Adolescent Acne: A Stepwise Approach to Management

Iris Woodard, BSN, ANP


Topics in Advanced Practice Nursing eJournal. 2002;2(2) 

In This Article

Abstract and Introduction


Acne is a common problem that affects about 90% of teenagers. It occurs during a time of low self-esteem and high concern about appearance. There are many acne products on the market, and making an appropriate selection can be daunting. But a simple step-wise approach to the selection of medications can remove much of the confusion. This article will discuss the etiology and pathology of acne, over-the-counter (OTC) and prescription medications used in the management of the disease, and some quick tips and teaching points for the patient.


It is estimated that about 45 million Americans have acne vulgaris. It is a disease of both adults and adolescents (Figure 1). In this article, the focus will be on the adolescent, but many of the comments about treatment apply to all age groups. Approximately 90% of all teens are affected by acne to some extent.[1] In girls, acne can precede menarche by more than 1 year.

Figure 1.

Reproduced from WebMD Scientific American® Medicine, an online, continually updated adult primary care reference text, available by subscription. To learn more click here.

The impact of acne may appear minimal to an observer but may be significant to the young person involved. There may be psychological effects as well. Adolescence is a time of low self-esteem, high peer pressure, rebellion against authority, and struggles to establish independence. The young person who has concerns about appearance will frequently choose to miss school, work, or social events, thus increasing feelings of depression and isolation.[2] Kellett and Gawkrodger[3] found that acne patients reported levels of social, psychological, and emotional problems as great as those reported by patients with chronic disabling asthma, epilepsy, diabetes, back pain, or arthritis. This study also reported that the impact on quality of life did not correlate with acne severity.[3]

Consumers of all ages spend approximately $100 million per year on OTC remedies for acne.[1] A study conducted in 2000 indicated that 75% of patients waited about 1 year before seeking professional help for acne. Nonprescription products tried most frequently were medicated cleansers, pads, and lotions. Acne was believed to be curable by 49% of those surveyed, and they anticipated that the duration of treatment would be less than 6 months.[4]

Teens obtain much false information about healthcare and proper treatment from friends and popular magazines. They do not understand that acne is a chronic problem and that therapy might be required intermittently for months, even years. Teens are especially impatient and should be informed about realistic expectations for improvement. They must be encouraged to continue therapy even if they feel that nothing is happening. Providing correct information will empower teens to make better choices and begin assuming responsibility for their own health care (Table 1).


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