Acne is the eighth most common skin disorder globally with a prevalence across all ages of around 9.38%.¹ It is caused by a buildup of dead skin cells and sebum²—an oily substance that the body produces normally to lubricate the skin and hair—in the hair follicles.
The blocked follicle can be open or closed, forming a blackhead or whitehead, respectively. If the blocked follicle becomes infected, it can form a pustule, cyst, or even an abscess.³
Acne is most common in adolescence, with rates approaching 100%.¹ However, it is also possible to get acne as an adult.
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Adult acne occurs in people over the age of 25. One study looking at randomly selected individuals with similar demographic characteristics found the prevalence of adult acne to be around 3% in men and 12% in women.⁴
Adult acne can be divided into two groups: persistent and late-onset. Persistent adult acne starts during adolescence and continues into adulthood. Late-onset acne appears for the first time when you are over 25.⁴ Both persistent adult acne and late-onset adult acne are more common in women than in men.⁴
A study looking at visits to the dermatologist for acne found that female patients accounted for two-thirds of visits; one-third of all dermatology consults for acne were by women over 25 years of age.³
Adult acne classically presents with inflammatory lesions on the lower third of the face, typically along and below the jawline. These can form nodules and cysts that can scar, leaving hyperpigmented (darker) marks.⁴
Acne doesn’t only affect your skin. It has a psychological impact, too. Acne has been associated with poor self-image, depression, and anxiety, and has been found to have a significantly negative impact on quality of life.³ The decreased quality of life resulting from acne is not limited to teenagers and is also found in adults suffering from this skin condition.⁴
There are various causes of adult acne. If you suffer from it, one or more of the following factors may be causing or contributing to this disorder.
Hormones play a major role in the development of adult acne, especially in women. Fluctuating hormones around the time of menstruation may trigger cyclical monthly acne breakouts.
Changing hormone levels associated with pregnancy and menopause can also trigger acne.⁵
Androgens stimulate the production of sebum. Disorders in which women have higher than normal androgen levels, such as polycystic ovarian syndrome, are associated with increased incidence of acne.³
Take a look at your family history. If you have a close relative who suffers from acne, you will have a higher chance of developing it as well.
Studies in twins have shown that skin sebum levels (i.e., how oily your skin is) are genetically determined. If you have higher sebum levels, you are more likely to struggle with acne.⁵
Cosmetics and skin or hair products that block your pores or contain a lot of oil can contribute to adult acne formation.⁴
Some medications may trigger adult acne. Typical culprits are corticosteroids and hormonal medications, such as certain contraceptives.
Anabolic steroids can also worsen adult acne or cause acne flare-ups.
If you think that your acne may be caused by your medication, speak to your doctor about a possible alternative. It’s important that you don’t just stop your medication without consulting your doctor first.
Stress can trigger the production of androgens. Androgens cause sebum production. When your stress levels rise, androgen levels increase and oil production increases as well. Oilier skin has a higher likelihood of acne development.⁴
Studies have shown an association between job stress levels and acne severity in adult women.⁵ It has also been shown that women with mandibular acne (the typical adult pattern of acne around the jawline) reported greater daily stress, and were more likely to have psychologically stressful jobs than women without it.
Smoking has been linked to an increased prevalence of acne.³ It disrupts normal follicular keratinization, leading to an increased risk of follicles becoming blocked.⁶ It also promotes inflammation of blocked follicles.
The treatment of adult acne depends on how severe it is.² Acne can vary from mild to moderate to severe. The following table can help you understand how severe your acne is.
Usually, topical treatment (treatment that you apply to your skin) is all that is necessary to treat mild acne. Topical treatment acts either by drying out your pimples, unblocking your pores, or fighting infection.
Topical treatments may include:
Benzoyl peroxide cream
Salicylic acid cream
Antibiotic cream or lotion
Moderate acne is usually treated with a combination of topical and oral treatment.
Topical treatment may include:
Benzoyl peroxide cream
Antibiotic cream or lotion
Oral treatments used together with topical treatments may include:
Antibiotics (may need to be taken for up to 12 weeks to be effective)
Some forms of the combined oral contraceptive pill in women
Severe acne is usually treated with oral isotretinoin. This is an effective treatment because it targets all four causes of acne by unclogging pores, decreasing sebum production, and reducing acne-causing bacteria and inflammation.
However, oral isotretinoin is associated with potentially severe side effects. It should always be prescribed and monitored by a dermatologist.
Oral isotretinoin may, at worst, cause malformations in the unborn babies of women taking it. Any woman taking oral isotretinoin is advised to use two forms of effective contraception to ensure that she does not get pregnant during treatment.
Spironolactone, a drug that inhibits aldosterone production, can be used for the treatment of moderate to severe acne in women.
In all forms of acne, cosmetics and face products containing oil should be avoided. Opt for water-based solutions and stick to products that are non-comedogenic, non-acnegenic, or oil-free.
Antibacterial or abrasive soaps, alcohol pads, and heavy exfoliation provide no added benefit and may further irritate the skin or damage it, allowing infection to occur.
Unfortunately, moderate to severe acne can leave scars. These may be darker lesions (hyperpigmented lesions) or pits.
Scarring can be treated by:
These treatments remove the superficial layers of the skin to varying depths, depending on the severity of the scarring, and encourage new collagen growth.
It’s best to speak to your dermatologist or doctor about the best option for you.
If you have mild acne, you can try over-the-counter treatments such as benzoyl peroxide or salicylic acid creams to manage it.
If non-prescription medications are not effective, or if your acne is moderate to severe, you should see your doctor or dermatologist so that they can prescribe an appropriate treatment. It’s important to know that there are effective and safe treatments available to get your acne under control.
Adult acne is acne that is present in individuals over the age of 25. It may be persistent, from adolescence, or may only appear when you are an adult. Adult acne is more prevalent in women than in men.
There are many causes of adult acne. It may be triggered by hormonal changes, stress, medication, the cosmetics you are using, your genes, or smoking. Eliminating the triggers that you can, such as the cosmetics you use or quitting smoking, may alleviate the severity of your acne.
Because adult acne has been linked to low self-esteem, anxiety, and depression, it’s important to know that you can get treatment for it.
Acne management is dependent on the severity of your acne and can range from topical creams to oral medication. Consult your doctor or dermatologist about the best management for this skin condition.
Acne | MSD Manual
Adult Acne | American Academy of Dermatology Association
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