Diagnosing and Treating Acne in Adults

Adult Acne

Adult acne or acne vulgaris is one of the most common conditions in the United States today. Adult acne affects more than 17 million people, or roughly 25 percent of adult men and 50 percent of women. Many adults develop or have recurring acne once they enter their 30s and 40s.

Adult acne can result in significant psychological and emotional strain, including depression, anxiety and embarrassment. Acne is a condition that unfortunately impacts ones social life and even ones personal life. Most patients who seek out treatment for acne suffer from lowered self-esteem because of their condition.

If you suffer from acne, whether mild or severe, know there are many effective treatments available that can help remove or improve your condition. Remember you are not alone. Consult with your doctor to find effective treatment strategies to improve your quality of life and your well-being.

Causes of Acne and Biology
What causes acne? There are several biological causes for acne, including:
  • Increased sebum production.
  • Inflammation or infection of the skin.
  • A condition called retention hyperkeratosis
  • Bacteria in the skin follicles
  • Hormonal changes.
There are also many external causes that can contribute to adult acne, namely the use of cosmetics and other skin creams and lotions. Water based products that are less comedogenic are less likely to irritate and clog pores, resulting in acne. Women are infamous for applying products to their skin to improve its appearance. Keep in mind when it comes to acne, sometimes less is more.

Certain soaps and detergents can also irritate skin and stimulate the body to develop of acne. Clothing that irritates the skin including bra straps or turtlenecks may worsen an existing condition.

Heavy sweating can also cause acne to develop. If you work out regularly, be sure to wash off sweat from your face, neck, chest and back to help prevent pores from clogging. Many patients believe that their diet can also contribute to acne outbreaks. Researchers are still working to discover whether diet plays an active role in the development of acne. There is some evidence suggesting that psychological stress can make acne worse.

Signs and Symptoms of Acne
Adult acne much like acne that occurs during puberty surfaces on the following areas of the body:

  • Face
  • Neck
  • Back
  • Chest
  • Upper Arms
  • Shoulders
Adult patients with acne may develop inflamed lesions, blackhead and whiteheads that may lead to scarring if severe. Patients with darker skin complexions may scar from acne lesions.

Doctors may classify adult acne in several different categories including:
  • Type 1 - This acne presents with comedones (whiteheads and blackheads) and few small-inflamed lesions or papules (pimples). Patients do not have scarring.
  • Type 2 - Patients with type 2 acne will have many facial acne lesions (pimples) and comedones.
  • Type 3 - Patients with Type 3 acne will have many comedones and papules or pustules that cover areas including the chest, shoulders and back. They may experience scarring and may also have some cysts or nodules.
  • Type 4 - This is the most severe form of acne. It results in severe scarring and may include severe cysts on the face and other areas of the body.
When you go to your doctor for treatment your doctor will take a medical history. Your doctor will look for symptoms of endocrine disorders that may contribute to acne. One example of an endocrine disorder that causes severe acne in women is polycystic ovarian syndrome or PCOS. This condition causes hyperandrogenism, which can contribute to acne development.

Occasionally acne may appear with another disorder such as Cushing's syndrome or congenital adrenal hyperplasia.

There are even medications that can cause acne. Some medications known to worsen acne and other skin conditions include:

  • Androgens
  • Azathioprine
  • Bromides
  • Barbiturates
  • Corticosteroids
  • Cyclosporine
  • Halgens
  • Iodides
  • Lithium
  • Phenytoin
  • Psoralens
  • Vitamins B2, B6 and B12
Your doctor will take note of where acne is located on your body, whether you have any scarring and whether any inflammation or infection exists. Your doctor will also look for signs of hirsuitism. This is a condition that can cause excess hair growth and acne in women.

Treatment of Acne Vulgaris in Adults
The treatment your doctor selects will depend on several factors including the type of acne you have and your previous medical history. There are many topical treatments available that are effective for treating acne.

Let's examine each of these in more detail.

Topical Retinoids - Doctors usually prescribe these agents to treat patients with comedonal acne or less severe forms of acne. Topical agents include all-trans retinoic acid, adapalene and isotretinoin. You can apply topical retinoids in gel form or using a cream or lotion. Creams and lotions are more moisturizing and soothing than gels, which can be drying. Solutions are also available to cover large areas such as the back and shoulders. You need to apply most of these medications twice daily to help reduce acne.

Topical Agents - There are other topical products that you can apply to the skin to relieve mild to moderate acne, including salicylic acid, azelaic acid and glycolic acid. These treatments are useful for patients with sensitive skin. They are usually less harsh and drying than topical retinoid formulas.

Extraction - For mild cases of comedone acne your doctor may also extract acne. Your doctor will excise lesions using a sterile lancet or blade by applying pressure to the skin.

Benzoyl peroxide - This is usually a good treatment for patients with mild to moderate inflammatory acne. Benzoyl peroxide acts as an antibacterial and an agent that removes pimples. You usually need to apply Benzoyl peroxide twice daily. You may combine this treatment with a topical retinoid. Your doctor may prescribe peroxide in a strength ranging from 2.5 to 10 percent depending on the severity of your condition.

Topical antibiotics - Your doctor may also prescribe topical antibiotics to remove moderate inflammatory acne. Sometimes use of topical antibiotics may promote the growth of more treatment resistant forms of acne, though usually this risk is reduced when benzoyl peroxide is combined with topical antibiotics as a comprehensive treatment therapy.

Oral antibiotics - Your doctor may prescribe oral antibiotics to help improve moderate to severe forms of inflammatory acne. Oral antibiotics may be used with hormone therapy to help minimize acne flair ups in women. Oral antibiotics prevent the growth of acne by inhibiting the growth. Typically a doctor prescribes oral antibiotics for four to six months. Some common antibiotics used to treated acne include:

  • Tetracycline
  • Doxycycline
  • Minocycline
  • Trimethoprim-sulfamethoxazole
  • Clindamycin
  • Erythromycin
Use of oral antibiotics may cause yeast infections in women. Doctors typically use this therapy as a last measure.

Oral isotretinoin - This drug, commonly referred to as Accutane, is also used to treat moderate to severe forms of acne. It helps reduce sebum secretion. Accutane may help reduce acne for up to one year after treatment. Patients with severe forms of nodular or cystic acne, as well as acne that does not respond to other forms of treatment including antibiotics, may be candidates for Accutane treatment.

Women can't use this product if they are pregnant or want to be pregnant. Thus your doctor will likely want you submit to a monthly pregnancy test if you are taking this medication to prevent birth defects. Accutane is a known teratogen, thus may cause spontaneous abortions or life threatening congenital defects.

Accutane may also cause many side effects including:

  • Dry skin
  • Photosensitivity
  • Pruritus
  • Depression
  • Decreased night vision
  • Hepatic toxicity
Some of theses side effects are more common than others. Your doctor may recommend liver function tests after starting therapy to make sure use of accutane does not affect your liver or triglyceride levels. The good news is most of the side effects of this drug can be managed effectively.

Hormonal Therapy - Hormonal and corticosteroid therapy are other treatments used for moderate to severe acne. Hormonal treatments include treatment with estrogen or an antiandrogen. This treatment method is considered an alternative to treatment with isotretinoin. Usually patients using hormonal treatments will need to continue for three to six months.

More commonly doctors use glucocorticoids to treat women who produce too much adrenal androgen. Oral contraceptives are prescribed for women with low androgenic progestin levels. Triphasic combination oral contraceptive pills with the ingredients norgestimate and ethinylestradiol help treat acne in many women.

Laser Therapy - Laser therapy may help reduce moderate or severe acne in some women. Studies suggest that use of a pulsed dye laser may help improve acne. Researchers need to study laser therapy further as a treatment for adult acne.

Fortunately most cases of adult acne are not severe. If however you suspect that you may have an underlying condition causing your acne, such as polycystic ovarian syndrome, it is important you consult with your doctor about treatment measures. You should also see your doctor if your condition rapidly becomes worse or if you suddenly break out in pimples without cause.

If you have mild acne, consider cleaning your face or affected areas using many over-the-counter treatments. You might also try using gentler soaps and detergents. Any clothing that irritates the skin should also be suspect for causing allergies.

Consider talking with your doctor about oral contraceptive therapy. Researchers are working to develop new oral contraceptives as well as the ones currently available to help reduce acne in women.

Most importantly, don't fret. Work with your doctor to come up with a treatment plan that will help improve your quality of life and self-esteem. There are fortunately many new treatments available to treat acne, and every day researchers are coming up with even more ways to combat this common condition.

Related Resources:
American Academy of Dermatology