Acne Attack Plan

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Somewhere between 10-14 years old is the onset of an acne attack. Here’s a guide on how to fight back. Well, if your teen cares. Wait until your teen is motivated to address the pimples, because otherwise you are just wasting your money buying products that will just clutter precious counter space in the bathroom, and wasting your breath reminding your teen to use them. If a teen is not interested in using acne creams or washing their face, I stop. I let them have control over this. Their face. Their choice. But when they are ready, scroll down for a printable pocket guide for them to keep track of their skin care routine.

So when they choose to fight back, the options seem endless, but don’t despair and don’t buy the most expensive products. In the plan below, I’ve only chosen inexpensive products with evidence-based ingredients.  Many factors cause acne (though greasy food is not one), so the plan starts out simple but gets a little more involved with possible prescription options and tips on how lifestyle and dietary changes can also affect acne, so please read to the end. And of note, if there is no acne, I recommend washing face and moisturizing twice a day with mild products such as Cetaphil or Dove

So here is the strategy: Face wash twice a day. Moisturize with a non-comedogenic (none pore-clogging) lotion. At night, apply Differin (click on the link to see the price and compare with what your copay might be as a prescription) which contains adapalene 0.1% gel. Purchase the 45-gram option since this fights all types of acne and reduces scarring. Wait 10-15 minutes between applying moisturizer and the medicated gel. This routine will help almost everyone with acne. *Do not use Differin gel or any other Vitamin A product such as Tretinoin if you are pregnant or planning on getting pregnant.

In addition, there are different types of acne which require different ingredients to look for in the face wash and moisturizer and perhaps more medication (applied on skin or taken by mouth). Give each regimen 2-3 months because sometimes these products accelerate acne maturation in order to eliminate it, making it worse, before it gets better.

  1. acne2Mild acne with just white heads and/or black heads and the occasional pimple,
  2. Moderate acne with more pimples and redness.
    • Use a face wash containing benzoyl peroxide, and keep in mind that in this case more is not better and may be more drying.  Benzoyl peroxide 2.5% has been found to be just as effective as 10% treatments. AcneFree Oil-Free Acne Cleanser contains both benzoyl peroxide 2.5% and citric acid, which also helps skin regeneration and healing.
    • Moisturize with a lotion containing salicylic acid, see above for recommended products.
    • Apply Differin gel before bed every night
    • If the acne is not improving after 2-3 months, call the pediatrician for an appointment for further evaluation. Prescription options may include clindamycin (antibiotic) gel, or some of the treatments below.
  3. Severe acne with pimples all over the face and discolored scarring.
    • Call the pediatrician for an appointment, because an oral medication such as birth control (post coming soon on this) for girls (check out this website for more information on options)  or an antibiotic pill such as doxycycline for boys.
    • Start the moderate acne treatment plan while waiting for your appointment.
    • The next step after this may be a referral to the dermatologist.
  4. If the face gets dry, swap out the acne face wash for a milder option such as Cetaphil. Avoid face wash scrub exfoliators because this can further irritate and inflame the skin, making the acne worse.
  5. At any point if you are concerned, or if the acne is moderate or severe, please make an appointment with the pediatrician who may also check labs or evaluate your child further for medical conditions that may be associated with acne.


Lifestyle changes that may help with acne or just help with health, energy, and mood, include not picking at the pimples, not touching your face, exercising 30-60 minutes most days of the week, getting 8-9 hours of sleep every night, eating a diet with plenty of fruits and vegetables and omega 3 fatty acids (commonly found in fish but also in canola oil, flaxseed, walnuts, soybeans, and eggs) (1), and staying hydrated with lots of water. Drinking less milk (2) and switching to whole milk may decrease acne (3), but make sure the diet still includes enough vitamin D and calcium from other sources (post on diet to come soon… like in the next 6 months).

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Mostly from UpToDate and also…
1. Bowe WP, et al. J Am Acad Dermatol 2010
2. Adebamowo CA, et al. J Am Acad Dermatol 2005
3. LaRosa CL et al. J Am Acad Dermatol 2016

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