Adult Acne: What’s the deal with that?

Acne is one of the most common reasons for visiting a dermatologist. Everyday I see several patients with acne, and many who are adult women. It is a myth that only teenagers suffer from acne. About 35% of women will suffer from acne at some point in their adult life – which just isn’t fair – to be fighting acne and wrinkles at the same time!

Why do we (I say we because I am part of the unlucky 35%) get acne as an adult? The theory is that most adult female acne is related to fluctuating hormones. If you think about it – our hormones fluctuate as adults frequently. There are normal monthly fluctuations and then you add fluctuations due to birth control, pregnancy, post pregnancy, perimenopause and menopause, it is a wonder that anyone has clear skin! 

Fortunately there are many treatment options for acne. When considering treatments in adult women it is important to remember our skin is aging and traditional acne medications may be too harsh. 

One category of topical treatment, Retin-A (also called tretinoin), is very good for light acne and is also anti-aging, a win-win! With Retin-A, I am very careful to prescribe the appropriate strength, as it can be drying and irritating to the skin. I usually prescribe a low strength and recommend applying a small amount (such as a fingertip) over a moisturizer and starting application every other night (or even every third night). It is important to use Retin-A at night because it is in-activated by sunlight. It is also VERY important to use sun protection if you use Retin-A because it will make your skin very sensitive to the sun.

Other topical treatments commonly used for acne are topical antibiotics and medicated washes (salicylic and glycolic are my favorite for mature skin).

If your acne is cystic (those big deep, red ones), scarring and more severe then we consider oral medications. Oral antibiotics can be used to clear the skin and creams are then used to keep the skin clear as oral antibiotics are not meant to be used long term. If someone needs a longer term treatment, an oral medication called Spironolactone can be very helpful. 

Spironolactone is a blood pressure medication often used off label for acne, it works by blocking the effect of male hormones called progestin, (women have male hormones too and they are part of the reason we get acne) at the level of the skin. Spironolactone works very well for some women – but it is not a cure- it only works when it is being taken. 

Which leads me to our most powerful medication for acne, Isotretinoin (commonly called Accutane). Accutane is our only cure for acne. Accutane can be a difficult medication to take due to lab testing and frequent office visits, but it can be life changing for people whose acne is severe, scarring, resistant to other treatment or just persistent for many years. I prescribe Accutane frequently for both teenage and adult patients.

I recommend calling your dermatologist if acne is a concern for you, there are many treatment options to help you achieve clear skin!