adult onset acne

yup, that would be me

I met up with a friend last week who pointed to her chin and said,”what’s up with acne at 50??” At 46, I’m still prone to occasional big zits too and currently have one that I’ve chosen to photograph- just want you to know that you’re not alone! My cousin is a dermatologist in the States, so I asked him to weigh in on this issue.

From Dr. Adelson:

“New reports suggest 12-25% of women aged 40-50 have acne. Most of us think this is more frequent than previous decades. We do not know why. But most (doctors) feel it is hormone related and screen for PCOS (polycystic ovary hormone) or excessive male hormone (androgen), if there is also a history of abnormal periods or hair loss. Theories include increased rates of obesity, high glycemic diets, increased anabolic steroid exposure in meat and milk, but studies are inconclusive. Men eat the same junk and don’t get acne. I see many women in great shape who eat super healthy and still have acne.

Me: my friend who pointed to her chin definitely falls into the category of women in great shape who eat healthy!

Treatment is tough. 4/5 women do not get improvement with anti acne antibiotics. Most prefer retinoids such as Tretinoin with benzoyl peroxide. A new topical Dapsone is becoming more popular in this group. Witch hazel has antiseptic activity will work but can be very irritating.

Me: I use witch hazel products from Boots and find they work well and on my skin are non-irritating. This may not be the case for everyone, though.

Soaps with triclosan are effective as are salicylic acid and benzoyl peroxide containing cleansers.

Here’s a list of products containing triclosan from the Dr. Ben Kim website:

* Provon® Soap
* Clearasil® Daily Face Wash
* Dermatologica® Skin Purifying Wipes
* Clean & Clear Foaming Facial Cleanser
* DermaKleen™ Antibacterial Lotion Soap
* Naturade Aloe Vera 80® Antibacterial Soap
* CVS Antibacterial Soap
* pHisoderm Antibacterial Skin Cleanser

When to go to dermatologist is a tough question that I will get to later since the flip side of the question is how often is the visit helpful to the patient. If the patient can get access to tretinoin or possibly the topical dapsone without a specialist, is the visit necessary? If there are other signs of PCOS then is a GP or GYN needed?

I may be an outlier opinion, but think I am right. Acne is so common it should be managed well by the primary care doc. There is nothing difficult about first or second line treatments. If the acne is complicated with cysts and the patient may need isotretrinoin (used to be called Accutane) or spironolactone, then a referral reasonable. Also some are using photodynamic therapy for recalcitrant cases and early scarring. Dealing with scarring using fractionated laser or other resurfacing techniques is best done in the more experienced specialist.”

Bottom line is that adult onset acne is treatable and you shouldn’t panic if you find yourself with occasional, but significant breakouts. All that may be required is a quick trip to your local drugstore for an inexpensive cleansing regimen from one of the brands mentioned above or look for products containing salicylic acid or benzoyl peroxide (a bit more drying, but definitely effective, though maybe just for spot treatment).

My next post will be from a friend, who recently went on Accutane and although her skin looks great, it was an unexpected journey.

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