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Everything You Wanted to Know About Adult Acne

Adolescent acne is challenging enough. But when acne strikes in your 20s, 30s, 40s or 50s, it can be devastating. It can shake your confidence professionally and socially, lead to anxiety and depression, cause scarring and even serve as a sign of a more serious health condition.

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But don't fear: Almost everybody with adult acne can be treated successfully.

Unlike teen acne, which affects more boys than girls, adult acne is more common in women. Most adult acne persists from adolescence; however, about 10 to 20 percent of cases occur sporadically after age 25, affecting even people who never had it in their youth.

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What Causes Acne?
The physiological pathways to acne are the same, regardless of age. Acne develops when oil-producing glands in the hair follicles produce too much sebum, an oily substance that lubricates the skin and hair. Excess sebum accumulates in clogged pores and provides fertile ground for a type of bacteria called Propionibacterium acnes. Subsequently, inflammation sets in, causing redness, swelling and pimples.

It may be tempting to blame breakouts on pizza, but the relationship between food and acne is unclear. While some evidence suggests that dietary components, such as starches, highly processed foods and milk, might worsen acne in some patients, it's very difficult to control acne through diet modification alone.

We do know that the following factors can contribute to adult acne:

Medication side effects: Drugs that may trigger acne in some people include prednisone, isoniazid, progestins, lithium and some seizure medications as well as B vitamins.

Hormones: In many cases, acne is linked to hormonal factors, particularly elevated androgen levels, male sex hormones also produced by women. Even when androgen levels are normal, medications that block them often help clear up acne.

Medical conditions: In some people, adult acne is a symptom of a more serious underlying medical condition, such as an adrenal or ovarian tumor; an inherited disorder called congenital adrenal hyperplasia; or polycystic ovary syndrome. You should see a dermatologist to rule out these conditions if you have any of the following signs:

Sudden onset of acne
Severe acne
Weight gain or obesity and acne
For women, having irregular periods or showing signs of virilization (such as hair growth on the face)

Acne-Fighting Medications
While managing acne can be frustrating for patients, numerous effective treatments are available. Dermatologists often prescribe several different drugs at once because various medications target different pathways of acne development, including the following:

For preventing clogged pores: Topical retinoids (applied to the skin), such as Retin-A, Tazorac or Differin.

For targeting bacterial and inflammatory pathways:
Benzoyl peroxide, azelaic acid, sodium sulfacetamide and topical or oral antibiotics, such as doxycycline or minocycline.

For hormonal-related acne:
Medications with androgen-blocking properties, including spironolactone and certain birth-control pills that contain both estrogen and progestin.

For severe cystic acne
Large, deep-set, fluid-filled bumps that can cause scarring can be treated with isotretinoin, an oral retinoid medication formerly sold under the Accutane brand, but is now available by a variety of other brand names.

When topical medications aren't effective, many adult women respond well to spironolactone, a generally well-tolerated medication commonly used to treat blood pressure. For those already considering oral contraception, a birth-control pill that counteracts acne may be a good option.

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Isotretinoin can be particularly effective for acne unresponsive to other treatments. However, like several other acne medications (including some topical drugs), you should never use it during pregnancy due to risk of birth defects.

Other Treatment Options
Treatments suitable for those interested in non-pharmaceutical options include laser therapy, chemical peels, photodynamic therapy and fractional laser technology, a skin-resurfacing treatment for acne scarring. Fillers also can help with acne scarring. But note, insurance often doesn't cover these procedures.

In addition to medical treatment, try these tips to help keep acne from worsening:

* Use oil-free, noncomedogenic makeup and hair products

* Avoid picking at blemishes and touching your face (even with your cell phone!)

* Wear loose-fitting clothing when exercising

* Use a gentle face cleanser and avoid rubbing vigorously

Keep in mind that acne won't improve overnight. Successful treatment depends on commitment and patience because acne often gets worse before it gets better, and medications may take up to a few months to yield results. As challenging as it may be, sticking to a prescribed treatment regimen offers the best chance for an acne-free adulthood.

-- Dr. Leger

Readers — Do you struggle with adult acne? What types of treatments work best for you? What are your tips and tricks for getting rid of pimples? Leave a comment below and let us know.

Marie C. Leger, M.D., Ph.D., is a board-certified dermatologist who practices both medical and cosmetic dermatology. She holds the academic appointment of Assistant Professor in The Ronald O. Perelman Department of Dermatology at NYU Langone Medical Center. Dr. Leger specializes in acne, rosacea, psoriasis, eczema, melasma, skin of color, rashes, skin-cancer screening, botulinum products, laser hair removal and general skin wellness. In addition, her research interests include technology and health, telemedicine, tattoo reactions and international dermatology.

Dr. Leger completed her dermatology residency at New York University, where she served as chief resident, and attended medical school at the University of Illinois. She also earned a Ph.D. at the University of Illinois in communications.

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