Adult Acne

Amy Jensen

by Amy Jensen | August 6, 2010 @ 03:00PM

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Your high school days are over. No more cramming for tests, no more worrying about a date for the Prom, no more pimples and problem skin, right? Not if you are one of four million adults who suffer from acne. If you've been dealing with acne since your teenage years, you've probably heard things like "Don't worry, lots of kids your age go through this" or "You'll grow out of it." While millions of teenagers suffer through this pubescent "rite of passage" and emerge clear skinned, others are not so fortunate. Sometimes acne does not clear up after high school or college. Or perhaps you sailed through your teens with perfect skin, only to start breaking out now that you are in your 20s, 30s or 40s. Surveys show that acne not only affects your skin, it can cause depression, lower your self-esteem, and inhibit your social life. If any of this sounds familiar, if acne is a serious problem in your life, you are not alone. Here's the good news - there's help. You need not suffer anymore. Whether you have mild occasional flare-ups or constant, painful, disfiguring acne, there are many effective treatment options available. The first step is consulting a dermatologist and deciding what type of acne you have and what might be causing it.

Are There Different Types of Acne?

Yes. Pimples (referred to as "lesions" by dermatologists) are generally classified by their size and whether they are non-inflammatory (blackheads and whiteheads) or inflammatory (pimples that are red, swollen and infected). All pimples start out the same. Each follicle or pore houses a small hair and a gland that produces an oily substance called sebum. In a normally functioning follicle, the dead skin cells inside the follicle are shed and travel with the sebum up to the skin surface to be washed away. When this process is not completed for whatever reason, blackheads, whiteheads or inflamed pimples occur. Blackheads are formed when dead skin cells and sebum are tightly packed inside a follicle whose walls have broken. The skin cells and oil give it a dirty appearance though this does not indicate the presence of dirt. When the follicle wall does not break, whiteheads are formed on or under the skin. Inflammatory lesions occur when the oily material inside the follicle ruptures into the surrounding skin. This produces a raised, red bump called a papule. Pustules are similar to papules but with visible pus and are slightly more inflamed. The most severe lesions are nodules, or cysts. They can be as large as a marble and quite painful. They produce a larger amount of pus and can leave devastating scars. When bacterial infection is added to the inflammation, a very rare but serious form of acne called Acne Conglobata may occur. It generally develops on the chest, back, and buttocks. Scarring is very deep and the acne itself is very difficult to treat.

What Causes Adult Acne?

There are many myths regarding the causes of acne. The most common being that stress and diet can actually cause acne. While there isn't proof linking foods to the onset of acne, some doctors of natural medicine believe that allergies to certain foods could cause breakouts. Stress can increase the intensity of flare-ups, but has never been linked directly to the start of adult acne. Proven causes of adult acne include imbalanced hormones, increased sebum production, and bacteria. All of these factors work together to start the vicious acne cycle.

Hormones and sebum production – Between the ages of eleven and fourteen, the body starts producing hormones called Androgens. Androgens are responsible for enlarging the gland that produces sebum. Over stimulated glands is the main cause of acne. Women tend to have acne flare-ups the week prior to their period or random flare-ups during pregnancy. Oral contraceptives that change a woman's hormone level can cause breakouts when started or stopped. On the other hand, oral contraceptives such as Ortho-Tri-Cyclen are often used to treat the hormonal imbalances that can cause acne in women. Because oral contraceptives are made especially for a woman's unique chemical makeup, men are not candidates for this type of treatment.

When bacteria enter into the picture, inflammation and redness are very evident, often more aggressive, whole body treatments, such as oral antibiotics, are necessary.

What Can Put Me at a Higher Risk for Developing Acne?

Stress almost always plays a roll in worsening illnesses. When people experience stressful times, their hormone levels fluctuate and can cause increased oil production in the skin. Most people notice an extra blemish or two before a major event in their life. Stress is never beneficial to any long-term illness, but is not a direct cause of acne.

Proper skin care is always important whether acne is present or not. Anyone who exercises, sweats, and doesn't properly cleanse his/her skin afterward is only inviting more flare-ups. Sweat traps dirt and oil in the pores, making it very important to shower after any workout.

High temperatures and humidity act in the same way, causing sweat to block the pores. Proper skin care is most essential.

Women need to check their skin care products and makeup to make sure that they are "non comedogenic," meaning that they do not contain ingredients that are known to induce acne.

What Treatments Options Are Available?

Luckily, there is a wide assortment of treatment options available. After diagnosing your type of acne and the severity, your doctor will work with you to determine a starting point for treatment. Most treatments take two to eight weeks before significant results are noticeable. Just remember to stay on the prescribed therapy until your doctor says otherwise. Most therapies fight acne in one of the following ways: reduce sebum production, ease inflammation, kill bacteria, or stabilize the androgen level in woman. Finding a treatment best suited for your needs can take a lot of trial and error. You will be anxious to see results but it can take up to two months. If you haven't seen positive results after a few months, notify your doctor.

Topical medicines, such as over the counter or prescription ointments or creams, are applied directly to the affected area. Most of these contain benzoyl peroxide, which helps to dry out the excess oil in the pimple and block the spread of infection. Antibiotics can also come in lotion or gel form and can be used together with other therapies. Topical medications are generally used in treating mild to moderate cases of acne. Differin is a relatively new topical medication that has so far been quite successful. Ask your doctor if Differin may help you.

Antibiotics are used mostly in cases of inflammation of infected acne. The uses of low-dose antibiotics over a longer period of time have proven to be safe, effective, and inexpensive. If you have acne breakouts in harder to reach areas, such as the back or shoulders, oral medication is an easier treatment than topical antibiotics. It is very important that you finish the complete course of antibiotics, unless otherwise directed by your physician. If a course of antibiotics is interrupted, they may become ineffective.

Hormonal therapy includes the use of birth control pills to reduce the amount of androgens in a woman's body. Your gynecologist might also suggest blood tests or an ultrasound to pinpoint an imbalance. Not all women respond well to this treatment and men are not candidates for oral contraceptive therapy.

Accutane is a highly effective drug and often produces dramatic results. Accutane also comes with some serious side effects and potentially life threatening risks. Accutane causes a high incidence if birth defects; therefore, women of childbearing age should use very reliable means of birth control or seek other acne treatments. The success rate of Accutane is upwards of 70 percent to 80 percent. The most likely candidate for Accutane therapy are those with deep, painful, nodular acne. Accutane is currently the only medication that actually shrinks the gland that produces the oily sebum found in acne. However, some physicians and lawmakers are fighting to more heavily regulate the use of Accutane. They have cited that the drug may trigger depression and suicide. Careful screening and evaluation must be done before the administration of this drug, as well as close monitoring during therapy.

Nutritional supplements, both oral and topical, that are said to reduce the intensity of acne flare-ups are abundant. (Remember to first consult your doctor before starting any self-care program.) Oral zinc supplements, pantothenic acid, topical niacinamide, and oral B6 have all shown to be effective in minimizing certain cases of adult acne.

In an age where alternative forms of medicine are quickly gaining recognition, herbal remedies are numerous. A topical solution of five percent tea tree oil has been compared in effectiveness to five percent benzoyl peroxide for relief of mild acne. The tea tree oil is slower in producing results, but has fewer side effects. Tea tree oil may be used topically at a five to 15percent dilution. Brewers Yeast (Hansen CBS strain) has given patients wonderful results with a success rate of around 80 percent. Most patients of a recent study said that their acne had completely healed. The only side effects noted so far are headaches in very sensitive patients and some flatulence. Acne sufferers taking anti-depressants or mood altering drugs may experience an increase in blood pressure.

Phone Acne?

If your acne breakouts are localized around your chin and jaw line, your phone might be the culprit. If you spend a significant part of your day on the phone, the oil and build-up might be irritating your skin. Try to cleanse the mouthpiece and receiver every morning with hydrogen peroxide or rubbing alcohol. Don't let the phone rest between your chin and shoulder. Keep it away from your skin.

What Now?

As with any health related problem, you need to work with your doctor to develop a "plan of attack." Keep your doctor informed of any changes so that he or she may provide the best possible care. Taking the time to take care of yourself is the first step to recovery.

Doc Talk

Here are some questions and information that will benefit both you and your physician during your consultation.

Information to Provide

  • A list of medications you are currently taking.
  • When flare-ups most commonly occur.
  • Any treatments you have already tried.

Questions to Ask

  • How severe is my acne?
  • What treatments do you recommend?
  • What are the possible side effects?
  • What is the approximate overall cost?
  • Does my insurance cover the treatment?
  • What can I do about existing scarring?

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