locations in Fort Lauderdale and Pembroke Pines in Florida.
Hormones play a large influence in the development of acne in teenage girls, said Dr. Lauren L. Levy, a Board Certified Dermatologist at Loucas Dermatology in New York City.
“At puberty, androgen secretion increases and acts on the sebaceous glands to make them larger – with increased androgen acne occurs,” she said. “We can blame some of acne on our parents as well, as there is a strong genetic component to acne.”
Additionally, the use of occlusive products – anything oil-based – can lead to follicular occlusion and acne, Dr. Levy added.
For instance, greasy hair products and oils that contact the forehead are often a culprit and result in numerous white or blackheads.
“More recently, there has been evidence to show that diet does, in fact, play a role in the development of acne,” Dr. Levy said. “Consumption of milk and dairy – especially skim milk – as well as foods with a high glycemic index, may exacerbate acne.”
Different Kinds of Pimples
There are different kinds of pimples, Dr. Yamauchi noted.
For instance, if the blockage does not result in inflammation, then a blackhead may form where the clogged pore stays open and there is a black discoloration due to oxidation and exposure to the air, he said.
“A whitehead is a clogged pore that is not open and stays closed and has a white appearance,” Dr. Yamauchi said. “If inflammation occurs from P.acnes, then the pimple becomes red and inflamed from pus that forms.”
At puberty, Dr. Levy said, there is an increase in the amount of sebum which can clog the sebaceous unit, “think hair follicle,” and lead to a comedone, “a black or white head.”
“If the process continues, then inflammation around the follicle may occur, leading to a large cyst with redness, swelling, and pain,” she said.
Acne in Teen Girls vs. Acne in Teen Boys
The main difference between the two sexes is that female hormonal changes that are related to menstruation can trigger acne, Dr. Yamauchi noted.
“Also, heavy creams and cosmetic products that teenage girls use can block the pores and cause acne,” he added.
Acne can be unique from person to person – and from boys to girls, Dr. Elias said.
“In teenage girls you would expect a higher component of the acne being due to fluctuating hormones, so this may alter how you treat a teenage girl versus a teenage boy,” Dr. Elias noted.
“In both boys and girls, it is important to recognize and treat acne early so it doesn’t lead to scarring, lower self-esteem, and depression and anxiety,” Dr. Elias further emphasized, adding that “treating acne can markedly improve a teen’s mood.”
Best Acne Treatments for Teenage Girls
The following acne treatments are considered the best by Dr. Yamauchi, Dr. Elias and Dr. Levy:
Topical therapy, the most common treatment for acne, include agents such retinoids (Retin-A), benzoyl peroxide, and clindamycin. These topical agents unclog the pores, exfoliate the skin, reduce sebum production, and kill the bacteria that cause acne, Dr. Yamauchi said.
“Topical agents can cause dryness of skin, especially if your skin is sensitive,” Dr. Yamauchi warned. “If that’s the case, then using them less often can minimize dryness,” he said, noting that “it’s okay to put moisturizer on your skin after applying a topical agent.”
Retinoids can also make your skin more sensitive to the sun, Dr. Yamauchi added; therefore, “wearing sunscreen is important if your doctor prescribes you something like Retin-A.”
According to Dr. Elias, the following can unclog pores and reduce oiliness, all-the-while improving blemishes and scarring: retinoids like over-the-counter adapalene (Differin gel), or prescription adapalene/benzoyl peroxide combinations (Epiduo), tretinoin (Retin-A), or tazarotene (Tazorac).
Topical retinoids reduce the development of new lesions and prevent the development of comedones, Dr. Levy noted: “They work by reducing skin cell desquamation – the initial step in the formation of a pimple.”
In other benefits, she said that retinoids also help with cellular turn-over, reduce pigmentary changes (dark spots left by acne) – and also build collagen over time.
“There are numerous different topical retinoids of varying strengths and formulations, so a discussion with your physician is important,” advised Dr. Levy, who agrees with Dr. Elias about adapalene – also known as Differin gel.
“Two years ago adapalene 0.1% gel (Differin gel) became over-the-counter, and is a great starting point for younger girls and boys with acne,” Dr. Levy said.
Oral therapy is commonly recommended if topical therapy alone is not sufficient, and these include oral antibiotics such as doxycycline or minocycline.
“Since acne may be linked to hormonal imbalances in girls, birth control pills may help,” said Dr. Yamauchi, adding that an androgen hormone blocker called spironolactone is commonly recommended by dermatologists.
For more advanced cases of acne that leads to scarring, isotretinoin controls cystic acne.
“However, this pill causes birth defects and routine monthly monitoring is required,” Dr. Yamauchi advised.
Dr. Elias said that oral antibiotics treat acne “rapidly and effectively” by decreasing the P. Acnes bacteria on the skin, while also leading to rapid resolution of inflammation in the skin by their anti-inflammatory properties, “very similar to how something like Tylenol or Motrin works for headaches, but for your skin.”
Dr. Yamauchi added that many people dislike taking pills for various reasons. For example, antibiotics can induce bacterial resistance and can change the flora in your system; while Doxycycline can make you more sensitive to the sun, “and some people get nauseous from it.”
“Minocycline has an uncommon side effect of dizziness and a bad headache,” said Dr. Yamauchi, further adding that antibiotics can cause yeast infections in the vaginal area.
“Isotretinoin is very effective, but requires blood testing monthly for pregnancy as well as checking your liver and cholesterol level since it can increase,” he said.
Dr. Levy added that the use of oral antibiotics “is not recommended for prolonged periods of time,” but may be used for several months to reduce acne lesions while other methods – such as topical therapies – are taking effect.
Oral contraceptives work by regulating the hormonal influences on the sebaceous gland by blocking both ovarian and adrenal production of androgens, Dr. Levy explained.
They may take 2 to 4 cycles to take full effect.
“Not all oral contraceptives are made equal,” she said, warning that some oral contraceptives can actually make acne worse.
“Confusing, right? So it is important to discuss with your doctor that the oral contraceptive will be used for acne,” Dr. Levy recommended.
“Oral contraceptives that contain norethindrone or norgestimate or drospirenone work better for acne,” Dr. Levy added. “Those that contain levonorgestrel may worsen acne. Contraceptive methods with high progesterone content (i.e. the Mirena IUD) may also potentially worsen acne.”
Procedures are commonly done to treat acne, Dr. Yamauchi said, and “one trick” is to come to the dermatologist’s office to have an inflamed pimple, such as a cyst, injected with a drop of cortisone.
“Frequently a cyst can form a knot or result in scarring,” he warned, noting that injecting cortisone will knock down the inflammation quickly to get rid of the pimple.
“Occasionally, a small divot can occur at the site of injection, but goes away,” Dr. Yamauchi said.
In other procedures, many teenage girls get facial treatments from an esthetician at the dermatologist’s office, he said, and “these treatments will also unclog the pores and make your acne better.”
If Certain Acne Treatments Aren’t Working
Dr. Elias offered the following advice if methods like topicals or prescription oral antibiotics aren’t working.
“The next step would be to discuss with your Board Certified Dermatologist systemic treatments,” he said.
These treatments include Spironolactone, an old blood pressure medication that is used in very low doses for acne, which Dr. Elias said has an “amazing effect” on reducing hormonal fluctuations in females, “and dramatically decreasing acne in teenage girls and adult women alike.”
Dr. Levy explained that Spironolactone blocks the androgen receptor and inhibits an important enzyme in the testosterone pathway.
“This medication works very well for girls with acne on the chin and jaw-line (i.e. hormonal acne) that is not improving with other methods and acne that is worse around the menstrual cycle,” Dr. Levy noted.
Additionally, Isotretinoin – also known as Accutane – “is a wonderful medication that is highly effective at treating many of the causes of acne, and can have spectacle effects on resolving acne and acne side effects,” Dr. Elias said.
“Isotretinoin prescriptions require you enroll in a governmental program called iPledge, so make sure you discuss this with your Board Certified Dermatologist,” he added.
How to Pick the Right Treatment?
The severity of the acne determines the treatment, Dr. Yamauchi said, with milder cases usually responding to topical therapy, and moderate to severe acne frequently treated with pills.
“Often times, combination therapy is done such as topical plus oral therapy as well as procedures done to the skin,” he noted. “Your doctor will provide you with best advice on what you can do and not do.”
Dr. Levy offered her expertise for oral contraceptives, retinoids, and Spironolactone:
Females with outbreaks around the time of periods or those with irregular periods are the ideal candidates.
“If you have a history of migraines with aura, history of blood clots, high blood pressure, or smoke, then hormonal contraception is contraindicated, so make sure you let your doctor know this,” Dr. Levy recommended.
All males and females with acne are candidates for retinoids. If you have eczema or sensitive skin, you may need to slowly use the retinoid to allow time for your skin to get used to the medication.
“I recommend starting with a lower strength retinoid and working up to a higher strength,” said Dr. Levy, adding that “retinoids also should not be used in those who are pregnant or trying to conceive.”
Females with hormonal acne are excellent candidates.
“If you have a problem with blood pressure, kidney disease, or high potassium, this medication may not be for you,” Dr. Levy said.
Also, certain medications (diuretics) may interact with this medication.
“Those trying to conceive should also avoid this medication,” Dr. Levy noted. “The medication can decrease breast milk supply, so those who are breastfeeding should also not use the medication.”
Potential Side Effects of Acne Treatments for Teen Girls
Before you try oral contraceptives, retinoids, Spironolactone, or antibiotics, it’s important to know the cons of each, which Dr. Levy has provided below.
Some oral contraceptives may cause weight gain, breast tenderness, spotting, mood changes, or headaches.
The only downside of using a retinoid is that the skin may become irritated or dry with overuse, especially during the winter or drier months of the year.
“But do not worry, there is a retinoid right for everyone, and certain tricks can get you to tolerate a retinoid,” said Dr. Levy, adding that these tricks include decreasing the use to two or three times a week, mixing with a mild moisturizer, or creating a “retinoid sandwich” that’s layered with moisturizer, retinoid, moisturizer.
While using retinoids, the skin is photosensitive, and avoiding sunlight and UV exposure is recommended.
Regarding Spironolactone, given the fact it is a blood pressure medication, headaches, dizziness, or headaches may occur, as well as increased potassium levels.
“Irregular periods and breast tenderness are also reported side-effects,” Dr. Levy said. “Patients on this medication may be asked to check their potassium level if on very high doses, have kidney disease, or are on other medications that cause an increase in potassium.”
The downside of antibiotics is that they cannot be taken long term, have a potential for allergy, and possible side effects include diarrhea, nausea or upset stomach.
Additional Tips for Treating Teen Acne
It is a human temptation to pick things off the skin, Dr. Yamauchi said; however, “it is not recommended to pick on your acne.”
“Doing so will lead to scarring and worsening of the acne,” he warned. “Stress also leads to a breakout of acne. Changing your diet such as cutting out sweets can help your acne. However, everyone is different, so if you notice a certain food that makes your acne worse, then avoid or minimize eating it.”
Dr. Levy added the following:
- Don't over-scrub your face
- Change your pillow sheet often
- If you work out, take off your makeup prior to working out. “I recommend simple micellar water, which is not irritating.”
Teenage acne tends to go away over time, Dr. Yamauchi said.
“Most girls will try over-the-counter remedies for acne,” he said. “If they work, that’s great. But if they don’t work, see your doctor. Follow your doctor’s orders and your acne should be kept in check.”
Dr. Levy advised: “Don’t lose hope, there is a treatment plan that works for everyone whether it be a topical or oral medication. Make sure you speak to a Board Certified Dermatologist about your acne as we are quite good at coming up with treatment plans for everyone.”
The bottom line is all types of acne can and should be treated these days, to prevent side effects like scarring and emotional distress, Dr. Elias added.
“Please make sure to see your Board Certified Dermatologist for the best treatment for your acne.”