Teen Skin, Simplified: Getting It Right Early

By Dr. Sheel Desai Solomon, MD, FAAD If I could offer every teenager a single piece of advice, it would be this: you require far less than you imagine, but you do require precision and you do require timing.

In clinic, I encounter a spectrum of presentations. Teenagers who are baffled by what is happening to their skin, and more so by why they have been brought in by their parents to others “skinfluenced,” with elaborate skin care routines and very definite ideas about what additional layers ought to involve.

Fortunately, we can and do help them all.

Adolescent acne is a physiological process and, importantly, one that is highly responsive to appropriately structured treatment, particularly when addressed early.

The Biology, Briefly Considered

During puberty, increased androgen activity stimulates sebaceous gland hypertrophy and sebum production. This, coupled with altered follicular keratinisation and the activity of certain skin bacteria, creates a microenvironment predisposed to inflammation.

Clinically, this presents as:

Seborrhoea

Comedonal obstruction

Inflammatory lesions of varying severity

This is expected biology. But it is also, in most cases, eminently manageable biology.

The Therapeutic Ladder

A concept I find particularly helpful for patients is that acne treatment follows a therapeutic ladder. The severity of presentation determines where one begins on this ladder.

We do not treat acne reactively or haphazardly. Rather, we begin with foundational therapies and escalate in a deliberate, evidence-based manner, guided by clinical response and always mindful of the risk of scarring.

This structured approach allows us to:

Intervene early

Optimise efficacy while minimising irritation

Prevent progression

Preserve the integrity of the skin over time

Where difficulties arise is in the absence of this structure, either through under-treatment, or more commonly, overcorrection without strategy.

The Foundation: Simple, but Not Optional

Wherever you start on the ladder you have to have a foundation. No ifs or buts.

Cleansing

Twice daily is sufficient.

A gentle cleanser forms the basis, with the selective introduction of prescription agents where appropriate. Excessive cleansing, despite its intuitive appeal, tends to destabilize the skin barrier and provoke further oil production (skin is annoying responsive).

Moisturization

Even oil-rich skin requires hydration.

A lightweight, non-comedogenic moisturiser supports barrier function and mitigates reactive sebaceous activity. However selection is key and choosing the wrong type can inadvertently create more pore blockage.

Photoprotection

Daily sunscreen, SPF 30 or higher. Non-negotiable.

Sun exposure contributes to post-inflammatory pigmentation and cumulative dermal injury, even in adolescence.

Escalation: When and How We Intervene

As acne becomes persistent, inflammatory, or begins to leave residual marks, we move up the therapeutic ladder. We want to clear your acne but also prevent long-term structural change within the skin.

Scarring is not inevitable, but it is far easier to prevent than to treat.

There are multiple excellent treatments which work beautifully together or independently depending on the patient and their presentation.

What might we prescribe:

• Topical retinoids

Including receptor-selective formulations such as Aklief, designed to normalise follicular turnover with greater precision

• Topical anti-androgen therapy

Such as Winlevi, which reduces sebaceous activity at the level of hormonal signalling

• Topical antibiotics (used in combination)

Often paired with benzoyl peroxide to reduce bacterial resistance and improve efficacy

• Niacinamide-based therapies

Offering anti-inflammatory effects alongside support for the skin barrier

• Benzoyl peroxide combinations

To enhance antimicrobial activity and maintain control

• Oral antibiotics

Used strategically for inflammatory acne, for defined durations, and always with appropriate topical maintenance

• Hormonal therapies (in appropriate patients)

Including oral contraceptives or spironolactone

• Oral isotretinoin

For severe, scarring, or treatment-resistant acne

At each visit we reassess and decide next steps as targeted intervention aligned with disease behaviour.

Beyond Topicals: The Modern Dermatologic Toolkit

Contemporary acne management extends well beyond creams and tablets.

We now routinely incorporate adjunctive technologies that allow for earlier control and superior outcomes:

Laser and light-based therapies

To reduce inflammation and bacterial burden

Chemical peels

Particularly salicylic and glycolic acid formulations for comedonal acne and texture

Early scar prevention and treatment

Including microneedling, laser resurfacing, and collagen-stimulating technologies

The Role of Follow-Up: Where our Expertise Matters Most

Equally critical is ongoing follow-up with a dermatologist as Acne is not static. It evolves. And treatment must evolve with it.

It is within these follow-up visits that we:

-Assess response with clinical nuance

-Adjust therapeutic intensity appropriately

-Introduce or withdraw therapies with intention

-Identify and address early signs of scarring or pigmentation

These decisions are rarely straightforward. They require experience, pattern recognition, and timing.

They are not decisions that lend themselves to trial and error, or to being guided solely by trends.

A Note on Overcorrection

The impulse to do more, to layer, to experiment, to accelerate while understandable is often perilous. Over-treatment is, in many cases, simply another form of under-treatment.

My Final Thought

Teenage skin does not require perfection! It requires early recognition, structured intervention, and thoughtful progression.

When managed in this way, acne can be controlled efficiently, progression can be halted, and scarring can be avoided altogether.

Do not delay a consultation, and do not feel you have to rely on guesswork. Because in dermatology, as in most things of consequence: timing, structure, and judgement are everything. And we are here to help.

Dr. Sheel Desai Solomon is a board-certified dermatologist and founder of Preston Dermatology & Skin Surgery Center, serving patients across Cary, Wake Forest, and Holly Springs, North Carolina.