What is the recommended treatment for acne in teenagers?

Treatment of Acne in Teenagers

For teenage acne, the first-line treatment should be a combination of topical benzoyl peroxide and a topical retinoid, with systemic antibiotics added for moderate to severe cases that don't respond to topical therapy alone. 1, 2

Treatment Algorithm Based on Acne Severity

Mild Acne

• Start with topical monotherapy using either benzoyl peroxide (2.5-5%) or a topical retinoid (adapalene 0.1% gel is available over-the-counter) 1, 2
• Benzoyl peroxide is strongly recommended as it has antimicrobial properties and prevents bacterial resistance 1, 2
• Topical retinoids (adapalene, tretinoin, tazarotene, trifarotene) are strongly recommended for their ability to normalize follicular keratinization and reduce comedones 1, 2
• Apply a thin layer to affected areas once daily after washing and completely drying the skin (wait 20-30 minutes) 3

Moderate Acne

• Use combination topical therapy including benzoyl peroxide + topical retinoid or benzoyl peroxide + topical antibiotic 1, 2
• Fixed-dose combination products like adapalene-benzoyl peroxide gel show significantly greater efficacy in adolescents aged 12-17 years compared to monotherapies 4, 5
• If inadequate response after 6-8 weeks, add oral antibiotics 1, 2
• Doxycycline is strongly recommended for patients ≥9 years old with moderate inflammatory acne 2, 1
• Minocycline or sarecycline are conditionally recommended alternatives 1, 2

Severe Acne

• Oral isotretinoin is strongly recommended for severe acne, acne causing psychosocial burden or scarring, or acne failing standard treatment with oral or topical therapy 2, 6
• Traditional daily dosing of isotretinoin is conditionally recommended over intermittent dosing 2
• Monitor for side effects including dry skin, cheilitis, and potential laboratory abnormalities 6

Important Considerations

Topical Therapy Tips

• Avoid excessive washing and harsh scrubbing as this may worsen acne 3
• Use a mild, non-medicated soap and wash gently 2-3 times daily 3
• Allow skin to dry completely (20-30 minutes) before applying topical medications 3
• Start with a pea-sized amount for the entire face to minimize irritation 3
• Expect some initial irritation (redness, peeling) during the first 2-4 weeks of treatment 3, 2

Avoiding Common Pitfalls

• Never use topical antibiotics as monotherapy as this increases risk of bacterial resistance - always combine with benzoyl peroxide 1, 2
• Benzoyl peroxide may bleach clothing and hair - warn patients about this side effect 7
• Topical retinoids may cause photosensitivity - advise patients to use sunscreen and minimize sun exposure 3, 2
• Improvement takes time - patients should be counseled to continue treatment for at least 6-12 weeks before evaluating efficacy 3, 2
• Don't ignore psychosocial impact - consider more aggressive treatment if acne is causing significant psychological distress 1, 2

For Female Adolescents

• Combined oral contraceptives are conditionally recommended for female teens with acne, particularly those with signs of hyperandrogenism 1, 2
• Spironolactone may be considered for female adolescents with moderate to severe acne resistant to conventional therapies 1

Adjunctive Treatments

• Intralesional corticosteroid injections are recommended for larger acne papules or nodules at risk of scarring 1, 2
• Azelaic acid is conditionally recommended, particularly useful for post-inflammatory hyperpigmentation 1, 2
• Salicylic acid is conditionally recommended for mild comedonal acne 1, 2

Maintenance Therapy

• Once acne is controlled, continue using topical therapy (retinoid ± benzoyl peroxide) to maintain results 2, 3
• Discontinue oral antibiotics once improvement is achieved (typically 3-4 months) to minimize bacterial resistance 2
• Continue topical therapy until directed otherwise by a physician 3