Q: Should a 9-year-old boy have acne on his face? It strikes me as early. He seems normal in every other way.
A. Typically, acne begins during adolescence, and its appearance is felt, at least in part, to be related to the rapid hormonal changes that occur as a part of this process. Occasionally, mild acne can be seen in the immediate preadolescent years. Since normal boys in the United States can begin puberty as early as 9 or 10, the onset of acne in your son is likely a sign puberty is not far behind.
Our understanding of the causes of acne has increased dramatically in recent years. Diet and personal hygiene are no longer believed to play a significant role. Stress, however, can cause well-controlled acne to flare, and some women will notice their acne increases as they approach their menstrual period.
number of excellent topical (applied directly to the skin) treatments are available. Tretinoi acid (vitamin A acid) and benzoyl peroxide, formulated as creams, gels or liquids of varying potency, are the mainstays of therapy. Antibiotics by mouth now play a lesser role.
For patients with very severe, disfiguring cystic acne, an oraform of vitamin A acid is highly effective. This drug can cause serious harm to a developing fetus, however. For teen-age girls who are sexually active, very stringent precautions to prevent pregnancy must be taken.
Since acne often improves during the summer, medications can sometimes be decreased or discontinued then. The topical medications used to treat acne make the skin more sensitive to )) sun, so adolescents using such medications during the summer must take special care to prevent sunburn.
Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.