What are the treatment options for acne in teenagers?

From the Guidelines

For teen acne treatment, I strongly recommend starting with benzoyl peroxide, topical retinoids, or topical antibiotics, as these have the strongest evidence supporting their use 1.

Key Recommendations

• Benzoyl peroxide is strongly recommended for acne treatment due to its effectiveness in reducing acne lesions and preventing antibiotic resistance 1.
• Topical retinoids, such as adapalene, are also strongly recommended for their ability to prevent clogged pores and reduce inflammation 1.
• Topical antibiotics, like clindamycin or erythromycin, can be used in combination with benzoyl peroxide to enhance their effectiveness and prevent resistance 1.

Treatment Approach

For mild to moderate acne, a multi-step approach can be taken, including:

• Gentle cleansing twice daily with a mild cleanser containing salicylic acid (1-2%) or benzoyl peroxide (2.5-5%)
• Applying a topical treatment containing benzoyl peroxide, adapalene, or salicylic acid after cleansing
• Combining these with a topical antibiotic like clindamycin 1% or erythromycin 2% for moderate acne

Additional Considerations

• Severe or persistent acne may require prescription treatments from a dermatologist, such as stronger retinoids (tretinoin), oral antibiotics (doxycycline 50-100mg daily for 3 months), or for females, hormonal treatments like birth control pills 1.
• Avoid picking at pimples, use oil-free, non-comedogenic products, and change pillowcases frequently to reduce acne triggers.
• Consistency is crucial, as treatments typically take 6-8 weeks to show significant improvement.
• Diet modifications, such as reducing dairy and high-glycemic foods, may help some teens, though evidence varies among individuals.

From the FDA Drug Label

In studies with isotretinoin, adverse reactions reported in pediatric patients were similar to those described in adults except for the increased incidence of back pain and arthralgia (both of which were sometimes severe) and myalgia in pediatric patients The use of isotretinoin for the treatment of severe recalcitrant nodular acne in pediatric patients ages 12 to 17 years should be given careful consideration, especially for those patients where a known metabolic or structural bone disease exists Use of isotretinoin in this age group for severe recalcitrant nodular acne is supported by evidence from a clinical study comparing 103 pediatric patients (13 to 17 years) to 197 adult patients (≥18 years)

Isotretinoin (PO) can be used to treat acne in teens, specifically those with severe recalcitrant nodular acne, ages 12 to 17 years, but with careful consideration due to potential side effects 2. Benzoyl peroxide (TOP) can also be used to treat acne, but it is essential to follow the instructions carefully and be aware of potential skin irritation 3.

• Key considerations for isotretinoin (PO) include:
  • Potential side effects such as back pain, arthralgia, and myalgia
  • Careful consideration for patients with known metabolic or structural bone disease
• Key considerations for benzoyl peroxide (TOP) include:
  • Potential skin irritation
  • Avoiding unnecessary sun exposure and using a sunscreen
  • Avoiding contact with eyes, lips, and mouth, as well as hair or dyed fabrics

From the Research

Treatment Options for Teen Acne

• Topical therapies such as retinoids (eg, tretinoin, adapalene), benzoyl peroxide, azelaic acid, and/or combinations of topical agents are first-line treatments for acne vulgaris 4
• Combinations of topical agents with systemic agents (oral antibiotics such as doxycycline and minocycline, hormonal therapies such as combination oral contraception [COC] or spironolactone, or isotretinoin) are recommended for more severe disease 4
• A fixed-dose combination gel of adapalene 0.1% and benzoyl peroxide 2.5% (adapalene-BPO) is efficacious and safe in the treatment of acne patients aged 12 years or older 5
• Adapalene/BPO plus doxycycline 200 mg was found to be highly effective when compared with isotretinoin in the treatment of patients with severe acne with nodules 6

Efficacy of Adapalene and Benzoyl Peroxide

• The combination of adapalene and benzoyl peroxide acts synergistically on inflammatory patterns through regulation of innate immunity 6
• Adapalene/BPO helps prevent lesion and microcomedone formation, and reduces inflammatory and non-inflammatory lesions 6
• A study found that 95% of subjects had at least a 2-grade improvement in IGA scores after 12 weeks of treatment with anti-inflammatory dose doxycycline plus adapalene 0.3% and benzoyl peroxide 2.5% gel 7
• Another study found that mean inflammatory lesion counts were significantly reduced from baseline to the end of the study (mean percent reduction, 66.2%) after 12 weeks of treatment with 0.3% adapalene and 2.5% benzoyl peroxide gel and oral doxycycline 100 mg twice daily 8

Safety and Tolerability

• Adapalene-BPO was well tolerated, with the mean scores of dryness, erythema, scaling and stinging/burning less than 1 (mild) at all study visits 5
• Treatment with anti-inflammatory dose doxycycline plus combination adapalene 0.3% and benzoyl peroxide 2.5% gel was well-tolerated with no serious treatment-related adverse events 7
• The combination of 0.3% adapalene and 2.5% benzoyl peroxide gel and oral doxycycline 100 mg twice daily was found to be safe and effective for management of severe inflammatory acne 8