Acne is one of the most common skin diseases in the general population, especially among adolescents. Adult acne is defined as acne that develops (late-onset acne) or continues (persistent acne) after the age of 25 years. Adult acne can affect up to 15% of women and it is less common in men.
The clinical features are quite characteristic, in that there are often multiple, deep inflammatory lesions along the jawline and chin and multiple micro-cysts or large whiteheads spread over the face. The deeper inflammatory papules along the jawline tend to be painful and obviously extremely frustrating for adult women. These deeper lesions have a high risk of producing permanent scarring or post-inflammatory pigmentation (PIH)
All acne is hormonally linked but there are often flare-ups premenstrually, during pregnancy, during peri-menopause, and menopause. On stopping the oral contraceptive pill, acne may flare up again.
Genetic or Hereditary Factors
More severe persistent forms of acne are often inherited from one of the parents.
Progesterone taken either orally by intramuscular injection, via implant under the skin or progesterone released from an interuterine device all might trigger or make acne worse. Oral, as well as topical corticosteroids, can also trigger acne. Similarly, oral mood stabilisers such as Lithium and Lamotrigine can also make acne worse.
Research has found that there is a relationship between stress and acne flare-ups. In response to stress, our bodies produce more of the male hormone which stimulates the oil glands to produce more sebum, leading to acne. This explains why acne can be an ongoing problem when we find ourselves under constant stress.
Excessive intake of dairy products and refined sugars has been shown to make acne worse.
If you have adult acne you should read the labels of your skincare products as you do not want to use too rich, thick or greasy moisturisers or sunscreens on the face and body. Always took for the terms oil-free and non-comedogenic in the products that you use.
Most people with adult acne will have more oily skin and therefore I would recommend a slightly foaming, neutral pH cleanser that cleanses your skin thoroughly without irritating it. There are various topical treatments that will help for the acne and you should look for the following ingredients – salicylic acid, niacinamide, azelaic acid, tea tree oil, and benzoyl peroxide.
If the acne is more severe especially the deeper papulopustular acne, oral tetracyclines may be indicated but these cannot be continued for too long a period of time. In my experience, many women with adult acne find it a very frustrating condition as they have acne as well as the start of fine lines and wrinkles.
Isotretinoin taken orally is the only drug that can cure you of your acne and this I prescribe frequently. It is generally a 6-7 month course and at the end of this period, there is an approximate 85% chance that the acne will stay away and not come back. This is a powerful medication so it needs to be given under proper supervision with regular visits to your doctor.
If the person with the acne is reluctant to take oral antibiotics, hormonal treatment or Isotretinoin, there is another option in the form of the Acleara Acne Clearing System. This consists of IPL treatment which reduces sebum production and has anti-inflammatory effects. It also has a suction device built into it that can extract blackheads and whiteheads. This device is available at certain clinics in South Africa.