Did you ever feel that you were too old for breakouts? Whether it is the adult or teenage form, acne can make people afraid to go out in public, anxious in social gatherings, avoid mirrors at all costs and wear tons of make-up to mask their unsightly scars. Your young children might have even asked you, at one point, why you have all those dots on your face. Clearly, acne carries emotional ramifications which, not only lower self-esteem, but can also lead to social withdrawal, anxiety and even depression.
Differences between adult and teenage acne
Did you know that men and women are equally afflicted with acne during the teenage years, but women have twice the risk of men in adulthood? Acne in adults may be either persistent acne which is childhood acne that never went away or late-onset acne that appears for the first time. Late-onset is less common, while persistent acne makes up 70 to 80 per cent of acne sufferers. The majority of acne in adults is focused on the lower portions of the face, around the chin, mouth and jaw line while acne in adolescence includes broader areas of the face. Adult acne may be more challenging to treat, which is not surprising, given the fact that adult skin is more sensitive, less elastic and heals slower than teenage skin. Unlike juvenile acne, which tends to be oily, adults typically have dehydrated skin which is more problematic for adults since acne medications are notorious for producing side effects of irritation and dryness. The already moisture deficient adult skin cannot afford to get even drier. There is also a misconception that teenagers only get acne; therefore, adults may be more embarrassed to seek treatment. Acne can be socially crippling for any individual - man or woman, adult or teen. However, unlike a woman, a man does not have the luxury of covering up his acne with make-up. There is also a perception that adults generally accept acne as being a part of life whereas teenagers, with their vulnerable egos, may be more traumatized by acne than adults. This is not always the case as research shows that adults with acne scars lacked self confidence, avoided eye contact, tended to be reserved, tried to conceal their face by hair styling and usually kept their head down.
The origin of a pimple
The starting point of the formation of a pimple is hormones. Androgens, like testosterone, stimulate the glands in the skin to produce oil. A blocked pore is caused by too much oil and the accumulation of skin cells that cannot be shed off. This blockage is a breeding ground for Propionibacterium acnes bacteria naturally found in the skin, which results in the release of irritating skin chemicals. Our immune system then comes to the rescue to help us fight off the bacteria; this inflammatory reaction is what creates the unattractive redness, swelling and pus, then voila`, a pimple is born!
6 Dos of Skin Care
1. Always moisture as adult skin tends to be on the dry side.
2. Wash the face twice a day to remove excess oils with mild facial cleansers.
3. Wear an oil-free minimum SPF 30 sunscreen even in the winter to reduce skin scars.
4. Follow a low-fat, high fiber diet that includes lots of fruits and vegetables.
5. Use oil-free products.
6. Reduce stress, stay hydrated, exercise and get regular sleep.
6 Don'ts of Skin Care
1. Vigorously scrub your skin which will aggravate acne.
2. Pick or squeeze pimples.
3. Rest your chin or cheek in your hands.
4. Wear make-up if you really do not have to.
5. Eat foods that you know trigger your acne.
6. Get lazy with your skin; keep up good skin care.
Acne medications
There are different formulations of products: creams, gels, solutions and lotions. Creams are usually used for sensitive and dry skin because they tend to be less irritating and less drying. Gels are used for oily skin since they have a better drying effect but may cause more burning and irritation. Solutions help oily skin and are mainly used with antibiotic skin products. Lotions can be used for dry and oily skin and their advantage is that they can be easily spread in larger areas of the body if needed for back, chest and neck acne.
Mild to moderate acne: benzoyl peroxide, salicylic acid and alpha-hydroxy acids (lactic acid and glycolic acid).
- Start with lower strengths then move up if you do not see improvements within several weeks.
- May take 2-3 weeks to see any benefits.
- Causes mild dryness and irritation (use an oil-free moisturizer).
- Can bleach clothing so make sure your skin is dry before touching any cloth.
When all else fails...
Visit a dermatologist. Sometimes, none of the above treatments will be effective and stronger medications are needed. Since adult-onset acne may not always respond to the typical acne products, it might be wise to see a skin specialist who specializes in skin care and hormones.
Stronger topical products: tretinoin (Retin-A), adapalene (Differen) and azelaic acid (Azelex).
- Sunscreen is a must since these medications increase your skin's sensitivity to sunlight.
- Applying too much will surely cause flaky, scaly, dry lizard-looking skin; more does not work faster and a small amount goes a long way.
- Do not give up on the medicine because you think it is not working; you need at least 3 months to see results.
- Avoid the eye and lip area and the creases near the nose because those are sensitive areas and are more prone to drying and peeling effects of the medications.
- Stay away from direct sunlight and avoid sun-tanning during use of these medications.
- Apply at night before bed, not in the morning.
- Make sure to wait till your face is completely dry before applying.
- If you have to remove unwanted facial hair, especially of the lip area, use caution since waxing can easily peel off skin leaving a sore mark for several days; threading and tweezing are preferred when using these products.
- Burning, irritation, redness and stinging are common side effects.
- If too much dryness occurs in the beginning of use, it is okay to use every other day or every third day then slowly increase usage to daily.
Antibiotics: clindamycin and erythromycin topical solutions are applied on the skin. Oral antibiotics such as tetracycline, minocycline and erythromycin may also be used but only under a physician's supervision. Side effects may include rashes, diarrhea, stomach upset, yeast infections, bacterial imbalances and sun sensitivity. Oral antibiotics must be used for months to clear up acne and if you are using birth control pills to prevent pregnancy, you must use an extra form of contraception during antibiotic use to avoid pregnancy; antibiotics make birth control medications less effective, so you might find yourself with an unplanned positive pregnancy test if you do not use a second reliable back-up method to prevent pregnancy while taking antibiotics.
Hormonal treatment: women who do not respond to medicated skin products and antibiotics may benefit from oral contraceptive pills to balance out the hormones, since many with hormonal acne break out around their periods. Mild side effects which go away with time may be breast tenderness, bloating and nausea. Anti-androgens may also be prescribed by a specialist, lowering androgens in the body thus producing less acne outbreaks. However, blood tests are required before treating acne with any hormonal medications, so be sure to consult with a specialist.
Severe acne: Oral high doses of Vitamin A, such as isotretinoin (Accutane), can be used for severe acne with lots of scarring. This is a potent medicine and used as a last resort. It is absolutely critical for women not to get pregnant while taking this medication because there is an extremely high risk for severe birth defects. Before treatment, women of childbearing age must have two negative pregnancy tests. Females must be on two separate forms of effective birth control from one month prior to use, during use and for one month after discontinuing use. Since it is unknown whether a man taking isotretinoin can cause birth defects, it is advised not to impregnate a woman. In addition, anybody taking this medication should be carefully monitored and get periodic blood tests.
It is normal to feel frustrated because you feel like you are going through puberty all over again. Do not expect results overnight. Acne treatments take months to work, not days. Your skin may look even worse for the first few weeks before seeing improvement as blemishes under the skin start coming out. Sometimes, you might have to use multiple treatments before finding the right one. Do not just keep waiting for the acne to clear up on its own, especially if you have been suffering with it for a long time; take the extra time and visit a dermatologist because you might be just one step closer to clearer skin.
Dr Sandy Zabaneh is a US board-certified Doctor in Pharmacy who holds a Bachelor of Science degree in Psychology, as well as a Bachelor of Science degree in Physiology from University of California, Davis. She is the Health Editor of U Magazine, clinical pharmacy consultant and life coach. Dr Sandy likes to follow the motto set forth by the World Health Organization in 1948: Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. Check out her blog at www.sandyzabanehblog.com www.sandyzabanehblog.com
