Our Pediatric Dermatologist, Dr. Swanson, talks about treating acne, what types of acne occur, the 3 over the counter ingredients for treating acne, what to expect at a doctor appointment, and a timeline for getting clear skin.

Acne is Treatable

So hello everybody, I am here to tell you about acne, everything you need to know, because as a dermatologist, acne consumes a significant part of my clinic day. So I see patients with acne every day and one of the main messages I really try to drive home with people is just how treatable acne is. Nobody has to suffer with acne anymore. We’ve got tons of different options. We’ve got topicals, we’ve got pills, we have medicines that work in all sorts of different ways to really target your acne.So nobody has to just live through their acne years. We can help make it better.

Different types of acne

There are some different types of acne. In general in dermatology, we talk about inflammatory acne, which is like the red inflamed bumps, and we talk about Comedonal acne, which is like black heads and little bumps. And the difference between these is important because sometimes the medicines we use, we choose on purpose because of the type of acne that a person has. But no matter what type of acne you have, we can really help with it.

First step in treating acne at home

One of the most important first steps when you’re starting to experience acne and you wanna make it better is that we recommend getting into a good skincare routine. We recommend washing your face twice a day with a gentle facial cleanser, something like Cetaphil or Cerave are good quality gentle brands. And we recommend using a face lotion with sunscreen in the morning, a face lotion without sunscreen at bedtime if you need it. But that’s a good first step. See this Amazon link for facial skin products recommended by Dr. Swanson.

Three main ingredients in over the counter medicines and their uses for inflammatory or comedonal acne

If you wanna try using some over the counter acne medicines, there are three main ingredients found in over the counter acne medicines. There’s one called Differin. And that main ingredient is a adapalene. And it works best for Comedonal acne for the little bumps and blackhead.

There’s benzoyl peroxide that’s in a lot of over the counter acne products it will bleach your pillow cases. So be mindful of that. Don’t use pillow case as your treasure, but benzoyl peroxide helps more with the inflammatory acne.

And then there’s salicylic acid, which is in a lot of over the counter acne medicines. And it also works better for the Comedonal acne. So those are some things you can start with. And if those steps don’t help you, then please come to see a dermatologist we’re here to help and we can make it better.

Hype or truth in acne treatments seen on social media or in stores

So there’s a lot of information out thereabout acne and some of it is based in truth. And some of it is a little bit kind of like hype. It’s not exactly true. I see a lot of irritation from a lot of the over the counter things that are advertised or maybe things that you might see on TikTok, because a lot of them can be really abrasive and irritating to your skin. I think even before you try something that you’ve learned about on social media, I would ask someone, your pediatrician, your dermatologist, because as a dermatologist, we see a lot of those treatments gone wrong

Witch Hazel for acne

Things like witch hazel is over the counter in herbal and can help some people, but can be very irritating

Acne Patches for acne

Things like the acne patches can be helpful as spot treatment, but can also be very irritating Things like the acne patches can be helpful as spot treatment, but can also be very irritating and can almost produce like a burn on the skin

Toothpaste for acne

I know that there used to be things on the internet about putting toothpaste on pimples And I don’t even know if there’s any science to back up its use, but we saw a lot of for a while from toothpaste being put on people’s faces. So if you read something online, take it with a little bit of a grain of salt, ask somebody you trust, your pediatrician, your dermatologist and get an answer as to whether or not these things are appropriate for you.

Does diet affect acne?

Another question that I get a lot about acne is does diet have anything to do with it And it’s a complicated question because it’s hard to know the truth I’ve been in practice for 12 years and I’ve seen kind of our thoughts and feelings about this issue, really wax and wane and vary over that 12 years. Our current feelings is that diets high in sugar and carbohydrates can contribute to more acne in some individuals. So what this means to me is basically do everything in moderation.

It doesn’t mean you can never have a cookie, just don’t exist on pizza and French fries alone. Have some meats, have some proteins have some fruits, have some veggies. And I think a balanced diet consisting of things all done in moderation, I think you’ll really be okay. If you do wanna make some diet modifications then just limiting your carbs and sugar would be a good way to go about it.

Aggressive acne treatment strategies vs gentle ways

Sometimes we see patients that hate their acne so much that they get very aggressive with their treatment strategy and they end up using maybe over the counter acne medicines too much. Maybe they rub too hard. They exfoliate or scrub too much for their skin and they end up getting rashes and sometimes even infections by taking it too far. A lot of the treatments that we recommend for acne are really quite gentle because you don’t have to destroy your skin to treat the acne. You can do it and get rid of your acne in a gentle way so that your skin is not traumatized.

Treatment timeline- what is a realistic timeline for getting clear skin

So in general, with acne and its treatment everybody wants their acne to get better super fast. And I completely understand that having acne stinks. But a lot of our treatments do take a little bit of time and we wanna give them time to work. The reason they do take a little bit of time is because the pimple that you’re gonna get four to eight weeks from now, it has actually already started its process of forming. So to really get in there and make a change, you have to be using something consistently for about two months to really be at the peak of its efficacy. And that’s true for our prescription topical medicines. It’s true for a lot of the pills we use.

Oral antibiotics we tend to give about two months to see what they can do.Medicines that work in a hormonal way for females with acne, things like birth control pills and spironolactone. Those medicines are great medicines, but they can be even slower. They can reach their peak efficacy at about six months. And so it’s important to talk with your dermatologist about what can I expect from this and set realistic expectations. Don’t expect things to be perfect next week. Sometimes it can be a struggle if people come to me and they say my homecoming dance is next Saturday and I need my skin to be clear. That’s a tough situation to put a dermatologist in because I definitely wanna help and I definitely know I have tools in my toolbox that can fix their acne but that timeframe is not really conducive to clearing up a person’s skin.

And so understand that it’s gonna take time but these medicines are good at their job. And if we try something and it doesn’t work right away we can try something different. So be patient with it, give it time, trust that either it will work or will try something different that works.

When minors do not want to talk about their acne with their parents

A lot of the patients I treat for acne are under the age of 18. And some of them might not feel comfortable openly talking about their acne with their parent around. Now we can work around that. So oftentimes at your very first appointment we need a parent there there’s some paperwork to fill out and all of that kind of stuff. But if you’d rather your parent not be in the exam room with you, that’s okay. We can have them go watch television in the lobby while we chat about your acne.

So be open, both with your parent and your dermatologist about what setting would make you most comfortable to openly talk about your acne and the treatment options for it. After the initial appointment parents can sign a form that allows their teenagers to come in by themselves. And so that’s of course fine. And then you don’t have to have a parent even physically present in the office. So we can definitely work with that. Be open with your parent, be open with your doctor about what setting would make you most comfortable.

More about the teen-parent dynamic from the American Academy of Dermatology –including “5 ways to Help Your TeenagerSurviveAcne”

Patients should know their acne treatment options

So whenever I see a patient with acne I always give them options to treat it. I don’t ever say, oh here’s the one thing you have to use to treat your acne because it’s really different strokes for different folks. A lot of people have different preferences. So I lay out two or three or four choices for things that I think would be reasonable for that patient. And then I let them choose.

And sometimes that decision is made entirely by the teenager, which is awesome. Love to see them take authority over the issue especially because they’re the ones that are gonna be actually applying the medicine. They’re the ones that are gonna be taking the pills. And so it’s really crucial that the patient themselves is on board with the treatment.

Sometimes a parent has strong feelings about the treatment options. That’s okay, too. It gives me good feedback as to which options might be right for that family and might not be right for that family but it’s just important in the clinic to be very open about what you want from a treatment and what’s most important to you. Let your doctor know about that. That helps us choose our treatment.

Shared decision making

I’m a big fan of what we call shared decision making. So I will often say to parents and their families I’ll say, you know, I’m the navigator, you’re the captain it’s my job to tell you which routes you can take.And it’s your job to pick which route you wanna go. And so that’s kind of what I’m there for, I’m your guide, but it’s very important that everybody is happy with the decisions that we’ve made for their treatment because especially the patient themselves ’cause they’re the one that’s going to be using the medicine.

If you are interested in a deep discussion on the myths and realities of Accutane for treating acne, watch this video by Dr. Swanson here.