I recently received an email from a distraught listener with a medical problem that I encounter quite often – adult acne. She writes:
I’ve been struggling with adult acne like crazy lately. I've always had little breakouts here and there, but since my third child was born 2 years ago, it's gotten really bad. I'm ready to cry...I just want beautiful skin again!”
Acne may not be deemed as a “dangerous” health condition (especially when compared to heart disease or cancer, for instance), but it is definitely serious enough to cause severe self-esteem issues and even depression and social isolation. It may not kill you, but it is sometimes enough to diminish quality of life – and that’s what makes it such an important topic to discuss. You might be surprised to learn that developing adult acne, when you may have never suffered from it as a teenager, is actually much more common than you think. So let’s learn more about why adults can develop acne and what you can do to treat it.
What Is Acne?
Acne is a disorder of the sebaceous glands in our skin. Sebaceous glands are cells that produce oil underneath our skin, often on the face, chest, back, and upper arms. These glands sometimes go out of whack and over-produce oils and debris, or they may house bacteria and cause acne.
What Causes Adult Acne?
Genetics: How much oil your glands produce is partially due to genetics. Thanks, Mom and Dad!
Hormones: Elevated testosterone or other hormones such as DHEAS can cause glands to over produce.
Medications: Corticosteroids, lithium, and anti-seizure medications have been shown to cause acne.
Over-the-counter skin products: Certain oil-based moisturizers and make-up can clog pores. Always look for the words “non-comedogenic” on skin products if you suffer from acne – this means the product inside the bottle won’t clog your pores.
I know what you’re going to say. “Dr. Majd, what about greasy foods? They cause acne, right?”
To this date, there is no good evidence that foods cause acne. Although some patients sure swear by it! Overall, I don’t think it hurts to stay away from chocolate or pizza , for instance, if you think they may exacerbate your acne symptoms.
For women to suffer from adult acne, you should ask your doctor if you could possibly be suffering from Polycystic Ovarian Syndrome (PCOS), which affects up to 10% of women. PCOS women often have higher testosterone levels (that can fluctuate through time). They may experience irregular periods, difficulty losing weight, hirsutism (excessive hair growth on the body), diffuse hair thinning on the scalp, more difficulty conceiving, or adult acne. More times than not, women who tell me they “all of a sudden” developed acne as an adult actually suffer from PCOS and don’t know it yet. Like our listener who wrote in, gaining weight (like after having a baby) can exacerbate PCOS symptoms.
Treatment of Adult Acne
Remember that no matter what type of treatment your doctor selects to treat your acne, it can take a minimum of 8 weeks to see a difference – it’s a slow process.
Here are some options on how to treat adult acne:
Over-the-counter aids: Products with the ingredients benzoyl peroxide or salicylic acid are the main acne fighting agents. But they can be harsh on the skin and can sometimes cause drying.
Retinoids: Topic creams such as adapalene or tretinoin are some of the mainstays of prescription acne treatments. They are derivatives of Vitamin A that are used to slough off and regenerate new skin layers. They can also be rather harsh and drying and only gentle cleansers should be used if using these products. These products can also be harmful to a fetus, so it is recommended that women are on a reliable source of birth control while using retinoids.
Anti-bacterials: Since bacteria clogging our pores are part of the problem, using either a topical or oral pill form of an anti-bacterial is also one way to treat adult acne. One common combo is to use a topical anti-bacterial called “clindamycin” cream or gel, in addition to a retinoid.
Hormonal contraceptives: Hormonal contraceptives often clear up acne. Some are specifically marketed for acne, but they all should have an equal chance in clearing up pores by regulating your hormonal levels.
Spironolactone: Spironolactone is one of our newer methods of acne control. It’s primarily blood pressure medication that is also a weak anti-testosterone which clears up acne. Your doctor may require monitoring of your blood pressure while taking this, as well as a routine blood test.
Isotretinoin (Accutane): For those with severe or cystic acne that does not respond to the previous methods, isotretinoin, an oral retinoid, is a possibility. Although it is not without risk and intake needs to be closely monitored by your dermatologist. It is often a last resort that does produce result in many patients.
If you suffer from PCOS, often treating the PCOS can improve the acne. Mainstays of treating PCOS are weight loss, exercise, and a lower carbohydrate diet. Hormonal contraceptives also have the benefit of regulating periods in those with PCOS, and spironolactone can also improve hirsutism on the body and hair loss on the scalp in these patients as well. If your primary care doctor is not an expert in PCOS, ask for a referral to an endocrinologist to treat PCOS.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
Acne image from Shutterstock