The Anguish of Acne
Dr. Susan Taylor’s Prescription for Acne

It is quite astonishing how many of my adult patients both at Society Hill Dermatology in Philadelphia, Pennsylvania and at the Skin of Color Center at St. Luke’s-Roosevelt Hospital Center in New York City are experiencing adult acne. Although many of us do not realize it, acne is a common problem among men and women in their 20s, 30s, and 40s. Many of these adults may not have had acne as teenagers so they are taken by surprise. I frequently hear my patients ask, “Acne at my age?” Yes, adults are now faced with bumps, blackheads and cysts. Whether it is the boardroom, the courtroom or the newsroom, it is often embarrassing. Often, colleagues and business associates may not view the acne prone adult as a competent professional based upon the adolescent appearing facial cysts and pimples. Teenage children might not listen to parents whose faces look like their 13 and 14 year old friends. The following information will allow you to more easily understand adult acne as well as provide easy ways to remove the anguish from adult acne.

What are the characteristics of adult acne?

• Adults with acne notice outbreaks of bumps, blackheads, whiteheads or cysts much like teenagers. These outbreaks may occur on the face, chest and/or back. Women are more prone to the development of outbreaks along the jawline and chin.
• The adult acne patient may not have had acne during the teenage years. Adult acne occurs from age 20 until age 50. It is often associated with stress with the worse outbreaks occurring when the adult patient is under severe stress.
• Adult patients with acne tend to have skin that is dry and sensitive as opposed to oily teenage skin.
• Hormonal influences may affect acne. Adult women often experience pre-menstrual flares of their acne. Abnormal hormonal levels may account for acne in some women.

What are the causes of acne vulgaris?

• Acne is caused by an over-production of sebum (oil) produced by the skin cells of the epidermis.
• A proliferation and overgrowth of bacteria also contributes to the formation of acne.
• The final factor is the plugging of facial hair follicles with debris from dead skin cells (clogged pores).

What are some of the triggers of adult acne vulgaris?

• There is a hereditary predisposition to acne vulgaris and acne is known to occur in multiple family members.
• Common triggers of adult acne in both men and women include emotional stress and hormonal fluctuations especially in women.
• Over-zealous facial washing or scrubbing can worsen acne particularly if acne puffs, rough sponges or rough wash cloths are used.
• Certain hair care products (mousses, gels and hair oil), oral medications (lithium and corticosteroids) and oil based make-up can exacerbate acne.
• Chronic friction or rubbing of the skin from a chin strap, weight bench or even the telephone receiver may also exacerbate acne.
• A common misconception is that diet is related to the development of acne. Dietary factors have no impact upon acne so you may consume all of the chocolate, fried foods and greasy food that you would like.

What are the treatment options available for adults with acne vulgaris?

• Although there is no cure for acne vulgaris, there are many effective treatments. Finding the best treatment often involves several visits to your dermatologist. I have found that combinations of medications both topical and oral provide the most effective treatments for my patients.
• Many adults opt to begin their treatment with over the counter products containing either benzoyl peroxide or salicylic acid. Although these products are helpful in many cases, one word of caution is that these products may dry the sensitive skin of adults. Always avoid the maximum strength preparations and if you are able to tolerate the lower strength products without difficulty, use them consistently for six to eight weeks. If you do not see improvement after that period of time, then you should consult your dermatologist for prescription medication.
• Prescription topical antibiotics in solution, gel, pads and lotion formulations, applied to the skin once or twice daily, are effective treatment for acne vulgaris for most adults. These antibiotics, which include clindamycin, erythromycin, sulfacetamide and metronidazole, improve acne because they reduce the number of bacteria proliferating on the skin.
• Another type of effective topical prescription medication for the treatment of acne is a retinoids. Retinoids unplug the follicles and prevent the formation of the earliest form of acne that is called a microcomedo. Your physician can select the most appropriate retinoid for your skin. The three retinoids to select from are adapalene, tazarotene and tretinoin.
• Oral antibiotics are often one of the most effective forms of therapy for adult acne. Usually an antibiotic from the tetracycline or erythromycin family is prescribed twice daily for several months. Antibiotics both decrease the skin’s bacteria and inflammation.
• Accutane is another prescription oral treatment for acne. Accutane is taken for a five month period of time and it is indicated for the treatment of severe cystic acne.
• The oral contraceptive pill has been demonstrated to improve acne is adult female patients. They may be used alone or in combination with other topical and oral medications.
• Stress reduction through exercise, meditation or other means can also serve to improve acne vulgaris.