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Acne in Adult Women
By Herbert P. Goodheart, M.D.,
Author of Acne For Dummies

High school is a memory. You have a career, or you're raising a family. Acne, you assume, is a thing of the past. But just when you think that you're out of the woods, acne hits you right in the face. Dermatologists regularly hear the lament, "Acne, at my age?!", expressed by women who suddenly develop acne after the age of 18 or 30 or even later in life. "It's not fair; it's supposed to be only for teenagers!" is usually the next statement. It may not be fair, but it's a fact. Many people -- mostly women -- get acne for the first time as adults or develop acne after years of being relatively pimple free. And sometimes teenage acne can continue unabated from teen years into adulthood.

Adult-onset acne, sometimes referred to as female adult acne, or post-adolescent acne is overwhelmingly a condition seen in women. It is a type of acne that turns up after the age of 18 -- later than the typical teenage variety of acne.

What causes it?

When acne begins in the teenage years, the increase in your androgens -- male hormones that are present in both men and women -- play a major role in its development. In a nutshell, these hormones stimulate your sebaceous (oil) glands, enlarging them, and they respond by producing excessive oil that helps to promote the lesions (pimples) of acne. Although the entire story isn't well understood, the vast majority of women who have adult-onset acne don't have elevated androgen levels; rather, they appear to have an increased response to normal levels of androgen, and to a much lesser degree, to their female hormone, progesterone, that also has androgenic effects. The other major female hormone, estrogen, has an opposite (estrogenic) effect and tends to curb acne. The presence of a certain type of bacteria is also believed to have a role in causing acne.

Currently, there is some disagreement about the link between diet and acne; several researchers are suggesting that there may be a degree of truth behind some dietary factors having an influence on acne. For example, certain dairy products and refined sugars that are in our diet are now being evaluated as possible acne triggers. The jury is still out on this issue. In the meantime, if you're absolutely convinced that a certain food type is making your acne worse -- avoid it!

In addition to a woman's own hormones, adult-onset acne may be related to, and heightened by, having an hereditary predisposition to acne. Also, the ingestion of external hormones and drugs that have androgenic effects such as those contained in certain acne-unfriendly oral contraceptive medications, food products, and performance enhancing drugs, have been suggested as possible culprits.

Acne and your menstrual cycle

I probably don't have to tell you about those little red bumps that appear on a monthly basis. You're probably well aware of those unwelcome visitors that appear, disappear, and reappear like clockwork during your menstrual cycle. They usually last for several days, but sometimes they can persist for a month or longer. Most often, pimples tend to pop up right before your period. This is the time -- usually two to seven days before your period -- when estrogen levels fall and progesterone levels rise. Much less commonly, you may see no apparent connection between the appearance of pimples and your menstrual cycle. In such instances, they will erupt with a mind of their own right before you have that important date, interview, cocktail party, public speaking engagement, or wedding! Perfect timing!

The appearance of post-adolescent acne differs from that of teenage acne in the following ways:

  • Pimples more often appear on the lower cheek, the chin, and along and below the jaw line. Although some women may have breakouts on the chest and back, most have acne blemishes exclusively on the face.

  • Blackheads and whiteheads are less commonly seen.

  • The inflamed pimples can be superficial or deep. Many women describe certain papules as "deep ones," the ones that feel like they come from under the skin. (If you get 'em, you know what I mean; you're able to feel them even though they are invisible to other people).

What if it's not acne?

The diagnosis of adult-onset acne isn't always clear-cut; it may easily be confused with other acne look-alikes such as:

  • Rosacea: Rosacea and acne look so much alike. They both often have red pimples and, of course, both appear on the face. A major difference is that rosacea usually turns up in people from age 30 to 50 and can be a longer lasting condition than acne. Symptoms of rosacea include facial pimples that are acne-like as well as a persistent redness from underlying facial blood vessels. In some women, both rosacea and acne can appear together.

  • Endocrinopathy: Sometimes what appears to be a simple case of adult-onset acne can be due to an underlying hormonal abnormality, called endocrinopathy At times like this, this type of acne may be difficult to get under control and other measures such as blood tests to look for higher or lower than normal hormone levels should be evaluated and treated by your doctor

What can be done to treat it?

Having acne can taking an emotional toll and be just as trying for adults as it is for teens. Job hunting, social events and dating can be negatively impacted by just a few pimples. Whether you have rather mild or severe acne, effective treatments are available.

  • Many of the over-the-counter topical products than contain benzoyl peroxide such as Clearasil can be very effective, and for many women, it's the only treatment necessary.
  • Topical or oral prescription preparations that are available only from a healthcare provider or dermatologist to treat your acne are very effective.
    • -- Topical retinoids such as Retin-A and Differin are a mainstay of acne therapy.
      -- Topical antibiotics directly kill P. acnes, bacteria that are considered to be involved in producing acne.
      -- Combining benzoyl peroxide with topical antibiotics or retinoids is a treatment option is referred to as "combination therapy". In fact, combination therapy is used to treat most cases of acne because acne is caused by a combination of factors.
      -- Oral antibiotics, most often with tetracycline derivatives, are generally used in the management of moderate to severe acne, particularly if you have more extensive, deep, or scarring acne.
      -- Hormonal therapy with certain oral contraceptives (birth control pills) or other anti-androgen medications can help to block the acne-causing response to your androgens.
©2009 Herbert P. Goodheart, M.D., author of Acne For Dummies

Author Bio
Herbert P. Goodheart, M.D., of New York, NY, author of Acne For Dummies,  is a practicing dermatologist who also teaches at the Mount Sinai College of Medicine. He is the author of a highly regarded dermatology textbook titled Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, which is in its third edition.

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