“Although acne is “merely” a superficial skin disease, it’s possible that it causes teenagers more misery than all other diseases combined. Developing sometimes when kids are as young as 11, and lasting into early adulthood, chronic skin problems wear on on the fragile self-esteem and mood common among adolescents. And if a serious case of acne develops, the consequences could include scars – and feelings of being unattractive – that last a lifetime.”

Two years ago, we wrote about how parents can help their children deal with skin conditions. Since then, new perspectives and approaches have come to our attention, and we’d like to share them with you.

What Causes Acne?

First, a little background. Acne results mainly from several factors: sex hormones (particularly testosterone) that rise with puberty, foods that affect those hormones, bacteria swarming in pores, and cleanliness of the skin.

Because the causes of acne vary from child to child, different kids respond to different treatments, so you may need to experiment with various methods. Ask your pediatrician for advice, and perhaps get a referral to a dermatologist. Meanwhile, consider the suggestions below.

A Word of Caution

The evidence is mounting that some conventional acne treatments have significant downsides. Most topical acne treatment – applied directly to the skin – is safe, both over the counter remedies and prescription medications. But oral medications have genuine risks; in the short-term they can seem like miracle cures, but they often have hidden consequences that last for decades or more.

The most common oral treatment for acne is prescription antibiotics. These are usually given for a minimum of 4- 6 weeks, and frequently much longer. (For instance, Jan took oral antibiotics continuously for about ten years, from 13 to 23.) In addition to creating antibiotic-resistant bacteria, antibiotics also kill beneficial bacteria in the intestines. This can lead to long-lasting bowel problems, particular if antibiotics are given over a lengthy period. While taking acidopholus bacteria in one form or another can compensate somewhat for the harmful effects of antibiotics, that’s usually inadequate to rebalance the intestines completely. Further, severe acne is often treated with Acutane, whose known potential side effects include depression and birth defects.

The other common oral treatment for acne is birth control pills for girls. Apart from any consideration that such a practice might promote sexual activity in some cases, a reasonable person would have concerns about artificially regulating a girl’s hormonal cycles at a vulnerable and young age.

Healthy, Clean Skin

Clear skin begins with clean skin. In addition to the benefits for personal hygiene, a daily shower is an opportunity for a daily shampoo, which will help keep skin clean. As to washing the face itself, there are many acne soaps available with different characteristics, and you should experiment to find the ones that work best for your child’s individual complexion.

Next, over-the-counter topical treatments are usually helpful. Benzyl-peroxide is a key ingredient found in many creams. Ironically, the lower concentration of 2.5% could be more effective than the more concentrated level (10%) found in most creams. 2.5% concentrations are found in Proactive products and in BP (which is less expensive and can be ordered at www.Acne.org). 10% concentrations are found in Clearasil and most over-the-counter creams.

A problem with benzyl-peroxide is that it is drying, necissitating a mointurizer. Also, since it contains peroxide, it will bleach any fabrics it touches, from bathroom towels to shirt collars, so be careful.

Topically, a fabulous natural supplement is vitamin B-3 (niacinamide) in a 4% or 5% lotion. You can get this is by prescription, but it’s also available as an over-the-counter product called Acnicure Lotion, found at www.acnemiracle.com. This product is not drying, and our kids like it a lot. It can be combined with other topical products, too.

If you consult a dermatologist, he or she may prescribe prescription topical antibiotics, such as clindamycin or vitamin A creams. These topical preparations work fine, with few risks.

Overall, the key is to balance how well various washes and creams clear the skin versus how much they dry and irritate it. You’ll just have to experiment – and keep in mind that other factors such as diet or hormonal ups and downs can affect the apparent results of topical treatments, and thus muddy the waters of your experiment. Hmm, one more complication in raising teenagers!

Nutritional Supplements

The number 1 natural treatment for acne is zinc. This mineral is critical for both hormone development (particularly testosterone) and for skin health, but if shortages of zinc make the body have to choose between reproduction and beauty, it will pick reproduction every time! White spots on the fingernails indicate zinc deficiency, but even without this sign your teenager could still benefit from zinc. Some studies have shown 50 mg. of zinc to be as effective as oral antibiotics for acne. Start with 50 mg. of zinc citrate per day. Try that for a month; if the results seem minimal, you could try 100 mg./day.

The second most important nutritional supplement for acne is fish oil. The essential fatty acids in fish oil make skin healthy and beautiful. Always use a molecularly distilled fish oil, because many fish these days unfortunately carry unhealthy loads of heavy metals and other toxins that must be purified. Most people take fish oil in capsules, but make sure your teenager is taking enough each day to get about 600 mg. of E.P.A., a long chain molecule which will be listed on the label.

Next, a product called Acnease is a blend of Chinese herbs that we’ve seen produce striking results. You can find it at the website, www. Acnease.com, and follow the directions there for its use. It’s an aggressive (and somewhat expensive) formulation that is safer than oral antibiotics, but it still has the potential for somewhat imbalancing the digestive tract. So, we suggest trying this product when other ones have not done the job completely.

Some other nutrients can also help a lot:

•  Vitamin E, 400 international units (IU) per day

•  Vitamin A, 25,000 IU/day. But if a girl might become pregnant, she should take no more than 5000 IU/day because of the risk of birth defects.

•  Vitamin B6 – Some girls experience a premenstrual aggravation of acne, and in these cases, 25 mg of B6 taken three times a day can help metabolize (and thus eliminate) the upsurge of hormones at that time of month.

•  Chromium, 200-400 micrograms (mcg) a day

•  Selenium, 200 mcg/day

Finally, keep in mind that your child may have to take nutritional supplements for several months for their beneficial effects to really take hold since it can take that long for the body to absorb enough to get up to effective levels.

Eating Smart

As with other aspects of treating acne, some kids will get more benefit from dietary changes than others.

Dairy products – milk, cheese, yogurt, ice cream, etc. – are usually the most problematic foods. If your teenager can totally avoid these for a couple of weeks, you’ll see if these make a significant difference.

High amounts of insulin can increase acne, so reducing sugar and white flour products – which raise insulin levels – will often help. Avoid foods with trans-fatty acids, such as fried foods, margarine, and synthetically hydrogenated vegetable oils. Lower salt intake, especially if it has been “iodized.” And then, there are people who simply cannot go near chocolate. Alas!

The Big Picture

In closing, here’s the boring but important parental lecture that all teens will shrug off to your face – but may remember quietly to themselves in their darkest moments: “You’re a great person no matter what your skin looks like. Besides, you look really fine anyway. In the long run, what matters most is being a good person, treating others well, showing up in life, and trying your best. You’re all those things already, so you’re sure to succeed in life and be happy. And we completely love and support you.”

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This is an article adapted from the book Mother Nurture (2002) by Rick Hanson, Ph.D., Jan Hanson, M.S. and Ricki Pollycove, M.D.