Learn How To Deal With Adult Acne

High school is an era gone. You’re either a professional or going to college. Or you are raising a family. You have settled down. You think acne is gone. Just when you think you are out of the woods acne strikes you in the face. Dr. Michael A. Sullivan is often referred to as “Acne at my age?” “Acne, at my age!” is the cry of women who suddenly get acne after they turn 30 or 40. It’s not fair, it’s supposed to be only for teenagers!” is often the next thing they say. Although it may not be fair, it is a fact. Many people, mostly women, get acne as adults. Teenage acne can sometimes persist into adulthood. This chapter will prepare you for unexpected situations when acne can rear its ugly head, including pregnancy, adulthood, and menopause. The majority of adult-onset acne cases are seen in women. This is why I will spend most of the chapter on adult-onset acne and how it affects women. As always, I will show you that there are ways to get rid of your acne. If you are one of the few men who have acne as an adult, I will help you to understand your situation in the end.

How to identify adult-onset acne

Adult-onset acne occurs after 18 years of age. This is different from the common teenage form of acne. It can appear in a woman’s 20s or 30s, but it is also possible later in life. Adult-onset acne is mostly a problem that affects females.

Adult-onset acne is more volatile than teenage acne vulgaris. However, teenage girls begin to notice those premenstrual “ups and downs” as they get older. Many women know that lesions can appear and disappear more quickly than with teenage acne.

Describe the symptoms

Post-adolescent skin is different from teenage acne.

  • It is less common to see blackheads or whiteheads (comedones).
  • Most breakouts are mild to moderate.
  • It is rare to see significant scarring. However, the term “significant” can refer to a relative.
  • Lesions are more common on the lower cheeks, the chin, and along and below your jawline. While some women may experience breakouts on their chest or back, most people have only blemishes on their faces.

Most breakouts are limited to small inflammatory nodules (pimples bumps, zits, zits), pustules, and inflammatory papules. For an example of adult-onset breakouts, see the color section in this book. You can have superficial or deeper papules and pustules. Some women refer to certain papules as “deep ones”, those that feel under the skin. (If you have ’em, then you will understand what I mean. Deeper ones are often palpable and more perceptible than the visible.

These are papules or pustules that don’t reach the skin’s surface and could never. These deep lesions can grow larger and are called cysts (or nodules). Nodules can be tender, hard lumps that can persist for several weeks or even months. They can grow up to an inch in size and may leave scarring after healing. Adult-onset acne is rare. However, scarring and nodules are not common. It is not always easy to diagnose adult-onset acne. Adult-onset acne may be confused with other similar disorders by your healthcare provider.

  • Rosacea: Rosacea is characterized by facial lesions containing acne-like pustules and red papules. Both rosacea, as well as acne, can be present together.
  • Pseudofolliculitis Barbae and Keratosis Pilaris: These conditions affect hair follicles and can sometimes look a lot like acne.
  • Endocrinopathy: Sometimes what appears to be a simple case of acne vulgaris or adult-onset acne can be due to an underlying hormonal abnormality, called endocrinopathy (pronounced en-de-krin-op-ath-ee). Sometimes, this can make it difficult to control acne. Your doctor should evaluate other options, such as blood tests to determine if there are higher or lower levels of hormones.

Emotional toll

Acne can be as difficult for adults as for teens. A few pimples can make it difficult to find work, be social, or have a good time dating. Even mild acne can make it seem small to others and cause people to miss out on potential opportunities and relationships. There are effective treatments available for mild and severe acne. Your condition can be improved. For stories about patients suffering from different degrees of acne, see the sidebars at the end of this chapter. You may have the same type as some of these patients.

Emerging at Any Age

Acne develops in the teenage years due to an increase in androgens, male hormones present in both men as well as women.

These hormones stimulate the glands and cause them to enlarge. They also produce excessive oil which promotes acne lesions. The vast majority of adult-onset women with acne aren’t affected by elevated levels of testosterone. They respond to normal levels of estrogen and, in a lesser extent, to progesterone. Both of these hormones have androgen effects. Estrogen, the other major female hormone, has an opposite effect (or estrogen) and tends to reduce acne.

In addition to a woman’s own hormones, adult-onset acne may be related to and heightened by, the ingestion of external hormones and drugs that have androgenic effects such as those contained in certain oral contraceptive medications, food products, and performance-enhancing drugs. The sections below will discuss common areas in your life where acne may be an issue, as well as the reasons why.

Acne and your menstrual cycle

You probably already know about the little red bumps that pop up on a monthly basis. You are probably familiar with those unsolicited visitors that appear and disappear like clockwork during menstrual cycles. These unwanted visitors usually disappear after a few days but can sometimes persist for up to a month. It’s not fun!

Pimples are most common right before your period. This is when estrogen levels drop and progesterone levels increase. It’s usually about two to seven days before your period. With this extra oil, acne can occur. You may not notice a connection between pimples and your period. They will sometimes erupt spontaneously right before an interview, wedding, party, or public speaking engagement. That’s great! Great!

Acne and pregnancy: New baby, new bumps

Acne can be unpredictable during pregnancy. Some women are blessed with clear skin and the “glow” of pregnancy. Enjoy it if this is you! But don’t get overconfident. It is common for acne to recur after pregnancy even though it has almost disappeared. Existing acne can get worse. The hormonal changes that occur during pregnancy can be quite dramatic. Your estrogen and progesterone levels are increasing, which means your skin is more sensitive to changes in hormones. Some women may develop acne when they are pregnant.

This is even though they have never suffered from acne in their youth. No matter how many times you’ve had acne in the past, pregnancy is a normal time for it to occur. It is impossible to prevent acne from developing during pregnancy. However, patience will help your skin to heal and return to its pre-pregnancy condition. Most lesions that occur during pregnancy are inflammatory and appear as papules or pustules. When hormone levels are rising, acne tends to get worse in the first trimester (the three months of pregnancy).

Progesterone, which is more male hormone-like than estrogen, causes your skin to secrete more. This can cause more acne. Your sebaceous glands can also go into overdrive during the first, second and third trimesters. This can lead to more severe and frequent breakouts. Breastfeeding can trigger some hormones that cause acne. You may want to continue treating those pimples. As I will mention, certain medications that you take or apply to your skin could end up in breast milk.

Pregnancy safe acne medications

If you are pregnant or nursing, it is best to say no to unnecessary drugs. You want to make sure your baby is safe from any potentially harmful substances. A topical acne-fighting cream is the best option for treating acne during pregnancy. Talk to your doctor about your acne treatment options if you are planning on getting pregnant. You should not use certain medications to treat acne if you’re not pregnant. They could be harmful to the developing fetus. Your doctor might recommend the following topical treatments during pregnancy:

  • Erythromycin is a topical antibiotic that can be found in many products.
  • Benzamycin Gel: Benzamycin Gel combines erythromycin and benzoyl peroxide.
  • Azelaic acid is a natural chemical that yeast produces. It is the active ingredient of the prescription drugs Azelex or Finevin.

Azelaic acid is classified by the U.S. Food and Drug Administration as a pregnancy-category B drug. This means that animal reproduction studies have not shown a risk to the fetus. However, there are no well-controlled and adequate studies on pregnant women. This drug should not be used during pregnancy, or by nursing mothers, as it is possible for the drug to pass into the mother’s milk.

I would recommend you avoid any oral medications that are used to treat your acne while you are pregnant. If your acne is severe, you can take oral erythromycin if you are not allergic. Your dermatologist might recommend another oral antibiotic if you are allergic to it or if it isn’t working.

Drugs that could be dangerous for developing fetuses

Some topical and oral medications are classified as pregnancy category C drugs by the FDA. The FDA categorizes some topical and oral medications as pregnancy category C drugs. This means that it is not known if the medication will cause harm to unborn babies. However, benzoyl peroxide and sulfacetamide have been around for years and there has never been any evidence that they are harmful to a foetus. There is no definitive evidence to support the use of some of these drugs, so it’s best to avoid them, unless your dermatologist or healthcare provider tells you otherwise. These acne creams have been around for many years. They are safe to use during pregnancy and nursing.

Benzoylperoxide: This drug is known for its long-lasting effectiveness. It is very effective in treating acne and can also be bought over-the-counter (see Chapters 7, 9, where I discuss topical treatments and the many benzoyl peroxide products available). There have been no reports of any problems with benzoylperoxide in pregnancy. Although benzoyl-peroxide is generally safe for use during pregnancy, it’s not known if it passes into breast milk. The FDA did not require testing of this product, as it has been in use for so many years. You should not use benzoylperoxide topical if you are pregnant or nursing your baby. Then you can decide if the risks and benefits are acceptable. It is best to use a combination product that contains erythromycin, such as Benzamycin Gel if you are pregnant or nursing. I will discuss this later.

Topical retinoids include tretinoin and Retin-A as well as Differin, Tazorac and Tazorac. Although there is very little absorption of topical steroids that could reach a fetus and no evidence that they can cause harm to an unborn baby, it’s best to stop using them once you become pregnant.

Clindamycin: This antibiotic is available as prescription products such as Cleocin T and several generics. It has not been proven that clindamycin can cause pregnancy. Combining clindamycin with benzoylperoxide can also be found in Duac Gel and Benzaclin Gel (see Chapter 9). If you’re pregnant or planning to become pregnant, it is not recommended to use products that contain clindamycin.

Aczone Gel: This gel contains dapsone. When dapsone has been applied topically, there is very little absorption in the bloodstream. However, when administered orally, it is known to be excreted in milk.

Birth defects have been linked to oral drugs

If you are pregnant, I advise against taking any oral medication to treat your acne. If your acne is severe, you can take an oral penicillin derivative such as amoxicillin if you are not allergic. Your dermatologist might recommend another oral antibiotic if you are allergic to penicillin, or if it isn’t working.

Your unborn baby can be affected by oral drugs. These cases are a clear indication that your baby may be at risk of serious birth defects if they take oral drugs. If you are pregnant or considering becoming pregnant, you should not use the following medications:

Tetracycline: Tetracycline (and its derivatives minocycline or doxycycline) may inhibit bone growth and discoloration in a fetus.

Hormones: Anti-androgens like spironolactone, which is often used to treat acne, may block testosterone and interfere with the normal development of a male fetus. This can lead to feminization.

Oral isotretinoin, also known as Accutane (or-so-treti-ne), is a powerful medication that is used to treat severe acne nodularis in carefully chosen patients. This drug can cause serious fetal abnormalities. Oral isotretinoin has many restrictions, which are understandable. Infants born to mothers who have been exposed to oral isotretinoin may develop serious birth defects. They should not be taken during pregnancy. Problems can still arise even if a woman is pregnant within a month of stopping taking the drug. Pregnancy is also associated with an increased chance of miscarriage and premature births as well as an infant death.

Recently published Swedish research showed that certain heart defects were more common in children born to mothers who took oral erythromycin during the first trimester of pregnancy. However, it is not certain that other factors contributed to the increase in malformations. These malformations did not increase after penicillin treatment.

You’re never too old

Many women go through menopause with their acne not getting worse. Yes, acne can occur during and after menopause. You may have thought that your years of acne and memories were over, but they are back just when you think your skin is clear. You’re not experiencing second adolescence. It’s the pesky hormones! While hormonally-influenced acne usually begins between 20 and 25, it can continue to affect women after 40, and even into their menopause. Acne can be a side effect of all the changes you experience during this period. Although acne is rare after menopause, it can occur when estrogen levels decrease and testosterone becomes the dominant hormonal.

Acne as an Adult Man

For most men, acne that appears after the age of 20 is not common. The bad news is that adult acne lesions tend to be more common on the back and chest in men over 20. It’s often called “backne” when it appears on the back. If you’re a man with acne, chances are one of two things is happening: The teen version. Although most teenage acne disappears by the age of 20, it can still persist. A man who is an athlete: Acne has been more prominently seen on the backs and chests of athletes in recent years.

Many believe that friction and sweating can cause acne, as the primary areas are often found under clothing. You’ve used performance-enhancing drugs: Another, more likely, source of chest and back acne may result from the use of performance-enhancing preparations that contain such ingredients as creatine, colostrum, and, of course, anabolic steroids such as testosterone and andro. There is no reason to believe you have acne. A dermatologist may be able to tell you if you aren’t suffering from rosacea or folliculitis. This can occur when you shave your head, chest, and back. Men are more likely to suffer from severe acne scarring than women. Men may have scarring from acne lesions, particularly if they had severe acne as teens.

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