Teenage Acne: Do Boys and Girls Experience It Differently?

The answer is yes. While there are many contributing factors to teenage acne, the main differences between boys and girls are linked to elevated levels of certain hormones. Here we’ll explore the role that hormones play in the development of those unwanted spots.

Acne usually begins in puberty and affects many adolescents and young adults, but it can occur at any stage of life. Approximately 85 percent of people between the ages of 12 and 24 experience at least minor acne.*

Source: American Academy of Dermatology, Acne Facts

Hormones Associated With Teenage Acne

Acne is most likely to occur during puberty due to increased levels of hormones in both sexes. At the onset of puberty, the hormone gonadotropin (GnRH) is released, causing the pituitary gland of both boys and girls to release two additional hormones into the bloodstream, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

In boys, these hormones trigger the production of testosterone and in girls, the production of estrogen is stimulated. This surge in hormones also creates an increase in the production of sebum (oily secretion of the sebaceous glands), which accelerates the development of acne.

Additional Challenges For Teenage Girls

As girls enter puberty and begin menstruation, they experience additional cyclical hormone fluctuations that can cause acne to worsen. During the first half of a girl’s menstrual cycle, estrogen is the main hormone and in the second half, it’s progesterone. An increase in progesterone increases sebum production. Simultaneously to this progesterone increase is the swelling of the skin and hair follicles, which acts to trap excess sebum and increases the incidence of acne in the 10 days leading up to menstruation.

Acne Basics

To better help you identify the different types of acne in order to assess the grade and find the appropriate treatment, Cynthia Price, M.D. provides some useful information in her article, Best Methods for Acne Treatment in Teenagers. Here is an excerpt from that article:

“Acne is a skin disease characterized by comedones, papules, pustules, cysts, and nodules. The four main drivers of the condition are: increased keratinization within the follicles; increased sebum production; proliferation of Propionibacterium acnes; bacteria; and inflammation. This condition presents in four grades:

Acne simplex

  • Grade I may include open or closed comedones. Inflammatory lesions and cysts are not typically seen. Scarring is unlikely in acne simplex as the lesions tend to be superficial; however, patient excoriation (picking) may lead to hyperpigmentation or texture changes. This is a particularly difficult message to get across to teenagers, as they live in the moment and would rather get rid of an obvious blemish, regardless of the long-term consequences.
  • Grade II will include the open or closed comedones seen in Grade I, in addition to papules and pustules. Cystic lesions and scarring are not common in acne simplex. Educating the teenager about refraining from picking is also critical with grade II acne.

Acne vulgaris

  • Grade III is characterized by inflammation and bacterial lesions. Open and closed comedones may also be seen and scarring will be more common due to the severity of lesions. Prescription therapies prescribed by a physician may be necessary.
  • Grade IV presents with deeper cystic and nodular lesions, as well as papules, pustules, and comedones. Scarring is very common due to the depth of the lesions. Prescription therapies prescribed by a physician are highly recommended. It is critical that the teenage patient understands the importance of not attempting to extract papules, cysts, and nodules. The lesions will not empty, and will potentially rupture the follicle wall below the surface of the skin causing dramatic inflammation, likely scarring and infection.”