What is the best treatment for a teenager with nose blackheads and acne?

From the Guidelines

For teenagers with nose blackheads and acne, the most effective treatment approach is a consistent skincare routine that includes a gentle cleanser, topical retinoids, and benzoyl peroxide, as recommended by the 2024 guidelines of care for the management of acne vulgaris 1.

Key Components of Skincare Routine

• Start with a gentle cleanser containing salicylic acid (1-2%) or benzoyl peroxide (2.5-5%) used twice daily
• Apply a topical retinoid like adapalene 0.1% gel (available over-the-counter as Differin) once daily at night, starting every other night to build tolerance
• For blackheads specifically, use chemical exfoliants containing salicylic acid or glycolic acid 1-2 times weekly
• Consider weekly use of pore strips for immediate but temporary removal of visible blackheads
• Incorporate a non-comedogenic moisturizer and SPF 30+ sunscreen daily, as retinoids can increase sun sensitivity

Additional Considerations

• If no improvement occurs after 8-12 weeks, consult a dermatologist for prescription options like stronger retinoids, topical antibiotics, or oral medications
• Avoid picking or squeezing acne, which can lead to scarring and infection
• Maintain treatment consistency as results typically take 6-8 weeks to become noticeable

Evidence-Based Recommendations

• The 2024 guidelines of care for the management of acne vulgaris recommend benzoyl peroxide, topical retinoids, and topical antibiotics as first-line treatments for acne 1
• Oral doxycycline is also recommended for moderate to severe acne 1
• The guidelines emphasize the importance of combining topical therapies with multiple mechanisms of action and limiting systemic antibiotic use 1

From the FDA Drug Label

Directions 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. The best treatment for a teenager with nose blackheads and acne is to use adapalene (TOP) once daily, covering the entire affected area with a thin layer, as directed for adults and children 12 years of age and older 2.

• Clean the skin gently and pat dry before applying the product
• Apply the product to the entire face, including the nose, if acne is present in that area
• Use once daily, as using more than directed may worsen skin irritation

From the Research

Treatment Options for Nose Blackheads and Acne in Teenagers

• The treatment of acne vulgaris, which includes nose blackheads and acne, should be based on the type of lesion and the severity of the acne, as well as psychosocial disability relating to the disease and the presence of scarring 3.
• For mild acne, topical treatments such as benzoyl peroxide, azelaic acid, and antibacterials are generally used for inflammatory lesions, while topical retinoids are particularly effective for noninflamed lesions 3.
• Combination therapies, including topical retinoids and antimicrobials, are recommended for mild to moderate inflammatory acne, and topical retinoids with oral antibiotics for moderate to severe cases of acne 4, 5.
• Oral isotretinoin is approved for treating severe recalcitrant nodular acne, but is often used to treat resistant or persistent moderate to severe acne, as well as acne that produces scarring or significant psychosocial distress 5, 3.

Maintenance Therapy

• Maintenance therapy with topical retinoids is important to prevent recurrences after discontinuing a successful treatment 6.
• A 12-month maintenance treatment with adapalene 0.1% and benzoyl peroxide 2.5% fixed combination gel has been shown to be effective in controlling acne relapse after treatment with oral isotretinoin 6.

Considerations for Teenagers

• Acne vulgaris affects approximately 85% of individuals aged 12-24 years, and can cause permanent physical scarring, negatively affect quality of life and self-image, and has been associated with increased rates of anxiety, depression, and suicidal ideation 5.
• First-line therapies for teenagers with acne include topical retinoids, benzoyl peroxide, azelaic acid, or combinations of topicals, while oral antibiotics, hormonal therapies, or isotretinoin may be recommended for more severe disease 5.