Treating Hard to Control Acne

After you get past getting your teen to use an acne medicine every day, there are many option for treating hard to control acne.

Does your teen or pre-teen have acne?

Does he want to get it under control? Will he actually follow a daily regimen your pediatrician prescribes?

Acne Treatments for Kids

While treating your child’s acne on you own with an over-the-counter product can be a good way to start, there are so many products, you do want to make sure you are using the right ones. In general, you should likely start with:

  • products with benzoyl peroxide (BP), which might include OTC 5-10% BP wash for your child’s back or chest
  • a gentle, soap free, pH-balanced cleanser to wash your child’s face twice a day or a salicylic acid cleanser
  • a facial toner, only if necessary to remove excess oil or makeup

When those regimens aren’t working, your pediatrician can prescribe stronger acne medicines, usually in a step-wise fashion, including:

  • a topical retinoid –  Tretinoin (Retin A), Adapalene (Differin), or Tazarotene (Tazorac)
  • a combination topical product – BP/clindamycin (BenzaClin), BP/adapalene (Epiduo), BP/erythromycin (Benzamycin),  tretinoin/clindamycin (Ziana)
  • oral antibiotics – doxycycline, monocycline, tetracycline

If your child isn’t tolerating these medicines, like if it is causing his skin to become dry, make sure he is also using a moisturizer and washing with a mild soap substitute, like Dove. Starting with the lowest strength medicine can also be helpful, perhaps even just using topical medicines every other day until your child gets used to them.

Treating Hard to Control Acne

What do you do if your child’s acne isn’t getting better?

Ask yourself these questions and discuss the answers with your pediatrician:

  • Has your child started puberty yet? If not, talk to your pediatrician or a pediatric endocrinologist to see why he or she has such bad acne.
  • Are you avoiding picking up an acne prescription because of the cost? Ask your pediatrician about lower cost alternatives.
  • Is your child really using his acne medicines each day?
  • Is your child correctly using his acne medicines each day, avoiding spot treating problem spots and using a pea-size amount of cream or ointment to cover his whole face? Teach her to use the 5-dot method of applying acne cream – with a small pea-size amount of cream, place dots of the cream on their forehead (1), cheeks (2, 3), nose (4), and chin (5). Rub the cream in until, keeping in mind that they are using too much if you can see or feel any left over cream.
  • What kind of acne does your child have? Comedonal (whiteheads and blackheads) and inflammatory acne (classic zits or pimples) are treated differently.
  • Does your child frequently touch or rub his face, which can make acne worse?
  • If using makeup, is it oil-free and noncomedogenic?
  • Is your child overdoing washing, using a harsh soap or astringent, thinking that dirt is making her acne worse?
  • Does your child use a non-comedogenic sunscreen, remembering that a sunburn will make her acne worse in the long run?
  • Does your child have severe acne, which should probably be treated with a combination of oral antibiotics plus topical retinoids with BP, with or without topical antibiotics?
  • Did you give the medicines enough time to work or have a relapse because you stopped them too soon? Acne often worsens before it gets better and oral antibiotics are often continued for months and months,  with a goal of being tapered and stopped after about three to six months.
  • Does your child need a step-up in therapy? Ask your pediatrician if you need to add on a new medicine, switch to a combination product, or move to a higher strength product.
  • Have you considered adding hormonal therapy (combination oral contraceptives) for your pubertal daughter with severe acne, such as Ortho-Tri-Cyclen, Estrostep, or Yaz?

Lastly, even with worry about possible side effects, oral isotretinoin (Accutane, Amnesteem, Sotret, and Claravis) is still a good option for teens with severe, refractory, and scarring acne. At this point, and perhaps even before, an evaluation by a dermatologist would be a good idea.

What To Know About Treating Hard to Control Acne

There are no quick fixes for acne, but your pediatrician can offer you a step-by-step regimen of topical and oral acne treatments.

More Information On Treating Hard to Control Acne

Last Updated on May 16, 2020 by Vincent Iannelli, MD

Author: Vincent Iannelli, MD

Vincent Iannelli, MD

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