Acne is common in teens and kids, but face breakouts triggered by wearing a mask—aka maskne—is on the rise. Experts weigh in on causes, treatment, and how to help kids through the emotional scars acne can leave.

By April Hardwick
January 25, 2021
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Credit: Caitlin-Marie Miner Ong

For many kids heading into puberty, one of the most challenging hurdles is adapting to changes in their skin. During the pandemic, the issue has only become worse for many.

While mask wearing is effective in stopping the spread of COVID-19, it can lead to "maskne," or mask-related acne. Whether you are prone to acne or not, wearing a mask for long periods of time can aggravate breakouts. A mix of stress and the humidity underneath a mask is a place where yeast and bacteria can thrive.

The good news is that acne, which is becoming more common between the ages of 7 and 12, is treatable. But it can cause a lot of heartache and even hurt a child's self-esteem in the meantime. That's why it's important to understand what causes acne and how to best approach treatment for your kids.

Here's your guide to treating your child's acne.

What Is Acne?

Acne vulgaris affects about 85 percent of adolescents and young adults, though it is more common in boys during adolescence. To break down the science: Acne is a skin condition that occurs when a pore gets clogged with sebum (oil), bacteria, and dead skin cells. During puberty, hormones cause oil production to go haywire and skin cells don't shed as quickly as they should—it's a perfect storm of clogged pores leading to breakouts.

Acne can appear on various parts of the body—face, neck, shoulders, upper back, and chest—as either a blackhead, whitehead, or inflammatory red lesion. More severe types of acne, nodular and cystic, usually require medical treatment.

What Causes Acne

Specific triggers are often hard to pinpoint since they can vary from one individual to another and can be linked to family history, but there are some factors to look out for.

  • Skin products. Pay attention to what you put on your skin. Most dermatologists suggest reading labels and understanding what to avoid, including anything oil-based, and only buying items specified as non-comedogenic.
  • Food. There has been much debate over whether certain foods cause acne, but paying attention to patterns doesn't hurt. "I tell my patients if they know every time they eat pizza they break out, then they should limit that food," says Kenneth Mark, M.D., a cosmetic dermatology expert with offices in New York and Colorado. Of course, avoiding certain foods can be difficult, especially for kids, but there is a growing consensus that high glycemic foods, including cereals loaded with sugar and candy, can trigger acne flares.
  • Face touching. Due to the COVID-19 pandemic, it's important now more than ever to avoid touching the face. Doing that not only spreads viruses, but it also spreads acne. "Touching or squeezing will only transfer bacteria from your hands to the skin, potentially making it worse," says Gary Goldfaden, M.D., dermatologist and founder of Goldfaden M.D. Skincare. "Squeezing also causes inflammation and redness and, in some cases, scarring."
  • Weather. Seasonal changes can also trigger breakouts. "As the weather fluctuates, your skin has to adjust, which is adding fuel to that fire," says Rita Linkner, M.D., FAAD, a dermatologist with Spring Street Dermatology in New York City. "You have to read what your skin is telling you, pay attention, and adapt to the changes with a specific product."

Acne Treatment for Teens and Kids

Skin issues and treatment may vary depending on your child's skin color. For example, post-inflammatory hyperpigmentation (PIH), or dark spots that sometimes show up after a pimple heals, can last up to six months longer in patients with darker skin making it important to use appropriate products, advises Laura Scott, M.D., FAAD, the associate director of the skin of color division at the University of Miami's Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery.

But regardless of skin color, Dr. Scott recommends using a daily SPF for those with acne-prone skin, such as EltaMD UV Clear Broad-Spectrum Everyday SPF 46.

For acne-prone skin during the pandemic, experts recommend choosing a mask with a soft cotton or non-chemically treated material. Though you'll also want to do your own research because not all masks can protect against COVID-19.

Do over-the-counter acne products work?

Over-the-counter products can show promising results, but it's important to know what to look for and understand that they might not work for everyone.

Dr. Linkner recommends patients use a 5 percent benzoyl peroxide wash, which can be used daily without irritation though it is a bleach and can stain clothing. Two ingredients that work well in combination are salicylic acid (helps to unclog pores) and lactic acid (improves skin texture and moisturizes skin). She encourages patients to find a brand that offers a good daily step-by-step regimen, such as Rodan + Fields Spotless Acne Treatment.

And although it may be difficult, patience is important. "Whatever treatment you decide to use, give it at least 10-12 weeks to see results," adds Dr. Linkner. "I tell patients that so they set their expectations properly. Often, it's hormonally instigated, so you have to be patient."

Certain skin types might be more sensitive to these products so it's best to consult with your doctor first in order to find the right balance.

Should kids use oral antibiotics?

Oral antibiotics for acne have become less popular because of resistance concerns. "Inevitably acne will come back because your body builds up a resistance to the drug," says Dr. Linker. They also tend to take longer to show results, and research shows they can also kill healthy gut bacteria, which may lower immune function.

Experts say oral antibiotics should be well-researched before incorporating them into a daily routine, but there are cases where they may be recommended. These can include cystic-type acne, possible scarring, or in cases where acne occurs on the back, shoulders, and chest, indicating that larger glands are involved, explains Dr. Linker.

When should your kid see a dermatologist?

"Typically, significant enough acne to warrant a dermatologist does not occur until teenage years," says Dr. Mark. But the acne should be the marker, not the age.

Most insurance plans cover acne-related visits and prescription medications, but always contact your insurance to help choose a doctor in-network and review your medical plan.

And keep in mind, sometimes medical intervention may be necessary even if you feel your child's acne isn't that severe. "When it affects quality of life and they are self-conscious is the threshold—not necessarily severity," says Dr. Linkner.

Acne's Emotional Scars

Acne isn't always just an exterior issue. "It significantly affects self-esteem in teens and can even affect how they do in school and beyond," says Dr. Scott.

The American Academy of Dermatology (AAD) says the skin condition can also cause depression, anxiety, decreased quality of life, and a feeling of being all alone. A 2017 survey on teens ages 15 to 19 found 71 percent of those who have had acne feel it "has a negative effect on their body image and attractiveness," while 67 percent said it negatively affected their self-esteem.

Francisco Tausk, M.D., a dermatologist specializing in psychodermatology and director of dermatology at the University of Rochester, has seen the effects on some of his patients. "With kids, I tend to be quite aggressive in treatment while also addressing their depression," he says. "Most times, just improving the self-image lifts the depression."

How parents can help

First, it's critical to validate your child's feelings. Let them know feeling upset over their skin is normal and OK. Then help them sort through a fake airbrushed reality that is common on social media.

Delaney Ruston, M.D., a primary care physician and creator of the documentary Screenagers, which shows how technology impacts kids' development, says platforms like Instagram, Snapchat, and YouTube focus heavily on a person's looks and cover up perceived flaws, making it easy for kids and teens to be hard on themselves. "Ultimately they love getting tons of people engaging in their posts and as a result there is tons of pressure to post and post a perfect image," adds Dr. Ruston.

Parents can encourage their kids to consume more empowering content. "Suggest they follow hashtags like #skinpositivity and #skinconfidence," suggests Dr. Scott. "These are great ways to get more real images on their feeds as well as follow brands that have not made retouching a part of their content." Some of those include Dove and Aerie.

Dr. Ruston adds, "Foster what is important, like self-love, self-care, and self-acceptance."

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