Acne is no fun for adolescents, most of whom develop at least an occasional pimple. But acne can be devastating for adults, especially women, who are more likely than men to have acne that continues into adulthood, redevelops after years of clear skin, or even makes its first appearance late in life.
There are two types of adult acne:
- Persistent acne. Acne that lasts beyond your mid-20s usually forms on the lower face, especially around the mouth, on the chin, and along the jawline. Unlike the milder acne you may have had as a teenager, persistent acne often causes inflamed pimples and deep-seated nodules or cysts — painful lesions that often lead to scarring.
- Late-onset acne. Even if you sailed through adolescence with nary a zit, you can first develop acne as late as 30, 40, or even during menopause. Late-onset acne can be just as severe as persistent acne, and can affect the chest and back as well as the face.
The Causes of Adult Acne
No matter how old you are, acne results when oil glands in your skin secrete too much sebum, a natural moisturizer you start producing in puberty. When your pores become clogged with excessive amounts of sebum and skin cells, it fosters the growth of the infection-causing bacterium P. acnes. Pimples, nodules, and cysts form as your immune system attacks the infection.
Common triggers of adult acne include:
- Hormones. Fluctuations in female hormones associated with puberty, menstruation, pregnancy, and menopause often cause breakouts. Some women develop late-onset acne when they stop taking birth-control pills that contain estrogen and progesterone. If you get pimples during stressful times, the likely culprit is overproduction of the male hormone testosterone, which stimulates oil glands and hair follicles.
- Medications. Although combination birth-control pills can help control acne — and are often prescribed for that purpose — progesterone-only pills can make acne worse. Other common triggers include corticosteroids and some medications used to treat epilepsy and depression, and to maintain sobriety.
- Genetic predisposition. Research shows that 50 percent of adults with acne have at least one first-degree relative (a parent, sibling, or child) who is affected by acne.
- Skin and hair products. Oily sunscreens, hair greases, and some cosmetics can promote a type of acne called “acne cosmetica.” To help prevent this condition, only use skin and hair products that are labeled “non-comedogenic” or “non-acnegenic.”
Acne Prevention Strategies
Proper skin care is a must. Here’s what dermatologists recommend:
- Practice gentle face washing. Wash your entire face from under the jaw to the hairline twice a day with a mild soap or facial cleancer, and then rinse thoroughly. Also wash after heavy exercise. Vigorous washing — especially with strong soaps or a rough scrub pad — irritates the skin and worsens acne.
- Protect your skin. Rule number one is to resist the temptation to pop or pick at your pimples. Also use a non-comedogenic sunscreen of at least SPF 15 when you spend a lot of time outdoors. Contrary to myth, excessive sun exposure isn’t good for acne. It prematurely ages skin, increases the risk of skin cancer, and — if you take some acne medications — makes skin more susceptible to sunburn. Also avoid clothing and sports equipment — such as tight hats and backpacks — that rub and irritate the skin.
Acne Treatment Strategies
Adult acne is more difficult to resolve than teenage acne. Products that worked wonders when you were 16 may not be effective at 40. They can also cause dry skin. If you have persistent or late-onset acne, you may need stronger medicine.
Over-the-counter options include:
- Acne remedies containing sodium sulfacetamide and sulfur.
- Topical retinoids, which are vitamin A derivatives that thwart microcomedones, the lesions that precede acne.
- Moisturizers and foundations that contain proven acne-fighting ingredients such as salicylic acid.
If these treatments don’t work, consult your family doctor or a dermatologist. Many women with adult acne don’t seek professional treatment because they mistakenly believe that nothing can be done.
Prescription options include:
- Topical medications combining benzoyl peroxide and an antimicrobial such as clindamycin or erythromycin.
- Topical medications combining clindamycin and a retinoid.
- Oral antibiotics such as tetracycline, doxycycline, or minocycline.
- Hormonal therapies such as oral contraceptive pills, flutamide and spironolactone (which inhibit male hormones), or hormone replacement therapy.
- Oral isotretinoin, a potent drug that in intermittent and/or low doses can help even patients in their 50s and 60s achieve clear skin.
Caution: Because some of these prescription medications can cause birth defects, it’s essential that women of child-bearing age use effective contraception at least one month before treatment, during treatment, and for at least one month after stopping treatment.
If a prescription medication doesn’t improve your skin within six to eight weeks, talk to your doctor or dermatologist about changing treatment.
When medications fail to resolve stubborn nodules or cysts, corticosteroid injections can reduce pain and swelling, and reduce the risk of scarring. If scarring does occur, surgical repair options include dermabrasion, fat transfer, and a new technique called photodynamic therapy that incorporates microdermabrasion followed by an acid peel and a laser treatment.
If you have persistent or late-onset acne, don’t despair. There’s no reason for this common and distressing condition to damage your self-esteem and quality of life. Today’s treatments are so effective that almost all cases of adult acne can be resolved.