If a sufficient length of time has gone by and they do not improve, I’ll boost up the adapalene and benzoyl peroxide to twice a day. If they have popular lesions, I might switch the antibiotic, too.Differences between Teen and Adult Skino Teenage skin tends to be oilier than adult skin because the surge of hormones during adolescence accelerates the production of sebum.o Dehydroepiandrosterone sulfate, testosterone, and dehydrotestosterone stimulate the sebaceous gland during adolescence, which is why oily skin is a special concern of teenagers.o The constant flux of hormones results in acne that can rapidly change in degree of intensity.o Hormonal changes influence the quality of the patient’s acne, which in turn affects response to therapy.o Teenagers are more susceptible to acne mechanica, because of friction from sports equipment.Tailoring Therapyo A patient who presents with mild, comedonal acne may respond well to first-line acne treatments, such as topical retinoid with benzoyl peroxide and an oral antibiotic, but hormonal shifts could interfere with this therapy’s effectiveness.o Dr Jan Hornets recommends waiting for a minimum of 6 weeks before altering any acne therapy, and then doing so by changing the dosage or type of only one medication at a time.o His first-line therapy is a topical retinoid, such as adapalene (Differin®), during the day and benzoyl peroxide at night.o If acne is more severe or fails to improve, he recommends using adapalene and benzoyl peroxide simultaneously twice a day.o When used together, benzoyl peroxide should be applied first, with adapalene on top, since this retinoid does not destabilize in sunlight.What Teens Prefer in Acne Therapyo Ease of use is primary.o A combination of a topical retinoid and benzoyl peroxide is Dr Jan Hornets’s first-line choice for this age group.o Gels are preferable to lotions; they help absorb excess sebum, and their texture is more acceptable to teenage boys.o Adding an oral antibiotic to standard topical treatment can help speed up improvement. The antibiotic should be discontinued once the skin clears.o For teens on isotretinoin, both doses can be given simultaneously to minimize confusion and missed doses.Hormonal Therapy in Teenagerso Teenage girls who request oral contraceptives from their dermatologist should be referred to a gynecologist if they have not yet consulted one.o Girls whose acne flares before the start of their menstrual cycle are ideal candidates for hormonal therapy.Avoiding Bad Habitso Noncompliance is the worst habit among teenagers, though most will adhere to therapy.o Sun exposure may be a problem if the teen is using an older topical retinoid, such as Retin-A. Switching to adapalene, which is not photosensitive, may be a better choice.o Sugar and junk food do not appear to exacerbate acne.Hyperpigmentation and Scarringo Teenagers need to understand that picking at acne causes scars and that scars are permanent.o In dark-skinned patients, even those who do not manipulate their lesions may develop areas of hyperpigmentation.o Hyperpigmentation can be treated with a combination of a topical retinoid and hydroquinone.Self-Treatmento Teens are particularly susceptible to acne remedies offered on TV, over the counter, or in health food stores.o If the teen prefers, most of these remedies can be continued even while on conventional therapy.Developing Rapporto It is paramount that the patients trust the dermatologist to be sensitive and confidential.o Information gleaned from interviews with teenagers should not be shared with parents.o Expressing interest in the teen as an individual helps establish a good relationship.Source: Free Articles from ArticlesFactory.com
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