What is acne in a child?

Acne is a disorder of the hair follicles and sebaceous glands. Hair follicles are the areas around the base or root of each hair. Sebaceous glands are the tiny glands that release oil (sebum) into the hair follicles. The sebum moistens the skin and hair. The sebum and hair get to the skin surface through tiny holes called pores. 

Acne is very common. Most children and young adults between ages 11 and 30 will have acne at some point. Acne most often begins in puberty. But it can happen at any age. There are different types of acne that affect newborns, infants, younger children, and adults. 

Acne may occur when the pores get clogged with dead skin cells and oil. Bacteria that are normally on the skin may also get into the clogged pore. Acne comes in several types. One type is a comedone. This is a plug of sebum in the hair follicle. They are either closed whiteheads or open blackheads. These are not inflamed or infected.

Inflamed acne causes red, painful bumps or sores. The sores may be infected with bacteria. This type of acne includes:

• Pustule. Bacteria cause the hair follicle to be inflamed. Pustules are closer to the skin surface.

• Papule. The wall of the hair follicle gets irritated. Papules are deeper in the skin.

• Nodule. These are larger, deeper, and more solid.

• Cyst. This is a nodule with pus.

What causes acne in a child?

The cause of acne is not fully understood. Acne is linked with:

• Hormonal changes during puberty, pregnancy, and the menstrual cycle

• Rising levels of male sex hormones (androgens) in both boys and girls during puberty that causes more sebum and more dead skin cells

• Using makeup or cosmetics that block the pores

• Using certain products to wash the skin

• Wearing clothes that rub or irritate the skin

• High levels of moisture in the air (humidity) and sweating

• Taking certain medicines, such as corticosteroids and seizure medicines    

Which children are at risk for acne?

Being a teen is the greatest risk factor for acne. A family history also increases the risk for severe acne.

What are the symptoms of acne in a child?

Acne can occur anywhere on the body. It is most common in areas where there are more sebaceous glands, such as:

• Face

• Chest

• Upper back

• Shoulders

• Neck

Symptoms can occur a bit differently in each child. They can include:

• Small bumps that are skin-colored or white (whiteheads)

• Small bumps that are dark in color (blackheads)

• Red, pus-filled pimples that may hurt

• Solid, raised bumps (nodules)

• Darker areas of skin

• Scarring

The symptoms of acne can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

How is acne diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. The provider will look at the areas of the body with acne. The provider may advise that your child see a healthcare provider who specializes in skin care (dermatologist).

How is acne treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. The goal of acne treatment is to improve the skins appearance and to lessen the chance of scarring. Treatment for acne will include gentle, regular skin care. Your child's healthcare provider may advise:

• Nonprescription cleansers and creams, lotions, gels, or other products

• Prescriptions that are put on the skin (topical) or taken by mouth (oral)

• Other therapies or procedures, such as laser therapy, light therapy, or chemical peels

• Draining of a cyst or injecting it with medicine

Topical medicines are often prescribed to treat acne. These can be in the form of a cream, gel, lotion, or liquid. These may include:

• Benzoyl peroxide. This kills bacteria.

• Antibiotics. These help stop or slow down the growth of bacteria. They also reduce inflammation.

• Retinoids. These stop new comedones from forming. They also encourage new skin cell growth and unplug pimples.

Medicines to take by mouth may be prescribed, such as:

• Antibiotic medicines. These may include tetracycline, doxycycline, or erythromycin. They are used to treat moderate to severe acne. 

• Isotretinoin. This may be prescribed for severe acne that can’t be treated by other methods. It helps to prevent new acne and scarring. Talk with your healthcare provider about the possible side effects of this medicine.

• Hormonal treatments. Girls may be treated with birth control or other medicines that help block testosterone (spironolactone).

All treatments for acne take weeks to months to start working. Be patient!

What are possible complications of acne in a child?

Acne can cause problems with self-esteem. It may cause emotional problems. It may result in depression, anxiety, and even suicidal thoughts. Severe or long-term acne may cause scarring. Serious infections may also develop.

Helping a child live with acne

Acne can be a long-term condition. Early treatment can help to prevent or lessen severe acne. Help your child by:

• Reminding your child to not pick, pop, or squeeze acne, which can spread infection and cause scars

• Talking with your child's healthcare provider if over-the-counter treatments don’t work well

• Being aware of your child’s emotional response to the acne. Get counseling for your child if they don't seem to be able to cope with the condition.

• Considering taking your child to a dermatologist for long-term or severe acne

• Making sure your child stops acne treatment slowly, not quickly, once acne clears

• Having your child treat acne a few times a week to prevent it from returning, if needed

• Making sure your child does skin care regularly and gently

When should I call my child's healthcare provider?

Call your child's healthcare provider if: 

• Your child is upset by their acne

• The acne is getting worse

• Over-the-counter treatments are not working

Key points about acne in a child

• Acne is a disorder of the hair follicles and sebaceous glands.

• Acne may happen when the pores get clogged with dead skin cells and oil. Bacteria that are normally on the skin may also get into the clogged pore.

• Most teens and young adults between 11 and 30 years old will have acne at some point.

• Both over-the-counter and prescription medicines are available to treat acne.

• Acne can have an emotional effect. This can lead to depression, anxiety, and even suicidal thoughts.

• Scarring can result from severe or long-term acne.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.