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My teenage son has a severe case of acne. What are our options?

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The question

My teenage son has a severe case of acne. What are our options?

The answer

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Acne in a teenager is about as inevitable as getting a parking ticket---almost everyone has had to deal with it at least once in their lifetime.

If it is mild, the issue is more one of inconvenience: getting teased by peers; feeling self-conscious and deliberately avoiding social events such as a dance. (For images of various degrees of acne, see The Acne Guide)

When pores in the skin get clogged up due to sebum (fat) production, caused by hormones, acne results. The face, neck, shoulders, back and chest are common areas. The presence of bacteria cause inflammation, leading to pus formation, appearing as whiteheads, blackheads or even cysts or nodules (deep and painful acne)

The role of foods in causing acne remains controversial - some patients noted improvements when they ate less greasy foods, eliminated milk, chocolates or nuts. Exposure to sun as a way to treat acne remains a myth.

Gels and hairsprays may aggravate acne. Scrubbing the skin can make matters worse too.

Dermatologists discourage the picking or popping of acne.

Maintaining a diligent hygiene with mild soaps such as Cetaphil and using products such as 1% salicylic acid and 2.5% benzyl peroxide may help for most patients. A low dose of tetracycline antibiotics may also be of great help.

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Acne scars are unfortunate, because they are preventable by using medication. Acutane has been available since the 1980s. It has potential side effects, such a liver damage, dry skin, and increasing lipid levels - so if your son is prescribed Acutane, be sure to monitor the treatment and side effects closely.

Of course, the risks of the medication versus the benefits must be clearly understood by families. Pregnant patients must avoid Acutane completely.

For more information on acne treatment see

Send pediatrician Peter Nieman your questions at He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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