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Adult sufferers find acne is hard to face

By Rebecca Rakoczy , Cox News Service

Published January 1, 2008 at 12:05 a.m.

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Age lines and acne? This wasn't supposed to happen.

Acne, normally the bane of teenagers, was flaring up on Kim Noble's 50-year-old face, causing the Atlanta businesswoman no small degree of frustration.

"I started when I was a teenager with acne problems, and as I got older, it got worse," she says.

"I was told it was due to stress and hormones. I've tried everything that was out there, from (rubbing) alcohol to injections to Accutane to Proactiv," says Noble, who has been seeing a dermatologist for years but still has flare-ups.

She's not alone. Dr. Jodi Ganz, an Atlanta dermatologist, estimates half her patients are adults with mild to severe acne breakouts.

"There are a ton of people with adult acne. For women, flare-ups usually occur the week before their periods; that's what we call hormonally linked acne.

"And there is a lot of what we call 'graduate school acne' for both men and women, flare-ups that occur between the ages of 25 and 30 in populations that have not had a breakout since age 16," she said.

While teen angst over pimples is legendary, adults are floored.

"We see people who are extremely upset about this. They thought this was a normal part of teenager-hood and they would outgrow it," Ganz says.

Acne begins usually the year before puberty's onset, says Dr. Leslie Lawley, an assistant professor of pediatric dermatology at Emory University. And that age keeps getting younger. "We've seen girls having their periods at age 9, so they are getting acne earlier," she says.

Acne is caused by an increase of hormones, which causes facial glands to create more oil that clogs up the ducts, allowing certain bacteria to grow. "That can lead to blackheads and whiteheads and more inflammatory bumps," she says.

Females deal with acne flare-ups longer. A University of Alabama-Birmingham School of Medicine study by the American Academy of Dermatology shows women older than 50 are twice as likely as men to suffer from some form of acne.

Why some people travel through life with unblemished skin and others with acne scars is also due to genes. It's likely that if your parents suffered from acne, you will, too.

There is speculation that lifestyle and culture may also contribute to the incidence of acne. "The rate of acne is so much less in non-Westernized cultures," Ganz says. She cites a 2002 study by the Department of Health and Exercise Science at Colorado State University of people ages 15-25 in Papua New Guinea and Paraguay that found extremely few cases of acne.

Treatment options

Drugstores offer a mind-boggling array of products, from the Power Pimple Peel to the formidable- sounding Terminator 10, next to standards like Clearasil and Stridex. A stroll down most malls finds a kiosk marketing Proactiv, the skin regimen touted by celebrities such as Jessica Simpson, Vanessa Williams and Sean Combs as an acne cure-all.

"The over-the-counter stuff isn't necessarily bad for mild acne," Ganz says. "Look for topical cream products with salycic acid or benzoyl peroxide. That's what's in Proactiv, by the way."

You might want to see a dermatologist if over-the-counter products don't work after two months, Ganz and Lawley advise. But be patient, they say. Even prescription medications can take six to 10 weeks to show signs of working.

The following medications usually are prescribed by dermatologists for moderate to severe acne. Your health care provider often can prescribe a generic form, which is less expensive than a brand name.

* Retinoids, also known as Retin A. One of the gold standards in fighting acne, retinoids work well on blackheads and whiteheads, Lawley says. Don't take retinoid if you're pregnant, however, or want to become pregnant, since they have been linked to birth defects.

* Combination of oral antibiotic and topical antibiotic creams. The oral antibiotic acts as an anti-bacterial to reduce infection; the topical antibiotic reduces inflammation.

Doctors often prescribe a tetracycline antibiotic for the oral dose. Doxycycline, a common name, is usually prescribed with a high-percentage benzoyl peroxide cream.

"But we do worry about the global issue of antibiotic resistance," Ganz says. "We try not to keep a patient on an antibiotic for too long.

"If someone needs an oral treatment, we start both on cream and oral antibiotic and decrease their reliance on oral and maintain the topical," she says.

* Accutane. "If the patient has seen no results and has been on oral antibiotics, Accutane is an option, but you absolutely cannot take it if you're pregnant," Lawley says. Accutane has been linked with depression and suicide, according to the U.S. Food and Drug Administration.

* Birth control pills. For women not trying to get pregnant, low-dose birth control pills can be helpful in controlling hormones, which aggravate acne. But Lawley doesn't prescribe them before ruling out risk factors such as age, whether the patient smokes or has a history of migraines. And she typically recommends an exam by a gynecologist.

* Corticosteroid injections. These shots dissolve acne cysts that do not respond to other therapies and treat scar tissue.

* Microdermabrasion or dermabrasion. Also known as "power peels," this method can reduce noticeable scarring and pock marks.

* Photodynamic therapy, also known as laser treatments. "ALA (a 20 percent solution of aminolevulenic acid) is painted on the skin, and a laser light activates the solution, killing the main bacteria. This is good for people who don't want to be on antibiotics or have problems with antibiotic resistance," Ganz says.

Comments

  • October 20, 2008

    1:40 a.m.

    Suggest removal

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