My 12-year-old daughter is beginning to get blackheads, whiteheads and pus-filled pimples. As a teenager and young woman, I had severe acne and was treated twice with isotretinoin. I was a virtual recluse because of my appearance until I was in my early 20s. I’m 40 now, and I haven’t had an acne outbreak for five years, but I have many acne scars on my face. I’m afraid my daughter is beginning to develop acne, and I don’t want her to experience the emotional pain and isolation I went through. What should I be doing for her?

A 12-year-old whose mother had severe acne is at high risk for developing severe acne. Your daughter should be seen by a dermatologist who can develop a planned approach to long-term observation and treatment. It is important to know that while there is no way to "turn off" an inherited predisposition to severe acne, a long-term treatment plan can control the acne.

Any child who has a parent or sibling (brother or sister) who has (or had) severe acne is at high risk for developing severe acne. The role of genetics in acne becomes less clear-cut after one gets beyond the immediate family. However, there do seem to be families in which patterns of acne are apparent—types of acne, severity, age at which acne develops, etc. A more generalized genetic influence is suggested by the slightly higher incidence of acne in Americans of European descent than in those of African or Asian descent.

As work on the human genome progresses, it is possible that the genetics of acne will eventually be better understood. Until that time, dermatologists can use what they know about genetic influences to help people at high risk for severe acne.