My D24 has had sporadic significant acne all summer–not the kind that they give accutane for (where most of the pores look affected), but the “significant blemishes emerging and fading” kind. About six weeks ago, I took her to the dermatologist, and they prescribed the usual course of treatment (topical antibiotic, retinoin, along with her regular skin care regimen). It hasn’t fixed the problem. I am frustrated, because she is! She’s beside herself. She has sorority recruitment in about 18 days, and her skin is not so reactive that it shouldn’t be treatable. I already asked them over text about the possibility of getting injections at the last minute. She has a telehealth appointment in two days. Do I just have to play the mean mom, to advocate for her, since she can’t tell outsiders about her feelings of desperation and low self-esteem? Any advice appreciated.
As a lifelong acne sufferer- I don’t think 6 weeks is adequate for the regime to work and for her to see significant changes. You could find a dermatologist who will prescribe some type of hormone treatment, but there are lots and lots of downsides to that so I think it’s typically a last resort for very severe acne and for people who can’t take accutane.
The only thing that worked for me on a six week timeframe was during my pregnancies- in fact, I knew I was pregnant with my second (even before I got tested) when my skin started to clear up on its own.
Maybe a trip to get a facial (most spas have the “acne sufferer” version) which may lessen the “look” and make her feel better? And then a visit to a department store counter for a lesson in how to use makeup for the best results? I am a Clinique user-- their reps are usually very good at recommending the right product and showing you how to apply it (they use MUCH less foundation than most people use on their own but they use high end brushes and sponges to apply it for maximum coverage). They have two product lines specifically for problem skin- Redness Solutions for rosacea and bad acne scars, and a special Acne line. I alternate…there is a yellowish pressed powder in the Redness Solutions line which gives a nice light sheen and seems to hid a lot without being icky and heavy.
Hugs to your D. Good luck–
So there is a lot to do. injections only work for very large inflammatory acne lesions and take a while to help. Oral antibiotics and hormone management can work but it is unlikely that she will have clear skin in 18 days. If the acne is a self esteem issue she could get accutane for moderate symptoms, but that takes a while to help and it will get much much worse first. My suggestion is to have her change the telehealth appointment to in person as a start
I recently came across pimple patches on social media, and many reviewers claim they’re very effective—some even say they can “suck” a pimple dry overnight.
I know some dermatologists may inject a tiny bit of steriod into a big zit and the zit does shrink after a day or two. Has your daughter been treated that way?
My D had acne that was triggered by hormones (accutane doesn’t work for that). The only thing that worked for her was (in addition to topicals) low dose birth control plus spirinolactone. She tried antibiotics, which often work for the kind of acne she had, but she discovered that she is allergic to that class of antibiotics.
I hope your D finds something that works for her. Acne is such a struggle - my family had it bad as young adults, and my kids inherited it from me.
As an aside, I think accutane is a miracle drug … if it had been around when my older brother struggled with cystic acne, it would have been a life changing thing for him … and two of my brothers + my son took it with great success … but I would never recommend it for moderate symptoms or for a short term fix. It takes several months to work, it has very serious side effects, and it requires blood draws to monitor for side effects.
That’s what I’m going to aim for (the injections)–and I have no problems with going to the cosmetic side of their practice so there isn’t the wait. That’s why originally all we could get was telehealth–because the scheduler was insistent that we should talk to one of their regular doctors before we go to the cosmetic side. It’s not the accutane style of problem. I’m convinced it’s hormonal and stress-produced. Her skin is smooth except where the blemishes come, and they are those classic cysts below the skin (not just inflammation at the surface). I had the same kind, but more severe, in my mid-20s while in grad school. They didn’t need to use accutane–they prescribed early versions of retinoin. Thanks for all the advice, everybody. I’ll do the best I can.
Thanks–she’s on birth control, so we’ve got that hormonal thing under control, at least. She’s not going to go off them until after rush.
I don’t know if they still use spirinolactone, but my D needed that along with bc to finally improve.
Yes, the injections are very effective in treating cystic acne. Many years ago I had one that lasted forever, and after one little injection and it was gone within a couple of days. Good luck.
The skin’s natural turnover is more than 18 days. As such Tretinoin, topical antibiotics, or similar are unlikely to lead to improvement in 18 days. Treatments that focus on cleaning or unclogging pores are more likely to have a positive impact within this period such as over the counter products (benzoyl peroxide, salicylic acid), or just partially concealing with makeup before event.
I know this isn’t what your daughter wants to hear, but most kids are more sensitive to the appearance of their own acne than others. It’s not the end of the world. If it were my child, I wouldn’t support corticosteroid injections for what sounds like not severe acne. I’d instead focus more on why it is leading to “desperation and low self-esteem” and ways to improve that.
You might look into blue light therapy. She would either wear a mask or sit in front of a small panel. Blue light (at very specific wavelengths) has been shown to be very effective at “curing” acne issues…sometimes very quickly as it has a strong antibacterial effect.
Thanks, Data10. My daughter has great self-esteem for someone who had a serious eating disorder a couple of years ago, and still battles those issues (as many do who have recovered from anorexia). As I’ve said elsewhere, she has depression and copes with it–takes meds, works out. Most of the time she’s happy or coping. But I firmly believe that the doctors can help her with this issue before her “big event”–a couple of spots on her face is not a big deal, but to have made no progress on cystic acne when I told her they could help her is not acceptable. She has enough on her plate without this issue.
@Data10 as someone who had a kid who had significant acne, I can say with certainty, this can be a BIG issue for some kids. Unless you have a kid who has dealt with this, I think it’s hard to describe the feelings they have.
Both of our kids are confident kids, but their skin issues caused them a lot of distress.
One of my kids was a candidate for Accutane, and it was a game changer. He actually had to do two rounds of treatment but it made a huge difference in his self perception.
Second kid had every topical under the sun at one point or another. She was lucky that her derm found one that worked well. While hunting…the derm advised NOT to wear any kind of make up foundation. So the kid didn’t. Again, once the fix was determined, this kid felt much better.
To @Snowball2 I hope your derm comes up with a suggestion that works. I also would suggest getting an in person appt, if possible.
Things that finally worked for my daughter: spirinolactone, eating a very healthy diet ( no sugar) and facials at her dermatologist’s office- I think it was Diamondgow- it took a bit to get it under control. Stress was definitely a factor.
Good luck to your daughter.
For those who are on spironolactone should have their renal function monitored periodically. I know of a relative who was prescribed spironolactone as an adjunct treatment, and because it is a diuretic she did not actually require, her kidney parameters—BUN, creatinine, and eGFR—became significantly abnormal despite her being asymptomatic. The medication ultimately had to be discontinued.
I agree 100%.
I agree. BUT-- as a lifelong acne sufferer, I wish someone had told me when I was a teenager that it was a “condition to be managed” vs. an illness which could be cured with a pill, cream, UV light, more sun/no sun, clinical trial (which turned out to be accutane) etc.
There are kids lucky enough to have 4-5 bad years which then clears up and only the occasional pimple or cyst afterwards. And then a not insignificant number of adults who need to find a way to live with it long term. I’m in the “live with it long term” group but it took a LOT of cycling through miracle treatments which didn’t work, tried and true treatments which didn’t work, and a couple of heavy duty pharmaceutical interventions which had horrible side effects.
And any dermatologist who promises a 6 week “cure” for ANYTHING… Maybe temporary clearing up on a short timeframe, but NOT a cure. I think the kids suffering with low self esteem and self-consciousness with severe acne deserve to know the truth about how long all these protocols take.
I like all of your suggestions, just don’t recommend pregnancy for the teens 
despite the fact that it worked for many of us!
Yes, that’s an important point. My D was advised not to use it long term. Many of the treatments for serious acne have side effects that must be carefully monitored - my S actually had to stop accutane for six months right after he began on it because of a health concern (he was put on a lower dose and slowly ramped up when he started again).
As those of us who had very bad acne or who have kids who had very bad acne can attest, it is not a trivial thing. The side effects of treatment need to be weighed against the psychological effects of not properly treating it. And as with the topic of another thread, osteoporosis, the decision is personal and varies from individual to individual.
I didn’t say acne was not a big issue for some kids. I did say rather than supporting corticosteroid injections for what sounds like not severe acne, I’d instead focus more on why it is leading to “desperation and low self-esteem” and ways to improve that.
Corticosteroid injections are not a long term solution. Changing how one reacts to the acne can offer a long term improvement. The history of depression is all the more reason to consider the psychological side as well, rather than treat it as an emergency that we need to fix in the next 17 days. Structuring the problem in this way may increase the degree of negative feelings in the likely event that there is not a successful fix in 17 days.