What are the treatment options for teen acne?

From the Guidelines

Treatment options for teen acne should prioritize topical treatments containing benzoyl peroxide or salicylic acid for mild cases, and oral antibiotics like doxycycline or isotretinoin for severe cases, as recommended by the most recent guidelines of care for the management of acne vulgaris 1.

Key Considerations

• For mild acne, start with topical treatments containing benzoyl peroxide (2.5-10%) or salicylic acid (0.5-2%), applied once or twice daily to affected areas.
• For moderate acne, topical retinoids like adapalene (0.1% gel, applied nightly) can be effective by promoting cell turnover and preventing clogged pores.
• Combination products containing benzoyl peroxide with either adapalene or clindamycin may provide better results.
• For severe or persistent acne, a dermatologist might prescribe oral antibiotics like doxycycline (50-100mg once or twice daily for 3-6 months), isotretinoin (0.5-1mg/kg/day for 4-6 months), or hormonal treatments like birth control pills for female teens.

Additional Recommendations

• Consistent gentle skincare is important—wash twice daily with a mild cleanser, avoid harsh scrubbing, use oil-free moisturizers, and always apply sunscreen during the day, especially when using retinoids which increase sun sensitivity.
• Results typically take 6-8 weeks to become noticeable, so patience and consistency are essential for successful treatment.
• The use of oral contraceptives (COCs) for acne treatment should be considered in female teens, as they have been shown to improve acne and have other non-contraceptive benefits, but their use should be carefully evaluated and monitored 1.

Important Notes

• The guidelines of care for the management of acne vulgaris recommend strong recommendations for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline, as well as oral isotretinoin for severe cases 1.
• Spironolactone, an aldosterone receptor antagonist, may be used in select women with acne, particularly those with signs of hyperandrogenism, but its use should be carefully evaluated and monitored due to potential side effects 1.

From the FDA Drug Label

Adults and children 12 years of age and older: use once daily clean the skin gently and pat dry before applying the product cover the entire affected area with a thin layer. For example, if your acne in on the face, apply the product to the entire face. do not use more than one time a day. Applying more than directed will not provide faster or better results, but may worsen skin irritation. Children under 12 years of age: ask a doctor

The treatment options for teen acne include adapalene (TOP), which can be used once daily for children 12 years of age and older 2.

• Key points:
  • Apply a thin layer to the entire affected area
  • Use once daily
  • Do not use more than directed
• For children under 12 years of age, it is recommended to ask a doctor. Another option is benzoyl peroxide (TOP), but the provided label does not specify an age range for its use 3. Isotretinoin (PO) can be used for severe recalcitrant nodular acne in pediatric patients ages 12 to 17 years, but its use should be given careful consideration 4.

From the Research

Treatment Options for Teen Acne

• Topical treatments: benzoyl peroxide, azelaic acid, and antibacterials are generally used for inflammatory lesions, while topical retinoids are effective for non-inflamed lesions 5.
• Combination therapies: adapalene 0.1% and benzoyl peroxide 2.5% fixed-dose combination gel has been shown to be efficacious and safe in the treatment of acne patients aged 12-17 years 6.
• Oral antibiotics: tetracyclines, oxytetracycline, and erythromycin are usually the first-line antibacterials for moderately severe acne, while minocycline and doxycycline are second-generation options 5.
• Isotretinoin: is the treatment of choice for severe nodular acne, but is associated with serious adverse effects and requires careful monitoring 5.
• Maintenance therapy: a 12-month treatment with adapalene-benzoyl peroxide after oral isotretinoin has been shown to be effective in preventing recurrences 7.

Combination Therapy

• The combination of a topical retinoid and antimicrobials is recommended for mild to moderate inflammatory acne, while topical retinoids with oral antibiotics are recommended for moderate to severe cases 8.
• The association of a topical retinoid and benzoyl peroxide seems to provide favorable evidence for this combination as maintenance therapy 7.
• Clindamycin 1%-benzoyl peroxide 5% gel is a stable formulation that is efficacious and well-tolerated, and can be used in combination with topical retinoids 9.

Efficacy and Safety

• Adapalene-benzoyl peroxide combination gel has been shown to be well-tolerated, with a fast onset of action and significant reduction in total, inflammatory, and non-inflammatory lesions 6.
• The combination of clindamycin and benzoyl peroxide has been shown to be well-tolerated, with excipients that minimize treatment-related irritation 9.
• Isotretinoin is associated with serious adverse effects, including teratogenicity, and requires careful monitoring 8, 5.