What are the treatment options for acne in teenagers?

Treatment Options for Acne in Teenagers

The recommended first-line treatment for mild acne in teenagers is a combination of topical retinoid and benzoyl peroxide, which should be used for 8-12 weeks before considering treatment adjustments. 1

Treatment Based on Acne Severity

Mild Acne

• First-line treatment: Topical retinoid + benzoyl peroxide 2.5-5%
  • Adapalene is FDA-approved for patients 12 years and older 2
  • Apply once daily to clean, dry skin covering the entire affected area with a thin layer
  • More frequent application won't improve results but may increase irritation 2
• Alternative options:
  • Azelaic acid (moderate evidence) 1
  • Salicylic acid (low evidence) 1
  • Clascoterone (high evidence) 1
  • Topical dapsone 5% gel (particularly effective for females) 1

Moderate Acne

• First-line treatment: Topical retinoid + benzoyl peroxide + topical antibiotic (clindamycin 1%)
• If inadequate response after 12 weeks, add topical clindamycin 1% (fixed-dose combination with benzoyl peroxide preferred) 1
• If still insufficiently effective, add systemic antibiotic (doxycycline 100mg daily) 1
• Note: Clindamycin is contraindicated in patients with history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis 1

Severe Acne

• First-line treatment: Systemic antibiotic + topical retinoid + benzoyl peroxide
• If ineffective or if scarring is present, oral isotretinoin 0.25-0.4 mg/kg/day for 16-20 weeks 1
• Important: Isotretinoin has significant contraindications and requires careful monitoring:
  • Absolutely contraindicated in pregnancy (Category X) 3
  • Not studied in children under 12 years 3
  • May affect bone mineral density in adolescents 3
  • Requires iPledge program registration for prescribers, patients, and pharmacists 4

Hormonal Acne

• Consider hormonal therapy (combined oral contraceptives or spironolactone) in addition to topical therapy 1
• Drospirenone-containing combined oral contraceptives are most effective for treating acne in females who also desire contraception 1

Treatment Duration and Expectations

• Patients should be counseled that treatments take 6-8 weeks to work 5
• Continue topical retinoid therapy for maintenance after achieving control 1
• If acne causes psychological distress or scarring, consider more aggressive treatment approaches 6

Important Considerations

• Antibiotic stewardship: Systemic antibiotics should be used only in combination with benzoyl peroxide and retinoids and for a maximum of 12 weeks 4
• Scarring risk: Control acne before addressing scars; early effective treatment prevents scarring 1
• Psychological impact: Acne can cause significant psychological distress, affecting quality of life and self-image, and has been associated with increased rates of anxiety, depression, and suicidal ideation 6
• Lifestyle modifications: Reducing high-glycemic foods and limiting dairy intake may be beneficial (moderate evidence) 1

When to Refer to a Dermatologist

• Moderate to severe acne not responding to first-line treatments
• Acne causing psychological distress or scarring
• No improvement after 4-6 weeks of lifestyle changes 1

Common Pitfalls to Avoid

1. Overuse of antibiotics: Oral antibiotics are currently overprescribed for acne 5
2. Inadequate duration: Not giving treatments enough time to work (minimum 8-12 weeks)
3. Skin irritation: Failing to counsel patients about potential skin irritation when starting topical treatments 5
4. Monotherapy: Using antibiotics without benzoyl peroxide, which increases risk of bacterial resistance 1
5. Ignoring psychological impact: Not addressing the significant psychological effects of acne, particularly in teenagers 6