Dr Phil Kieran: Is my teenage daughter's acne due to a hormonal imbalance?

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Dr. Phil Kieran

GENERAL PRACTITIONER

My daughter, who is 13 years old, has acne. Her diet is good, and she drinks plenty of water. She got her first period three months ago, so a hormonal imbalance could be the cause. What treatment would you recommend?

Acne is often the first time young people seek medical attention after childhood. The condition can range from mild spottiness to large areas of skin coverage, with scars forming as the spot heals.

It usually starts in the early teens but can develop as young as seven. Acne mostly affects the face and upper body, with some areas affected more heavily than others depending on the individual. Increasing activity of the skin’s oil glands is the most common acne trigger and as we progress through puberty these changes are most pronounced.

Your daughter has just started having periods and it usually takes up to three years for her cycle to settle into a normal rhythm. During this time, hormone fluctuations can lead to large swings in the oil glands, causing the acne to flare up and die down unpredictably. A healthy diet, sufficient exercise (the target for a 13-year-old is a minimum of about 30 minutes but ideally about 60 minutes five days per week) and good hydration are changes she can make to reduce the frequency or severity of acne breakouts. Unfortunately, there is no surefire way to prevent acne from happening in your teens.

If the acne is relatively mild, over-the-counter acne preparations can help by reducing the clogging of the pores and the subsequent inflammation. These products often have an anti-bacterial effect, tackling a bacteria called Cutibacterium, and can help the skin to return to normal. However, it is essential to know that acne is not caused by poor hygiene and overwashing the skin can make it a lot worse.

If you have tried OTC treatments (give it six weeks to see if it works) and there is no improvement or it is causing severe distress, it is a good idea to see your GP. They may recommend prescription treatment such as a combined ointment with antibiotic and peroxide to clear blockages. This is often the first line of prescription treatment, particularly for someone younger.

Your daughter is unlikely to need blood tests as her current hormonal imbalance is caused by the rapidly changing levels associated with puberty and is not necessarily an abnormality. I usually explain to a patient that it can be a normal part of life and if not causing too much distress or any scarring it can be treated with milder treatments until the skin settles down.

For some people, the skin changes can be much more dramatic, and we would be inclined to treat more aggressively if there are signs of scarring. If this were the case, you would consider starting a course of antibiotic tablets (generally for a period of three months and then review).

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