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Acne For Dummies (For Dummies) ~ Herbert P. Goodheart M.D.

Posted Jul 20 2009 10:19pm

High school is a memory. You have a career, or you’re raising a family. Bad skin, 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. 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.

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. 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. If you’re absolutely convinced that a certain food type is making your acne worse — avoid it!

Acne and your menstrual cycle
You’re probably well aware of those unwelcome visitors that appear, disappear, and reappear like clockwork during your menstrual cycle. 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.

The appearance of adult 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.

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. 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.
  • 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 take 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

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