My tween is starting to experience breakouts. They are increasing and I’m wondering what’s the difference between “normal” acne and the need to see a dermatologist. Also, any recommendations for daily skin care or acne management? Are there types of products to avoid, like the harsh astringents?

Acne is common in tweens and teenagers, and it can range from mild to severe. As your child goes through puberty and likely experiences breakouts of some level, it is important to understand what causes acne, how to treat it, and when it’s time to see a doctor. It’s equally important to sift through the misinformation surrounding acne, so that you and your child can navigate these breakouts with the needed facts and patience.

Separating myth from fact
Many people believe acne is a result of what you eat. While such a connection might help convince your child to cut down on chocolate, these sweets and other foods are unrelated to breakouts. Rather, acne comes from excess oils that block the pores. A common source is the oil produced by hormone imbalances that take place during puberty. Other sources include oil-based makeups, hair-greasing products, working around grease in a fast-food restaurant, or sweating inside sports equipment like headbands, visors, or helmets. (Helmets are recommended, and young people should simply wash their face with water after helmets are removed and clean their helmet with a bleach wipe.)

Developing good skin care habits
Whether or not your child has acne at this point, it’s important for tweens and teens to develop good skin care habits. This means twice-a-day face-washing with plain water if the teen is not wearing makeup. Those wearing makeup should try a gentle face wash. Regular soap is too harsh and should be avoided, and face-washing should be gentle (no scrubbing). Skin can create its own oils if it gets too dry, and those with dry skin should use an oil-free, non-comedogenic moisturizer. Look for the words “oil free” or “non-comedogenic” on the product – they can typically be found on the front label. While good skin care is essential in helping prevent further pimples, it is unfortunately not the solution for pimples already formed.

Treating mild acne
Mild acne, which often exists primarily on the nose and forehead, can often be treated with over-the-counter acne washes with salicylic acid or benzoyl peroxide. Such ingredients are often written on the front of the label, or listed under “active ingredients.”

These products are effective, but need to be consistently used as directed and take four to six weeks to work. Many young people are not compliant and become impatient with the lack of immediate results — often the biggest barrier to these products being effective.

Be consistent, and beware of highly priced, heavily marketed acne treatments, as they often include the same exact acne-fighting properties as over-the-counter products.

When to see a doctor
It’s time to talk to your pediatrician if your child’s acne is spreading beyond the forehead and nose. A number of pimples on the child’s cheeks, chest, or back are signs of more moderate acne.
Parents should pay special attention to signs of severe acne that comes with scarring, and immediately speak to a pediatrician, who will likely refer you to a dermatologist or adolescent medicine specialist. Such signs include having nodules or cysts (pimples that are generally harder and larger than usual size, often the size of an eraser tip on a pencil); abundant acne on the face, chest or back; and darkening of the skin and remaining redness once pimples have resolved. Such acne requires treatment to prevent life-long scarring.

Treatments for severe acne often include oral medication with potential serious side effects, which should be discussed at length with your prescribing doctor.

When to let it go
I often find that parents, rather than children, are the ones most concerned about a child’s acne. If your child is not experiencing signs of scarring and is not worried about his or her pimples, I strongly recommend letting it go. There are plenty of other areas related to your child’s health and safety with which to concern yourself.

When I mention this to parents, I often see teens breathe a sigh of relief. If you are taking action on less-than-serious acne, make sure it’s your child who wants to make the change.

Whether your child is yet to experience breakouts or is currently seeing blemishes, it’s important to practice good skin care, use oil-free makeup only, avoid squeezing pimples, and be patient if using an over-the-counter acne treatment. Pimples that do not appear to be scarring can be resolved with treatment and time.

Laura K. Grubb, MD, MPH, is an adolescent medicine specialist and pediatrician at Tufts Medical Center.