Beat your adult acne
BY Suzanne Wangmann body+soul
From the occasional pimple to multiple breakouts, your blemish problems can be solved.
We've all been down to breakout town. We ask ourselves if that chocolate bar was to blame. We ask ourselves if our cleansing regimen is substandard. But mainly we ask ourselves why we're still struggling with this "teenage" complaint.
The truth is adults get acne too. It usually occurs in women over 30. Many may never have had a pimple in their lives but suddenly find themselves in the grip of aggressive acne on the neck and lower face.
Dietary and hygiene factors can contribute, but all acne is driven by sex hormones, called androgens. Some acne is caused by a genetic predisposition where dead skin cells build up inside the pores. These dead cells act like plugs, so instead of oil travelling from the oil gland, up the pore and out onto the surface to moisturise your skin, the oil gets blocked.
Propionibacterium bacteria love this oil so they infect the pore and you get a pimple. (Blackheads and whiteheads are potential pimples that haven't been attacked by this bacteria yet.) Hormones make the pore sensitive, easily inflamed and swollen, which makes it more likely for them to become blocked.
Adult acne is cystic, which means it forms lumps under the skin. These cystic pimples can scar badly, so see a GP when they first appear. Don't reach for the soap as it only removes surface oil and don't use moisturisers if your skin is oily.
If pimples don't respond to over-the-counter treatments (allow them three or four months), see your GP. They can offer a range of prescription drugs that target the main causes of acne: hormones, blocked pores and Propionibacterium infection.
Internal drugs, such as the contraceptive pill and antibiotics, are usually prescribed for acne. You can also use topical antibiotics, but dermatologist Dr Phillip Artemi warns against using internal and external antibiotics at the same time, as it's doubling up on the same treatment.
External medication is used to treat pore blockages. You can try salicylic acid or benzoyl peroxide, or the GP may prescribe a peeling agent such as tretinoin. If you don't see results after three months, see a dermatologist.
Although dermatologists may offer the same drug suggestions as a GP, they have more experience monitoring skin conditions. Dr Artemi says it is using the right combinations that counts. In cases when acne is cystic and scarring, isotretinoin may be prescribed.
The anti-acne arsenal
Salicylic acid: A topically applied anti-inflammatory chemical. It is used in various over-the-counter products to treat the inflamed skin around the pimple.
Benzoyl peroxide: A beta-hydroxy acid that penetrates the skin's oily layer, clears blockages and kills bacteria. Start on a low concentration (one to four per cent) and increase over time. Available over the counter and on prescription.
Contraceptive pills: These neutralise the effects of the sex hormones which cause pore inflammation.
Antibiotics: Two types – tetracyclines and minocyclines – are used. Both can make you more prone to sunburn, but be especially careful with minocyclines.
Tretinoin: A cream derivative of vitamin A that clears pores. It has been linked to birth defects, so women should be on the pill or avoid sex while using it. It can make skin photosensitive, but is safe as long as you know the side effects. Can be prescribed by GPs and dermatologists.
Isotretinoin: Known by the brand Roaccutane, this vitamin A derivative is taken internally to prevent oil production in pores. It is used for severe cystic acne but can make skin dry and sensitive. Patients should not fall pregnant while on it as it has been linked to birth defects. Its success rate is about 80 per cent but it doesn't get rid of acne forever. Can only be prescribed by dermatologists.
See our top eight acne treatments gallery.
Read our fact sheet on Adult acne.
What you need to know NOW
Acne strikes about 85 per cent of the population at some time; 10 to 20 per cent of cases are adults.
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