My daughter has bad acne!

Good day,

My 11-year-old daughter has bad acne, both blackheads and whiteheads. Like me, she has large pores. How can I help her achieve healthy skin?

Dear Reader,

Your daughter is not alone. Acne affects over 85 per cent of people at some point, especially adolescents. Acne vulgaris involves inflammation of the hair follicle and its attached oil-producing gland (sebaceous gland). Its main causes include hormones stimulating sebaceous glands to produce excess oil (sebum), blockage of pores by dead skin cells, a bacterium called propionibacterium acnes, and inflammation.

Other factors which may lead to acne include genetics, oily make-up, oily hair products, hot humid climates, some medications (e.g. steroids), stress, industrial oils, tight clothing and friction. Studies differ as to whether or not foods cause acne. Some have suggested worsening of acne by dairy products and diets high in sugar.

Acne may present with blackheads (comedones the result of clogged, open pores) and whiteheads (comedones due to clogged pores covered by skin), solid bumps (papules), pus-filled bumps (pustules), deep lumps (nodules) and deep fluid-filled lumps (cysts). Complications of acne include scarring, dark spots, keloids and psychosocial problems. Acne should be treated to prevent these complications. Its treatment is mainly based on its severity and psychological impact.

Exfoliating

You should minimise all potential causes of acne where possible. Acne treatments act in various ways such as unclogging pores (exfoliating), reducing oiliness, fighting bacteria and reducing inflammation. Acne treatments and procedures may reduce the appearance of enlarged pores, but cannot totally eliminate them. Mild acne can be treated with over-the-counter (OTC) products containing ingredients like benzoyl peroxide (2.5 to five per cent) and/or salicylic acid (0.5 to two per cent).

These may be irritating, so start with lower concentrations and be careful when combining products. It is best to choose gentle cleansers when using acne treatments. If tolerated, exfoliating (deep cleaning) cleansers and toners/astringents can be used. Regular bathing soaps and blue 'cake' soaps are not recommended. Scrubs should ideally not be used more than once weekly. Oil-free (non-comedogenic) sunscreens should be used since acne treatments can make the skin more sensitive to the sun and since the sun can make dark spots darker. Oil-free moisturisers may be needed to counteract the dryness resulting from acne treatment.

Avoid picking, squeezing

Your daughter should also avoid aggressive scrubbing, picking or squeezing the skin. Squeezing acne lesions can often cause them to go deeper, potentially causing dark spots and scarring. If acne is not improving using only OTC products, your dermatologist can prescribe medication suitable for her. These include topical retinoids (vitamin A derivatives), benzoyl peroxide and topical antibiotics.

Some oral acne medications may be added if necessary. We always weigh pros and cons of treatment based on the individual. Acne treatment may take at least four to eight weeks to give good results. There is no permanent cure, so maintenance treatment is required to keep acne controlled. Optional procedures include professional comedone extractions, chemical peels, microdermabrasion, injectable steroids (into deeper lumps), light therapy and lasers.

Treatment can also be recommended for dark spots, scarring, keloids and psychological problems. Acne can cause significant emotional problems, so try to keep her feeling positive about herself - inside and out. All the best!

Dr Arusha Campbell-Chambers is a dermatologist and founder of Dermatology Solutions Skin Clinics & Medi-Spas. Email yourhealth@gleanerjm.com.