Acne in Teenagers
A guide for parents and teenagers. Why waiting it out costs more than treating it, what the myths get wrong, and how to build a routine that survives week two.
Part of the Complete Acne Guide.
Key fact: The advice to wait and let teenage acne pass is the reason a lot of adults have scars. Acne does usually resolve with age — but scarring is permanent, and it happens during the waiting.
Why it happens now
Puberty raises androgen levels, androgens enlarge the sebaceous glands, and the glands produce more oil. Combine that with the follicle lining shedding cells more stickily, and the pore blocks. It happens to most teenagers, to some degree, and it is a normal consequence of normal development rather than a sign that anything is wrong.
Acne typically starts between eleven and fourteen, often earlier in girls than boys, and frequently begins as blackheads and whiteheads across the forehead and nose before inflammatory spots appear. It usually peaks in the mid to late teens.
How severe it becomes is substantially inherited. If both parents had significant acne, a teenager is considerably more likely to, and more likely to have it for longer — which is useful to know early, because it argues for treating sooner.
The case against waiting
“They'll grow out of it” is usually true and frequently the wrong conclusion. Two things happen during the waiting.
Permanent
Scars left by untreated inflammatory acne
8–12 wks
Before any acne treatment can be judged
Peak years
When acne coincides with exams and self-consciousness
The first is straightforward: deep, inflamed spots left untreated for months cause scarring, and no treatment for established scarring is as good as not having caused it. The strongest predictor of acne scarring is how long active acne went untreated. Our guide to acne scars and marks covers which lesions scar and which do not.
The second is that acne peaks at exactly the age when appearance matters most, and the evidence on its psychological impact is not subtle.
What parents notice, and what it means
| What you see | What it suggests |
|---|---|
| Blackheads and whiteheads, no redness | Comedonal acne. Responds well to topical treatment and is the easiest stage to treat |
| Red, sore spots that come to a head | Inflammatory acne. Worth treating properly rather than with face wash alone |
| Deep, firm, painful lumps that last weeks | Nodular acne. This is the kind that scars. Get it assessed rather than managed at home |
| Marks left behind after spots heal | Usually pigment rather than scarring, and it fades — but it means inflammation is happening |
| Skin picking, or avoiding mirrors | Worth a conversation. Picking worsens both scarring and mood |
| Withdrawing from swimming, sport or photos | The acne is affecting their life, which is a reason to treat regardless of how it looks |
The part that is not about skin
Acne is consistently associated with lower self-esteem, social withdrawal, anxiety and depression in adolescents, and the association does not track neatly with how severe the acne looks to someone else. Mild acne can matter enormously to the person who has it, and dismissing it because it looks manageable is both unkind and clinically wrong — distress is a recognised reason to treat.
Worth acting on: avoiding school, sport, swimming or social situations; refusing to be photographed; reluctance to leave the house; persistent low mood; or picking at skin that leaves it worse. Any of these is a reason to seek treatment, whatever the acne looks like. If mood is the greater concern, say so — it changes what help is offered.
What does not cause it
Teenagers get told a lot of things, most of which are wrong and some of which make the acne worse.
- Not poor hygiene. Acne is inside the follicle, not dirt on the surface. Scrubbing harder inflames skin and damages the barrier, which makes treatments sting and get abandoned. Washing twice a day with something gentle is enough.
- Not chocolate or greasy food specifically. The evidence on diet is limited. High-glycaemic diets and, in some studies, skimmed milk show a weak association — nothing that justifies restricting a growing teenager's diet.
- Not something that toothpaste treats. Toothpaste on a spot irritates skin and can cause a chemical burn.
- Not solved by sunbeds. Sun may briefly mask redness and does not treat acne, while raising skin cancer risk and worsening pigmentation left by spots.
- Not a reason to skip moisturiser. Dry, irritated skin is the commonest reason a teenager stops using something that was working.
What helps
Treatment follows the same principles as in adults, starting with topical treatment and escalating where acne is inflammatory or persistent.
| Stage | Typical approach |
|---|---|
| Blackheads and whiteheads | A topical retinoid such as adapalene, or benzoyl peroxide, used on the whole affected area rather than on individual spots |
| Inflammatory spots | A combination topical such as benzoyl peroxide with clindamycin, addressing more than one mechanism |
| Widespread or truncal acne | An oral antibiotic such as lymecycline for a defined course, always alongside a topical — see also back, chest and body acne |
| Severe, nodular or scarring | Referral for isotretinoin under a dermatologist |
Two rules cover most of what goes wrong. Treat the area, not the spot — the point is to stop the next spot forming, and dabbing treatment on visible ones does not. And give it twelve weeks before deciding it has failed.
Age and pregnancy. Licensed ages differ between products, so check the pack and ask a pharmacist. Retinoids and tetracycline antibiotics must not be used in pregnancy or where there is any chance of it — a conversation to have directly and privately with an older teenager, not an assumption to make.
Making a routine one they will actually follow
The best treatment is the one that gets used. Most teenage acne treatment fails on adherence rather than on pharmacology.
- Once daily beats twice daily if twice daily is not going to happen. Evening is usually more realistic than morning.
- Leave it where it will be used — next to the toothbrush, not in a cupboard.
- Warn about the first fortnight. Dryness, flaking and a short-lived worsening are normal. Unwarned, that is where people quit.
- Start every other night with a retinoid and build up, rather than nightly from the start and stopping in week two.
- Moisturiser is part of the treatment, not a luxury.
- Photograph it monthly. Progress over twelve weeks is invisible day to day and obvious in two photos.
- Hand it over. An older teenager managing their own treatment sticks with it better than one being reminded.
When to get help
Seek advice if there are deep or painful lumps rather than surface spots; if marks or texture changes are appearing; if three months of over-the-counter treatment used properly has not helped; if acne is on the back and chest as well as the face; if there is a family history of significant acne or scarring; or if it is affecting mood, school or social life. Options that do not need an in-person appointment are on our acne treatment page.
Frequently Asked Questions
Should my teenager just wait for acne to clear on its own?
Usually it does clear with age, but scarring caused in the meantime is permanent, and the strongest predictor of acne scarring is how long active acne went untreated. Deep, painful spots are the kind that scar and are worth treating promptly. Acne also peaks at the age when appearance matters most, and its effect on mood and confidence is a recognised reason to treat regardless of how the skin looks to someone else.
Does chocolate or greasy food cause teenage acne?
There is no good evidence that chocolate or fried food causes acne. Some studies show a weak association with high-glycaemic diets and, less consistently, with skimmed milk, but nothing strong enough to justify restricting a growing teenager's diet. Acne is driven by hormonal changes at puberty acting on the oil glands, and how severe it becomes is substantially inherited.
Is teenage acne caused by not washing properly?
No. Acne forms inside the hair follicle, not from dirt on the surface, and washing more aggressively makes it worse — scrubbing inflames the skin and damages the barrier, which makes treatments sting and get abandoned. Washing twice a day with something gentle is sufficient. Toothpaste on spots is another common mistake: it irritates skin and can cause a chemical burn.
Why is my teenager's acne worse after starting treatment?
A short-lived worsening in the first few weeks is normal with most acne treatments, particularly topical retinoids, along with dryness and flaking. It settles. Being warned in advance is most of what gets people through it, because this is exactly the point at which treatment is usually abandoned. Starting every other night and building up, and using a moisturiser alongside, both make the first fortnight easier.
How long before acne treatment works in teenagers?
At least eight to twelve weeks before it can fairly be judged, and often longer for acne on the back and chest. Treatment should be applied to the whole affected area rather than dabbed on individual spots, because the aim is to stop the next spot forming rather than to treat the ones already there. Taking a photo once a month helps — progress is invisible day to day and obvious across three months.
References
- National Institute for Health and Care Excellence. Acne vulgaris: management (NG198). nice.org.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Acne vulgaris. cks.nice.org.uk
- NHS. Acne. nhs.uk
- British Association of Dermatologists. Patient information leaflets and isotretinoin guidance. bad.org.uk
- Medicines and Healthcare products Regulatory Agency. Isotretinoin: Pregnancy Prevention Programme and safety review. gov.uk
- DermNet. Acne and acneiform eruptions. dermnetnz.org
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Several acne treatments, including oral retinoids and the tetracycline antibiotics, must not be used in pregnancy or when there is any chance of becoming pregnant. Acne treatment takes weeks to months to work and a short-lived worsening at the start is common. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.