Adolescence or teenage, is a stage of physical, emotional and social development in a person's life that shapes them into the person they want to be. It is a tender and impressionable age of self-discovery and developing one's self-esteem and social skills necessary to function effectively in the society.
Acne vulgaris is a nightmare in this tender age of an individual and can have a serious impact on their psychosocial development. The prevalence of acne in adolescence varies from 77-97% with a peak around puberty or age 17-19 years in most of them! In the United States, nearly 50 million people are affected by acne out of which 85% of them are adolescents aged between 15-17 years. Surprised??
Why is it that that this coming-of-age, sweet-sixteen party comes with a havoc of painful bumps and zits on your skin? What really botches growing-up so bad that teenage life is broadly disguised as a big walking pimple!
“It is easy to display a wound, the proud scars of combat. It is hard to show a pimple”- Leonard Cohen, The Favorite Game
Well, there are multiple factors that come in to play their roles:
1) HORMONES: Oh, yes! The same hormones that are shaping your body into curvy feminine and brawny masculine are also playing up with your skin. Our skin has oil glands as a normal constituent, that helps in keeping it soft and elastic. The oil glands are more concentrated on the T-zone of face: forehead, nose, nasal crease and chin.
Now, all of us have some amount of androgens (male sex hormone) or testosterone in our body..(yes females have them too)! During puberty there is a spike in body's androgen levels. These androgens act on their receptors present on the oil glands in skin making them increase in size and triggering them to produce more oil or sebum (which makes the teenage skin look bright, oily and shiny!). When the skin gets stuffed with the oil made by oil glands, the skin pores start getting clogged and additionally the infamous Propionibacterium acnes or the acne bacteria feeds on the oil and grows. Finally, as a result of constant excessive oil production, clogging of pores, accumulation of skin keratin because of clogged pores and overgrowth of the acne bacteria, a big drama of inflammation ensues which presents as black head, white head, painful papules, pustules, nodules or cysts- based on the extent of inflammation in them. Acne on chest and back is also a component of hormonal acne and shouldn't be ignored. Truncal acne (chest and back) are slightly difficult to treat since the medicines take longer to get absorbed due to thicker skin and friction with clothes worn.
2) MENARCHE: The puberty takes the females in particular, on a crazy hormonal drive. The monthly period brings with it a bizarre surge of hormones, responsible for all the mood swings and pre-menstrual flare of acne in a lot of teenagers. This hormonal acne usually peaks around 17-19 years in most young female girls.
3) STRESS: Yes, sweet sixteen isn't that sweet after all. Adolescent life is exposed to various stressors like studies, performance pressure at school or college, infatuation and adolescent love stress and of course the stress of a pimpled face that prevents you from looking your best in your youth. All these stressors fuel up the underlying inflammatory cascade, and hence more acne bumps! Popping a pimple, smearing it with toothpaste or lemon juice or all the home made remedies your mom or granny suggest, only ends up angering it and leaves ugly dark spots or acne scars when they finally heal. Never pop a pimple and lemon juice or toothpaste do not treat pimples. Popping a pimple is like forced reduction externally while the internal inflammation ignites further with the pressure and friction you cause in your painful attempt to pop a pimple! Toothpaste can give a soothing effect due to menthol in most of them and the baking soda, hydrogen peroxide etc can help in drying the acne. But this tactic can do more harm than good. The basic pH, components like sodium lauryl sulphate and triclosan can irritate the skin, overdry it and trigger acne all over again! A good quick home based hack for angry pimple is applying ice on it. Again, don't rub it vigorously. Use an ice pack or ice cubes in. soft cotton cloth and dab it softly to help in soothing the inflammation to some extent. Did you know that some people derive pleasure and weird sense of satisfaction from popping or scratching their pimples? Its called Acne excoriee or picker's acne, its an obsessive-compulsive disorder (OCD) where the pleasure factor from popping pimple dominates and finally leads to lot of ugly acne scars that can take years to heal. These patients need active counselling and psychological support to treat the condition. In severe cases of acne excoriee, your dermatologist might refer you to your psychiatrist to help you better with the OCD.
4) GENETICS: Ah, this catches up always! If your mom or dad or elder siblings suffered from bad acne in their teenage, there is a higher probability of you going down that road too.
5) FOOD FACTOR: Although not clearly established- junk, fried, high glycemic index or sugars etc. harm your gut health and contribute to inflammation and acne. Avoiding them, regular exercising, drinking optimal amount of water and opting a healthier, balanced diet goes a long way in keeping your skin cleaner and brighter all your life.
IMPACT OF ACNE ON TEENAGERS
This is the era of social media obsession!! Everyone wants to look their prettiest self, get that perfect "instagram-worthy" face. The social pressure to look unrealistically beautiful and attractive is so strong, that Instagram introduced filters for you to camouflage the on-screen appearance of your skin! The cosmetic industry is flooded with camouflage products and concealers to hide the acne bumps and their marks perfectly. Teenagers with acne issues are mocked in schools and colleges and suffer social embarrassment to a great extent. This can leave a very negative impact on a child's social development in these years.
Several studies have found that teenagers, especially girls are susceptible to anxiety and depression during acne breakouts. This is because teenagers are usually under intense pressure to gain approval from their peers as they strongly believe that physical appearance, attractiveness or facial beauty is of utmost importance to fit in with their fellow peers.
"After lunch, I asked my "friend" if I had anything on my face and she said "Yeah, Pimples". I get made fun of for my acne all the time".
Being at the receiving end of all the bullying and bad jokes at school, it is common in adolescents to skip school which directly affects their academics. Parents need to be careful to seek help with a dermatologist, instead of normalising adolescent acne, if their child is having serious trouble with their acne. A good dermatologist advice and counselling on adolescent skin care can go a long way in building your child's self-confidence and being 'comfortable in their own skin'.
Some researches have also shown that young people with acne have less career options like pursuing a career in modelling, acting, flight and hotel attendants etc. It can affect their dating life negatively as well.
"When I talk to people, I feel like they are staring at my face instead of my eyes. I overheard a guy telling his friend that he stopped dating me because of all the pimples I had on my face. I skipped class to cry in the bathroom"
Acne can have a great impact on the quality of life of a teenager both physically as well as psychologically. Early treatment and psychological counselling assistance can help in reducing the hardship of teenagers by administering their mental health and boosting up their morale.
How to treat Adolescent Acne?
Various treatment options are available for adolescent acne.
There are topical medications containing Benzoyl peroxide, Clindamycin and Salicylic acid, that help in decreasing bacterial growth and reducing inflammation. Topical retinoids like Adapalene and Tretinoin aid in reducing the plugging of skin pores with keratin, which is the main contributor of initiating inflammation. It also helps in reducing appearance of acne scars. Azelaic acid is a topical depigmenting agent that helps in lightening acne marks (posy-inflammatory hyperpigmentation). A dermatologist recommends the right combination of topical and oral medicines for your acne after assessing your skin type and acne severity.
Oral anti-acne medicines are needed when the acne is moderate to severe grade. Antibiotics like-Erythromycin, Doxycycline and Tetracycline (avoided in children less than 8-12years) help in combating the bacterial component which is high in acne that are pustular and cystic. Oral Isotretinoin is one of the most acne treatment that acts on the oil glands to prevent them from excess sebum production, reduces keratin plugging of skin pores and is an anti-inflammatory agent as well. It is a strict prescription medicine that should be taken only under dermatologist supervision.
A good anti-acne face wash is a must have for acne-prone skin. The face wash should be unscented and contain active acne ingredients like benzoyl peroxide, salicylic acid, lactic acid, tea tree oil etc. Use an anti-acne face wash 2-3 times a day to keep your face free of excess oils. The contact time of a face wash should be at least 2 minutes on your skin.
Sunscreens are BFF of skin- the sooner you realise, the better. SPF of 30 or above is a must-have whenever you are going out in sun. It should be applied at least 20 minutes before stepping out in sun. Apart from all the great anti-ageing, anti-sunburn and tan effects, sunscreen prevents UV-rays induced acne trigger.
Finally, to sum it up, adolescent acne is a big nuisance of growing-up days and shouldn't be considered a norm of teenage life. It is a treatable and preventable condition and parents should be careful of its long-term physical and psychological impact on their child's blossoming up age. Instead of spending years of time and huge amounts of money to deal with acne scars in adulthood, it is a wise option to tackle them in the young age itself. Thankfully, there is a growing skin consciousness in present day world. Children are being vocal about their problems, seeking dermatologist advice and consultation. Parents too, need to be proactive in seeking help for their child's teenage acne issue.
Acne treatment is affordable and effective and could be the best gift to your child struggling with the issue of adolescent acne!
You can get in touch with dermatologists who are experts in Acne treatment, on the AcneConsult app absolutely free of cost and seek help for acne and acne-like skin conditions.