What You Need to Know About Acne
The acne cycle is the same at any age... Hormones prompt the oil glands to secrete oil, the pores get clogged with dead skin cells, bacteria cause the area to get red and inflamed, and you have a pimple. Teenage acne is due to the surge of hormones associated with puberty, and adult acne can be related to hormonal surges that occur with the menstrual cycle.
Putting these similarities aside, I believe that stress plays much more of a role in adult acne than teenage acne. We often underestimate the effect stress has on our bodies, but on a biological level, working too much and sleeping too little does cause hormonal changes (mainly elevated levels of cortisol) that send oil glands into overdrive and in turn cause acne.
Although the basic tenets of acne treatment are the same, there are subtle differences between adult and teenage skin which may affect how we approach treating acne. As we get older, our skin gets drier, so it is important to listen to your patient and see what type of skin they have and perhaps use gentler products than you would in teenage skin.
The first step in clearing acne is to cleanse properly with a product designed for your skin type. Wash in the morning, at night and after exercise, but avoid washing too much and using harsh scrubs, which can actually make matters worse. If your skin is really dry and/or sensitive, use a cleanser geared toward sensitive skin. I like SkinMedica's Sensitive Skin cleanser because it cleans without over drying the skin. If you're on the oily side, try a salicylic acid wash, such as SkinMedica's Purifying Foaming Wash, to help gently and effectively exfoliate dead skin cells and unclog pores.
We like to pair these cleansers with the Clarisonic Skin Care Brush to help deep clean acne-prone skin without causing irritation. This device uses sonic frequency to remove oil, dirt and debris from the skin, while gently exfoliating to keep pores clear. The Clarisonic also leaves skin feeling smooth and soft and is a great addition for any skin type.
After cleansing, we must address the bacterial component of acne. Topical benzoyl peroxide (BPO) and either topical or oral antibiotics can help target this part of the acne puzzle.
Benzoyl peroxide washes and creams can be found in many over-the-counter preparations, but these may be too harsh for patients with sensitive skin. Pharmaceutical companies have also come out with many effective antibiotic/BPO combinations, which have been found to both decrease bacterial resistance and be more effective than either product alone. Finally, low dose oral antibiotics may be needed to get more inflammatory acne under control.
Retinoids are essential for preventing blemish formation and minimizing breakouts, but some adults cannot tolerate prescription retinoids, even using them every other day. In these cases I recommend SkinMedica's Tri-Retinol Complex, which can be tolerated by most skin types and prevents whitehead and blackhead formation without causing redness
I have found that breakouts along the jawline and neck in adult women seem to be linked to their menstrual cycles. For prescreened patients, spironolactone or birth control pills can help prevent bothersome monthly flare-ups. Hormonal acne can also manifest with more cystic and painful lesions. Low-dose steroid injections done in the office can offer a quick fix to treat these lesions. Accutane is a very effective option for those people that have been suffering from acne for most of their lives, and cannot get any relief. We closely monitor patients during this five- to six-month course of treatment with monthly office visits and blood work.
Peels do not get enough attention in acne treatment. These are terrific for addressing both existing acne and the resultant scarring. Older patients may not want to be on oral antibiotics or birth control pills and need other options. In addition, they have more concerns about appearance as they interact with people in the workplace. These patients have seen rewarding results after a series of chemical peels such as SkinMedica's Vitalize peels.
Acne can have an effect on self esteem at any age, but your dermatologist can help. If you've tried over-the-counter products to no avail, your dermatologist can recommend a skin care regimen and prescribe medications that have been proven to improve acne.
Mona Foad, M.D., FAAD
in On Call
on June 23rd, 2011