What is normal?Suggestions for skin careCommon skin conditions
What is normal?
Adolescence is a period of significant physical change. This includes the process of puberty, brought about by increased hormonal production beginning around 11 or 12 years of age (may occur earlier or later). These hormones have effects on many different parts of the body, and the skin is not spared.
Changes normally seen in the skin at this time include increased oil production (sebum), acne, and hair growth, particularly involving the groin and underarms. Boys will develop thicker, “terminal” hair on their face, limbs and bodies. Approximately 90% of adolescents will be affected by acne at some stage.
Stretch marks may appear, resulting from the rapid growth and change in body shape that occurs over this period. These are usually a dark pink or purple at first, but will fade with time. Although these changes are normal, they may cause teenagers to feel embarrassed or self-conscious.
Suggestions for skin care
For teenagers with oily skin or acne, using a gentle facial cleanser once or twice a day may help. Avoid using soaps and toners, as these can dry out the skin, leading to unnecessary moisturising, which may aggravate any acne tendency. Teenage girls are often susceptible to the marketing of night-time moisturisers, which are rarely necessary in this age group.
The most important management for the skin at all ages is the use of a sunscreen in the morning, but this age group need to be aware not to use products that are too greasy, which can aggravate underlying acne.
Male teenagers will find that they generally need to choose a less oily sunscreen for their face than females. Alcohol or gel-based sunscreens are useful on hairy areas.
Adequate sleep and good nutrition will also help the skin. Finally, people at all ages should check their own skin every three months.
Common skin conditions
Acne is one of the most common skin conditions that adolescents experience. Other commonly occurring conditions include psoriasis, eczema and contact dermatitis.
Acne is very common in this age group. There is increasing evidence that low glycaemic index foods may help acne, so once again, the importance of a healthy diet is emphasised. However, if acne persists after appropriate skin care, there are more sophisticated prescription treatments available. If it is severe or causing concern for any reason, consider consulting your doctor. Even relatively mild acne can often cause great distress and damage to self-esteem and self-confidence, at this vulnerable time of life. Of greatest concern is the development of cystic acne, which is characterised by painful lumps or blind pimples under the skin. These lesions may cause permanent scarring, and assessment by a doctor for referral to a dermatologist is strongly recommended.
Although uncommon in this age group, skin cancer does occur among teenagers. Skin cancers will usually present as a spot, freckle or mole that is visibly different to the skin surrounding it. It is often a new spot but skin cancer can also be present in a pre-existing spot that has changed colour, size or shape.
While it is the most commonly occurring form of cancer in the broader population, 95% of skin cancers can be successfully treated if found early. It is important that you see a dermatologist if you have any marks or spots on your skin that are:
- changing shape
- bleeding or itching.
The term "alopecia" refers to hair loss. Teenagers can experience alopecia areata, an autoimmune disorder that occurs when the immune system attacks the hair follicle causing inflammation around the hair root. The hair root then becomes inactive and the hair falls out.
If you experience sudden or significant hair loss or hair thinning, then you should see a dermatologist for a specialist medical diagnosis and treatment.
Eczema is also not uncommon in this age group. The presentation is similar to that in infants and children, with the skin around the joints typically affected by a very itchy, red rash. At this stage the flexures, or the skin inside the knees and elbows, are typically involved.
Occupational Contact Dermatitis
Contact dermatitis is often seen in this age group, commonly with involvement of the hands. It often occurs as a result of exposure to irritating substances when young people start off in the workforce in menial roles, particularly in hospitality. Surprisingly, the most common skin irritant is wet work. Repeated wetting and drying is extremely damaging to the skin barrier. People who have a past history of eczema in infancy, even if it has resolved, or who have associated asthma and hay fever, are more at risk of irritant contact dermatitis than others who have never had eczema. These people may also have sensitive facial skin and find that their skin is more irritated by cosmetics and frequently wearing makeup. Nevertheless, they are often completely unaware that their skin may be more easily irritated because of their history of eczema, and in many cases may not remember that they had eczema as a young baby or child.
The occupations that are most associated with skin problems are those featuring a lot of wet work: hairdressing, food handling and nursing, while motor mechanics also are exposed to many different types of irritants including oils, brake fluid and petrol.
Psoriasis may present for the first time in adolescence. This condition is partly related to a genetic susceptibility, and is characterised by red patches with a white, scaly surface, and that may sometimes resemble eczema. A “guttate” pattern is occasionally seen in adolescent and typically may follow a bacterial throat infection, presenting with lots of small, tear-drop shaped red patches covering much of the body. While other types of psoriasis can persist for years, guttate psoriasis usually settles and may not require treatment.
Psoriasis can take a number of forms but all of them can be a source of huge embarrassment for teenagers, who are often already quite self-conscious about their appearance. Psoriasis usually improves in the summer months, and thus some treatments will include a component of UV therapy. There are many different prescription treatments available, including topical treatments (creams and ointments), tablets and UV light phototherapy.
The field of psoriasis has recently been completely reinvigorated by the use of a new class of treatments, the ‘biologics’, which can be extremely effective in severe disease.
In addition to acne, some adolescents may notice the appearance of little yellow or white spots occurring on the penis or labia, on the lips or inside the mouth. These are known as Fordyce’s spots, and are actually oil glands in the skin that have grown in response to the hormonal changes occurring at puberty. They are harmless and extremely common, and are not caused by a sexually transmitted disease.