Acne Treatment for Teenagers: A Dermatologist’s Guide

Teenage acne treatment in London

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By Dr Mary Sommerlad | Consultant Dermatologist, Dermasurge Harley Street

Teenage acne occupies an odd position. It is so common that it gets treated as a phase to be waited out, and simultaneously it is one of the most distressing things a teenager will deal with, at exactly the age when appearance and social standing feel inseparable. Parents are often caught between not wanting to make a fuss and watching their child cover their face with their hand in conversation.

Waiting it out has a cost. Acne that inflames for long enough can scar, and scarring is considerably harder to treat than the acne that caused it. The useful question is not whether teenage acne is normal, since it plainly is, but whether the treatment being used is actually working and how long it has been given to prove it.

Why acne happens in the teenage years

Puberty raises androgen levels in both boys and girls. Androgens enlarge the oil glands and increase sebum production, the lining of the follicle becomes stickier and blocks the pore, and a bacterium that lives normally on everybody’s skin, Cutibacterium acnes, multiplies in that blocked, oil-rich environment. Inflammation follows, which is what turns a blocked pore into a red or pus-filled spot.

Genetics has a strong influence. If both parents had significant acne, their children are considerably more likely to as well, and often follow a similar pattern and severity. That is worth knowing early, because a family history of scarring acne is a reason to treat sooner and more decisively rather than starting at the gentlest possible rung of the ladder.

Several things commonly blamed for acne matter less than people assume. Poor hygiene does not cause it, and over-washing makes it worse. Chocolate has no convincing evidence behind it, although high-glycaemic diets and, in some individuals, skimmed milk have modest associations. Sweat itself is not the problem, though occlusion from helmets, sports straps and prolonged mask wear can aggravate it locally.

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What acne actually looks like, and why the type matters

Treatment follows the type of lesion, so it is worth knowing the vocabulary.

• Comedones, meaning blackheads and whiteheads, are blocked pores without much inflammation. They respond best to treatments that normalise how the follicle sheds skin cells.
• Papules and pustules are the red bumps and pus-topped spots of inflammatory acne, and they need treatments that address inflammation and bacterial overgrowth as well as blockage.
• Nodules and cysts are deeper, painful, longer-lasting lumps. This is the type most associated with scarring, and it is the type that should reach a dermatologist early rather than late.
• Marks left behind divide into post-inflammatory pigmentation, which is a flat brown or purple stain that fades over months, and true scarring, which is a change in the skin’s texture and does not resolve on its own.

The distinction between marks and scars matters enormously to a worried teenager. Flat discolouration will fade. Indentations and raised areas will not. Explaining that clearly is often the most reassuring part of a consultation.

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What to try first, and how long to give it

Mild acne can be managed at home, provided the approach is consistent and given a fair trial. The most common reason over-the-counter treatment appears to fail is that it was abandoned after two weeks, applied only to individual spots, or stacked with three other products that irritated the skin.

A workable routine is short. A gentle non-foaming cleanser twice daily, an over-the-counter active such as benzoyl peroxide or a topical treatment containing salicylic acid applied to the whole affected area rather than dabbed onto spots, a light non-comedogenic moisturiser, and daily sun protection. Apply the active every night, expect some dryness in the first fortnight, and judge the result at eight to twelve weeks. Acne treatments work by preventing the next generation of spots, so improvement is always slower than a teenager wants.

Two habits undo good treatment. Squeezing deep lesions increases inflammation and is a genuine cause of scarring, and scrubbing damages the barrier and worsens irritation without touching the underlying process. Heavy occlusive make-up is fine in principle, provided products are non-comedogenic and removed properly.

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When teenage acne needs a dermatologist

Arrange a specialist assessment in any of the following situations.

• There are nodules or cysts, or the acne is painful and deep
• Scarring has already started, meaning indentations or raised areas rather than flat marks
• Two adequate courses of treatment, each given eight to twelve weeks, have not produced meaningful improvement
• The acne is on the chest and back as well as the face, or is widespread
• Dark marks are being left behind, which is more common and more persistent in richly pigmented skin
• The effect on mood, school attendance or social life is out of proportion to how the skin looks to everyone else
• In girls, acne alongside irregular periods, excess hair growth or scalp hair thinning, which may point to an underlying hormonal cause worth investigating

That last point about mood deserves emphasis. Distress is a legitimate clinical indication in acne, not a reason to feel that a consultation is an overreaction. Where acne is affecting a teenager’s confidence significantly, that alone justifies treating it properly.

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What specialist treatment adds

A consultant dermatologist has access to the full treatment ladder and, more importantly, the experience to judge which rung to start on rather than working slowly upward while scarring accumulates.

Topical retinoids are prescription vitamin A derivatives that address blockage, inflammation and pigmentation together. They are frequently the missing piece in a routine that is otherwise sensible, and they are used across most acne types.

Topical and oral antibiotics reduce inflammation and bacterial overgrowth. Current practice is to use them in combination with other agents rather than alone, and for defined periods rather than indefinitely, to limit antibiotic resistance.

Hormonal treatment is an option for some teenage girls whose acne is hormonally driven, discussed alongside the family and only where appropriate.

Oral retinoid treatment, prescribed by a consultant dermatologist for severe or scarring acne that has not responded to other treatment, is the most effective option available and carries the most significant monitoring requirements. It involves blood tests, careful counselling, and strict pregnancy prevention requirements for female patients. Our detailed article on severe acne and isotretinoin covers what the treatment involves in full.

Cosmetic and device-based treatments are not the answer for active acne in a teenager, and we do not offer cosmetic procedures to under-18s. Where scarring needs treating, that conversation happens once the acne is properly controlled and, in most cases, once the patient is older. Our acne scarring page explains the options that exist for adults.

Results vary from person to person, and an assessment with a consultant dermatologist is required to determine which treatment is appropriate.

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What happens at the consultation

The appointment covers when the acne started, what has been used and for how long, how the skin has responded, whether there is a family history, what the current routine looks like, and how the acne is affecting daily life. The skin is examined, including the chest and back where relevant, and the type and severity of lesions are recorded so that progress can be judged objectively at review rather than from memory.

For a teenage patient, the consultation is directed at them rather than over their head. Adherence is the single biggest determinant of whether acne treatment works, and a teenager who understands why they are applying something, and what will happen in the first few weeks, is far more likely to keep going. A parent is present, and older teenagers are often given part of the appointment on their own if they would prefer it.

You should leave with a written plan, a realistic timeline, and a review appointment. Acne treatment is judged over months.

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Why choose Dermasurge Clinic

Dermasurge is a consultant-led dermatology clinic on Harley Street where medical and cosmetic dermatology sit under one roof, with on-site M22, Q-switched and other laser platforms for the cases where they are appropriate.

Dr Mary Sommerlad is a consultant dermatologist on the GMC specialist register whose specialist interests include paediatric dermatology, skin of colour dermatology and inflammatory conditions of the face. She holds a Diploma in Child Health from the Royal College of Paediatrics and Child Health alongside her dermatology training. She practises alongside Dr Hiba Injibar, consultant dermatologist and founder of the clinic, who also treats both adults and children.

Acne in adolescence is treated here as a medical condition with a scarring risk, not as a cosmetic complaint, and the plan reflects that. You can read more about our children’s and adolescent service on our paediatric dermatology in London page, and about the clinic’s approach to acne at any age on our acne treatment in London page.

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Frequently asked questions

At what age should a teenager see a dermatologist about acne?

There is no set age. The trigger is the acne rather than the birthday: deep or painful lesions, any sign of scarring, dark marks being left behind, or a failure to improve after two properly conducted courses of treatment. Acne beginning before around the age of nine is a separate situation and is covered in our article on when childhood acne needs specialist treatment.

How long does acne treatment take to work?

Most treatments need eight to twelve weeks before their effect can be judged fairly, and some continue improving for several months after that. Skin sometimes appears worse in the first few weeks as existing blockages surface. Stopping early is the most common reason a treatment is wrongly labelled a failure.

Will my teenager be scarred?

Not necessarily. Scarring risk is highest with deep nodular or cystic acne, with acne left untreated for a long time, and with persistent squeezing. Treating effectively and early is the most reliable way to reduce that risk. Flat brown or purple marks left after spots settle are pigmentation rather than scarring and do fade, though it can take months.

Does diet cause teenage acne?

Diet is a minor factor at most. There is modest evidence linking high-glycaemic diets and, for some individuals, skimmed milk with acne severity, but no evidence that any single food causes it. Restrictive diets are not recommended for a growing teenager, and dietary change is not a substitute for treatment.

Is acne treated differently in brown or Black skin?

The acne is the same condition, but the pigmentation left behind is more prominent and longer lasting, and it is often what concerns the patient most. Treatment therefore starts sooner, addresses inflammation decisively to limit further marking, and includes management of the pigmentation itself. Our article on dermatology for skin of colour goes into more detail.

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Book a consultation

If your teenager’s acne is painful, is leaving marks or scars, or has not responded to what the pharmacy or the GP has suggested, an assessment with a consultant dermatologist will establish which treatment is appropriate and how quickly to escalate.

To arrange an appointment, book a consultation at Dermasurge Clinic. More about the clinic and the team is at dermasurge.co.uk.

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