What helps against spots?

When we contacted Kristin Kernland Lang about acne, the first thing she said was: «Please don't talk about skin blemishes.» She is a paediatric dermatologist at the Cantonal Hospital in Baden AG and emphasises: «Acne has nothing to do with impurities and is not self-inflicted. This term only contributes to stigmatisation.»

Acne is actually the most common skin condition worldwide. According to the dermatologist, over 85 per cent of all young people are affected by it. Almost every teenager is familiar with the occasional spot here or blackhead there .

Acne itself is not bad. What is bad are the scars that remain.

Kristin Kernland Lang, dermatologist

However, in 15 to 30 per cent of cases, acne is so severe that it requires medical treatment. The skin condition can also be triggered cosmetically by using the wrong products. Or it can occur later in life. However, this article deals with hormonal acne, which is widespread among teenagers.

Until a few years ago, the rule of thumb was that acne began between the ages of 15 and 18 and disappeared again by the age of 25 for most people. However, as puberty is occurring earlier and earlier in the Western world, Kristin Kernland Lang now sometimes treats children as young as nine.

Acne is just as much an issue for young men as it is for young women. However, young men tend to suffer from more severe cases, with their backs often being severely affected.

How acne develops

«Acne is a systemic disease that is usually triggered by hormones and manifests itself on the skin,» explains Kernland Lang. During this phase of life, the sebaceous glands produce too much oily secretion – stimulated by male sex hormones, which are produced in particular during puberty, even in girls.

This causes the sebaceous glands to become blocked and sebaceous plugs to form: comedones, also known as blackheads. These in turn provide a breeding ground for bacteria, which can then cause purulent inflammation and pustules. «Acne itself is not bad,» emphasises the dermatologist, «what is bad are the scars that remain.» That is why treatment is now started much earlier.

In general, acne at age 12 usually manifests differently than at age 16 or 18, according to the dermatologist. Acne begins with the formation of comedones and, during adolescence, is characterised by red, inflamed pustules that often heal with scarring. «This also reflects physical development,» says Kernland Lang.

Influence of genes and nutrition

But why are some young people severely affected by blackheads and spots, while others are hardly affected at all? "Hereditary factors play a major role here,» says Kristin Kernland Lang. The condition can be more severe, especially if the parents had acne. Diet also has an influence. «There are certain foods that further exacerbate the severity of the inflammation,» says the dermatologist.

Milk, for example, and the consumption of carbohydrates with a high glycaemic index. These are carbohydrates that cause blood sugar levels to rise sharply , such as those found in soft drinks. Milk protein powder, which many adolescents take to build muscle, can also exacerbate acne. «That doesn't mean that those affected can never consume these foods again,» says Kernland Lang. «They are simply in a phase of life where their skin is saying, «That's too much.» Later on, things will be fine again.»

The first step in treating spots and blackheads is therefore to try out how your skin reacts when you give up milk and sugary drinks for three months, for example. «It's worth trying this restriction and taking action yourself,» encourages Kernland Lang.

She would then visit a dermatologist «when the acne appears and, above all, when it becomes bothersome,» according to the dermatologist. «Then the motivation to take personal responsibility is higher.» In general, however, those affected should see their paediatrician, family doctor or dermatologist sooner rather than later.

Caring for your skin properly

Proper skincare is another way to get acne under control. It is important to cleanse your skin in the morning and evening – using a mild, non-antibacterial cleanser. In fact, there are more and more cosmetic and medical products available that can be purchased without a doctor's prescription.

Stress can further exacerbate inflammatory skin conditions such as acne.

Julia Rümmelein, psychotherapist

Kernland Lang also recommends consulting a medical beautician who can help with cleansing, tailor make-up to individual needs and guide young people through the jungle of products available. They can also help to determine whether the beauty tips circulating on TikTok, which are often tailored to Korean women, actually make sense.

Various medications

If diet and daily skin care are not enough to control acne, medication can be used to counteract it. «In the past, antibiotic preparations were often used,» says the dermatologist. «Today, medications containing the active ingredient isotretinoin are more likely to be prescribed for severe, scarring acne.»

However, vitamin A acid preparations have side effects such as dry skin and lips and can initially worsen existing acne. In addition, women must not become pregnant while taking the medication and for two months afterwards, as there is a risk of malformations in the unborn child. «But it is the most effective active ingredient on the market and, when used correctly, a very good medication,» says Kernland Lang.

The contraceptive pill can also improve the appearance of hormonally induced inflammatory acne. This is why gynaecologists sometimes prescribe it to their patients as an acne treatment. «But that is a side effect of the pill. Acne can also be treated without taking the pill,» says the dermatologist.

However, Kristin Kernland Lang observes that, in general, acne is stigmatised more today and society is less tolerant when it comes to appearance. «We all – but especially young people – measure ourselves against edited, unrealistic images that we see every day on social media,» says the doctor. It is therefore no coincidence that many sufferers not only experience the physical symptoms of the skin condition, but also suffer psychological distress.

Psychological effects

This is where Julia Rümmelein comes in. The psychotherapist heads a therapy unit at the Clienia Schlössli private clinic for psychiatry and psychotherapy in Oetwil am See, Zurich, and specialises in psychodermatology, i.e. the connection between the psyche and the skin. «If your face is covered in spots and blackheads, this can seriously undermine your self-confidence and cause emotional distress – which can sometimes lead to depression, for example,» she explains.

There are far more people who have spots in their youth than people who are completely free of them.

Julia Rümmelein, psychotherapist

Puberty is already a vulnerable phase for young people, as their entire bodies are undergoing changes and everything is transforming. Therefore, it is common for those affected who are not yet confident in their self-image to become preoccupied with their reflection, attempt to conceal their skin condition by any means necessary, or withdraw completely.

«The resulting stress can act as an additional aggravating factor for inflammatory skin conditions such as acne. This is because it has been proven to influence physiological processes that promote sebum production and skin inflammation,» says Rümmelein. Excessive concealment with the wrong products or squeezing inflamed areas often leads to worsening symptoms.

How parents can support their child

How can parents best support their children in this situation? «Offer to talk and, for example, tell them about yourself if you also suffered from acne,» advises the psychotherapist. This can give the child the feeling that they are not alone and that it is nothing to be ashamed of. It is also important to boost self-esteem and think together about «What else makes me who I am?» In this way, parents can help broaden their child's perspective to include other strengths such as social skills, hobbies or character.

It is equally important to seek dermatological advice, as this often gives young people the feeling that they can do something about it and are not helplessly at the mercy of the situation. Clicking through social media together is also a good idea to see what young people are comparing themselves to: where are filters used? And what does normal skin actually look like during puberty?

Above all, Julia Rümmelein believes it is crucial for young people to realise: «I'm not doing anything wrong! My body is simply undergoing hormonal changes, which can also manifest themselves on my skin.» And: «There are far more people who have spots in their youth than there are people who are completely free of them.»