“I can’t believe I still have acne.” Wilma F. Bergfeld, MD, regularly hears this lament from dismayed patients who haven’t been to a high school dance since Jimmy Carter was president. “Adult acne is often denied, but it exists, it’s important, and it’s worthy of treating,” says Dr. Bergfeld, section head of clinical research in the department of dermatology at the Cleveland Clinic Foundation, Cleveland, Ohio.
The first study in 20 years to assess the prevalence of acne in adults was recently published in the Journal of the American Academy of Dermatology. Dermatologists in England examined women and men between the ages of 25 and 58 and found that 12% of the women and 3% of the men had clinical (visible) facial acne. What’s more, acne prevalence didn’t drop significantly until after the age of 45.
“About 10% of the acne patients I see are adults, and I’m definitely seeing more adult acne patients than I used to,” confirms Marco Petrazzuoli, MD, assistant professor of dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
What Causes Acne?
Acne at any age is a disease of the sebaceous hair follicle–a wide, deep hair follicle with attached sebaceous glands. Sebaceous glands produce sebum, a pale yellow, oily liquid that lubricates the skin but also fuels acne. Sebaceous hair follicles appear on most body areas, but they are most plentiful where acne is most common: the face, back, and chest.
Sebum secretion increases in early adolescence, when boys and girls begin producing androgenic hormones that stimulate the sebaceous glands. In skin without acne, sebum flows through the follicle to the skin surface, carrying with it the wispy, dead skin cells constantly being shed from the follicle’s lining. In skin with acne, these skin cells clump together and are trapped–along with sebum–in the follicle. The blocked follicle also acts like a greenhouse for the overgrowth of a bacterium called Propionibacterium acnes, which plays a role in acne inflammation.
As skin cells and sebum accumulate in the follicle, they form a bulging mass called a microcomedo (plural, microcomedones). You can’t see a microcomedo, but it is the first acne lesion. All acne lesions–from noninflammatory blackheads and whiteheads to inflammatory papules and pustules– get their start as microcomedones.
Is Adult Acne Different?
“Adult acne has a different presentation compared to teenage acne,” points out Dr. Petrazzuoli. “Teenagers have oily skin with acne in the T-zone area around the nose and upper cheeks. Adults have less oily skin and sometimes more inflammatory, tender lesions on the lower cheeks, jawline, and even the neck.”
Adult acne takes two general forms–acne that begins during the teenage years and just never goes away, and acne that erupts for the first time after the age of 25. The persistent, simmering form accounts for about 80% of cases.
Some adult acne is provoked by greasy moisturizers, hair products, and sunscreens. Dr. Petrazzuoli says he has seen adult acne caused by iridescent powders that contain tiny color particles which may block the follicles, causing acne. Dr. Bergfeld reports seeing more athletic women who develop what she calls “exercise acne” after pumping sweat and sebum onto their skin during vigorous workouts.
Acne in women can also be associated with hormonal fluctuations in the menstrual cycle or hormonal abnormalities caused by ovarian cysts. Treatments for infertility, certain birth control pills, and hormone replacement therapy can also influence acne in women.
How Is Adult Acne Treated?
Acne can’t be cured, but it can be treated. There are many effective topical and systemic acne treatments, but treating adults can be challenging. “What is appropriate for a teenager with acne may not be appropriate for a teenager’s mother with acne,” says Dr. Petrazzuoli. “Products that work for teenagers can be too drying and irritating for adults.”
If you’ve been waiting for your acne to clear up since you were a teen or you’re experiencing your first serious outbreak as an adult, it’s a good idea to see a dermatologist.
A dermatologist can determine if your acne is associated with an underlying medical condition or is exacerbated by medications, greasy cosmetics, or physical activity. Most adults with acne have tried a lot of treatments over a lot of years, and a dermatologist will bring both experience and creativity to the treatment of acne. “You have to be innovative when treating adult acne,” Dr. Bergfeld warns. “A cookbook approach won’t work.”
Another reason to get treatment is to prevent scarring. “If you halt the progression of acne, you prevent scarring,” notes Dr. Petrazzuoli.
But the scars acne leaves are not just physical. Acne causes emotional scars that can distort body image and erode self-confidence. People with acne date less, eat out less often, and even have higher unemployment rates than their clear-skinned peers, studies show. Measures of how skin disease affects quality of life show that adults older than 40 with acne are even more upset by their skin condition than are younger people with acne.
Don’t wait acne out. If you have acne–no matter what your age–you deserve effective treatment that will help you face the world with a clearer complexion and a more confident attitude.
Article By: Kristin Richardson, Medical Writer