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Helping Teens Cope with Problem Acne

By: Steven Donaldson CAE


Helping Teens Cope with Problem Acne

Steven Donaldson, LPC, CAE

For those of us who suffered from moderate to severe acne during our adolescence, it is easy to grasp the idea that acne is traumatizing to young people. My own memories included fearing how ugly white heads were, and spending hours in front of the mirror extracting them, hoping none would emerge while I was at school.  I remember trying scrubs and special brushes, skin drying astringents, and prescription Retinol.  None of them worked, especially for the deep acne cysts.  My parents did not want me on long-term antibiotics, nor did they want to risk the side effects of Accutane. The long and short is that I felt ugly, unacceptable, and embarrassed.  And I had no solution.

Studies indicate that my experience was not unique.  Adolescent acne is not uncommon.  Prevalence rates are estimated to be as high as 85%.   S. Zahra Ghodsi, et. al. (2009) found that 14% of students assessed to have moderate to severe acne. Lauren K Dunn, et al. (2011) concluded that the presence of acne can negatively affect quality of life, self-esteem, and mood in adolescents. Acne is associated with an increased incidence of anxiety, depression, and suicidal ideation.

One of the complications for children with problem acne is emotional isolation.  Adults typically do not approach teens about their acne. Educators, aunts and uncles, pastors, and coaches seldom, if ever ask kids about their experience being an acne sufferer.  Many children do not even have a parent who will help them with treatment. The reasons for this are likely multi-dimensional. Caring adults don’t want to comment fearing it could embarrass them.  In addition, there have not very many good solutions for acne.  It is difficult to talk to a hurting person if you do not feel you have anything to offer.  This leaves the teen isolated, with no one to offer emotional support, problem-solving and reassurance.  We as professionals should find ways to bring up the topic with young people we work with.  One of the bedrock principles of counseling is, “talking helps.”  

It is also helpful to know something about what can be done about acne.  Young people often feel responsible for their acne.  This makes the problem worse.  It is important for young people to know that acne is not a short-term condition, that it is not caused by dirty skin, diet has little to no effect on acne, scrubbings you skin multiple times a day will not get rid of acne and that genetics can play a role in whether you develop acne and how severe it is.  This information is often very helpful to teens in decreasing shame and having accurate information.  

Treatments for acne have been difficult either due to low efficacy or the potential for dangerous and annoying side effects.  Topicals such as Benzoyl peroxide or topical retinoids can be very helpful for surface level acne but do not reach cystic acne below the surface.  Oral antibiotics and proven to be helpful but risk antibiotic resistance.  They also may require multiple courses.  Isotretinoin (Accutane) does do well in targeting cystic acne but affects many systems and can be dangerous to a young person’s health.  It also causes systemic drying causing hair to dry, lips and skin to chap and mood problems.  Aesthetic skin lasers have been very good at decreasing acne pustules.  They however must be used often to maintain results.  A very new treatment on the market is called AviClear.  It is a different type of laser that specifically targets and down regulates the sebaceous glands.  In this way it functions very much the same as Accutane but without any of the negative side effects.  This is a very new treatment, so it is not widely available.  It is not yet covered by insurance.  The very good news is that it only requires 3 30-minute treatments and the result appear to be very long lasting.  The treatment is so new that outcome data is still limited, however results are demonstrating that at 3 years after treatment results have been maintained or even improved.  

Conclusion:  Acne in adolescents affect more than just their skin. Psychological and emotional impact are prevalent and can be severe.  Complicating this problem is the lack of connection with helpful adults who can provide emotional support, accurate information and problem solving.  Educators, coaches, relatives and parents would do well to find ways to broch the subject and help young people talk about their experience with acne.

About the author: Steven Donaldson is a Licensed Professional Counselor who has worked extensively with adolescent clients in hospital, residential and out-patient settings.  He is also a Certified Advanced Aesthetician who is part owner of RejuvaMed Skin & Body in Tigard, Oregon.

S Zahra Ghodsi 1, Helmut Orawa, Christos C Zouboulis, J Invest Dermatol. 2009 Sep;129(9):2136-41.

Dunn, Lauren K;O'Neill, Jenna L;Feldman, Steven R, Acne in Adolescents: Quality of life, self-esteem, mood, and psychological disorders, eScholarship, UC Davis Dermatology Online Journal Volume 17, Issue 1.

For more information about acne treatments including laser treatments, AviClear and scare revision, go to: and  

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.