While a lot of us have fond memories of high school, memories of stressing about covering up acne isn't one of them. For some people though, acne isn't just a bad memory. For many people, and especially women, acne doesn't go away as an adult, and acne is no less stressful for adults.
What is Adult Acne?
Acne, whether as a teenager or adult, is similar in that it is caused by a confluence of factors: acne bacteria (P. acne), clogged hair follicles, inflammation, and increased production of sebum. Hormonal factors like testosterone also play an important influential role as a proximate causes of acne. Adult acne isn't uncommon, especially in women, and it's not all that different from teenage acne in terms of the day to day management. It's similarly annoying, and can be painful, if inflamed. Inflammatory acne (pimples and pustules, rather than blackheads and whiteheads) has the potential to cause scarring, and this risk increases if you try to pop it yourself, by pushing the acne further down inside the hair follicles.
What's Different about Adult Acne?
Perception: Acne is acne, but often just as important as what a skin condition is, is how patients feel about it. Many feel embarrassed about having acne “at this age” and feel that pimples should never pair with wrinkles.
Demographics: Acne affects both men and women, almost universally in their teenage years. Adult acne affects women much more than men, as many cases of acne are triggered by hormonal changes.
Factors: The two factors that are unique to adult acne is the effect of menopause, and the use of birth control pills; both influence hormonal levels which affect acne formation.
Treatment Options: For adult women, there will generally be better access to a variety of treatment options compared to teenage acne.
Maintenance and Daily Skincare
There is no silver bullet for acne1 and treatment takes time and patience. This is true of teenage acne, and also true of adult acne. Don't expect to get rid of acne in a week; it simply doesn't work that way. In the meantime, patients need to learn to live with acne in a smart way - lifestyle and skincare will lead the way.
- Don't over-cleanse. Cleanse once or twice daily using lukewarm water and a gentle cleanser. Don't rub your skin dry. Pat it gently after the cleanse.
- Don't pop pimples. Everyone knows it, but tons of people still do this. You risk scarring and irritating it.
- Benzoyl peroxide, retinoids, and salicylic acid are common acne fighting ingredients that are effective in fighting acne. These are available over the counter.
- Make note of your “acne triggers.” We know now that acne can be affected indirectly by stress, as well as foods or drinks in some people2.
- Follow the usual precautions with acne - Get enough sleep, hydrate well, exercise (stress is a major trigger for acne), cleanse every day, keep items that touch your face, like your pillows and cellphones clean.
- Be sensible with your diet. The exact relationship between diet and acne isn't precisely known yet (and it is likely very individual) but we do know that for many people, there is a strong correlation. If you know that certain foods seem to trigger acne for you, be sensible about your choices.
Sometimes, hormonal imbalances can overwhelm what over-the-counter acne products can provide. If the store bought acne products and lifestyle changes aren't working, or your acne is severe, you may need a dermatologist's help. They can also provide you access to powerful prescription treatments.
Topical antibiotics: Sometimes, antibiotics are used (usually in combination with other acne treatments). They help to reduce the P. Acnes, but more importantly they help to reduce inflammation, which we now know is a major factor in acne3.
Birth control pills For adult women with acne, birth control pills which contain estrogen and progesterone help to reduce the amount of androgen (the male hormone) in the body, which helps reduce sebum levels, and helps control acne.
Light Therapy: Non-laser light therapy is a treatment option that is sometimes used in combination with other topical treatments to help reduce inflammatory acne (pimples and zits rather than whiteheads/blackheads). They can be at home-devices, or more powerful ones at a dermatologist's office4. While they are effective at temporary reduction of acne, they will not completely clear the skin, nor will it have a lasting effect.
Spironolactone: This medication, originally designed for treating high blood pressure, is also used off label to treat hormonal acne in women.
Isotretinoin: Isotretinoin, better known by one of its trade names, Accutane, is the preferred solution for moderate to severe acne by dermatologists. It is a “cure” to acne, however, it is a powerful medication with powerful potential side-effects and is not for everyone.
1This isn’t entirely true. For people with moderate to severe acne, most dermatologists recommend isotretinoin (better known by their trade name Accutane) which is the only actual “cure” for acne. It is however, a power medication that isn’t for everyone. Otherwise, however, acne treatment requires patience and daily maintenance.