Teen acne is one of the most common skin conditions, and generally more common in girls than boys.

Two of the most frequently asked questions from clients at our practice: “Why is my teen’s acne treatment not working?” and “Why is my teen’s skin constantly clogged, as she treats it, it clears up and three weeks later her skin is a mess again?”

We’ve got clinical answers. The root cause of teens’ acne lies in their genes – acne is genetic. There are two inherited genetic flaws for those with acneic skin.

The first is retention hyperkeratosis (also known as cell buildup), in which skin cells do not shed as they are supposed to, but rather stick to the skin. The epidermis, or the outer layer of the skin, lines the hair follicles, and wherever there is cell buildup, there is thickening of the stratum corneum and thickening of the follicle wall. By using any type of scrub or exfoliating agent, you are only removing the debris on the surface of the skin and not exfoliating inside the hair follicles, where the problem lies for acne-prone skin.

The second genetic factor is the oiliness of the skin you inherit. The size, shape, productivity and consistency of the oil glands are influenced by hormones. There is no permanent fix for this condition, but it can be controlled with proper treatment and appropriate use of skincare products.

Acne bacteria are anaerobic bacteria that thrive in an oxygen-free environment and are part of the normal flora that lives on the skin. In normal conditions, follicles are irrigated with oxygen and the bacteria don’t have a chance to overgrow. However, hormone fluctuation causes a surge of oil secretion in the follicles. The mixture of dead skin and sebum is very sticky, thus preventing the oxygen from irrigating the follicles – creating the perfect environment for bacteria to grow and feed off of the mixture and leading to clogged pores.

The bacteria will then produce waste products rich in fatty acids, prompting an inflammatory response causing the follicle wall to rupture. Then, the immune system is activated and white blood cells via the blood stream reach and engulf the follicle. This will give rise to a red bump. White blood cells get in and fight off the bacteria, which leads to pus formation. Stress and hormonal imbalances are the leading cause of this chain reaction.

If after two to three months of treatment the acne shows no signs of clearing, then we highly recommend the client see a dermatologist for further assessment and prescription medication, as it could be a sign of other hormonal disorders.

Acne triggers

What effects does food have on acne? Food can be a major trigger but not a cause. We recommend a reduction in carbohydrates and dairy products,

as they affect the hormones and, as noted above, the overproduction of sebum occurs when hormones are out of balance.

Do makeup and skincare make acne worse? Spreading agents in makeup or skincare can be comedogenic and clog the pores. One popular product people are using these days is coconut oil, which is highly comedogenic. Another is vitamin E in makeup. Vitamin E orally is great because it makes the sebum soft, but avoid using it topically, as it clogs the



There are a number of clinical treatments used for acne-prone skin, including HydraFacials and DermaSweep, as well as a variety of peels that will control sebum secretion and skin cell buildup.

The COVID pandemic and covering of the lower face with a mask has created more skin problems than ever before, and has given rise to acne among teens and student-athletes. Acne mechanica is the leading cause of the breakouts related to masks, with constant friction of the fabric or synthetic material prompting breakouts. The best ways to reduce the inflammation are to use natural cotton fabric masks that are more breathable for the skin, and to wash masks daily with hot water and antibacterial soap.

The more we learn about the nature of acne, the better we can control it, leaving teens with one less thing to worry about.

Los Altos resident Marjan Kashi is a licensed medical esthetician, electrologist and the founder of Pure Serenity Skincare, located at Rancho Shopping Center. For more information, call 999-7873 or visit pureserenityskincare.com.