“Why do I have acne at my age?”
Postadolescent acne, also known as adult acne, can be very frustrating for adults, especially for
Q: What are the proposed reasons for female adult acne?
A: Some reasons may be:
• Women working and the stress involved
• Later ages of which women are having children
• Use of certain oral contraceptives
• Food additives and injection of hormones and antibiotics in livestock
Q: Is it influenced by hormones?
A: Absolutely, acne is influenced by hormones. Women report premenstrual and midcycle
flares of inflammatory acne. Pregnancy, oral contraceptives, and hormonal supplementation
also appear to affect a women’s complexion and cause fluctuations in acne. Lesions normally
appear around the jawline, mouth area, and chin. These lesions tend to appear and reappear
like clockwork according to a woman’s fluctuating levels of circulating hormones.
Q: Do men get acne too?
A: Yes, however, it is traditionally unusual. When it appears, it tends to involve the upper back
and upper arms. Athletic activities have been seen to increase acne in men and women as
well. It has been speculated to be caused by one of all of the following: sweating, mechanical
friction, anabolic steroids, and creatine-containing dietary bodybuilding supplements. Men’s
acne has no such fluctuations.
Q: What ways acne is treated?
A: Since acne is chronic inflammation of the sebaceous gland (oil gland), it can only be
managed. The goal is to: prevent scarring, help improve patient’s appearance, make every
effort to control acne with topical therapy alone.
Treatments are individualized and frequently involve a “trial and error” approach beginning
with agents that are known to be most effective, less expensive, and having fewest side effects.
Acne is a multifactorial disease. Mild acne can be managed successfully with over-the-counter
remedies. Every effort should be made to control acne topically if possible or to eventually
taper off oral medication as soon as control is achieved. Patients should not squeeze or pick
Q: What are the topical treatments?
A: Benzoyl Peroxide: (e.g., Clerasil, and Oxy 5 and 10)
• Helps with inflammatory and noninflammatory lesions
• Dry and peel the skin, and help clear blocked follicles
• May be used alone or treat mild acne, but for more severe cases, it should be used in
conjunction with topical retinoiods, as well as topical or systemic (oral) antibiotics
• Lower-strength (e.g., 2.5%) is less irritating for adult acne, and probably as effective as
the 5% or 10%.
• Benzoyl peroxide is also available in combination with erythromycin (Benzamycin) and
• Prescription benzoyl peroxide formulations are probably no more effective than the
over-the-counter products. Generic products may vary from batch to batch in terms of
quality control and inert ingredients.
A: Topical Retinoids: (e.g., Differen cream or gel, Retin-A Micro, and Avita)
• Has anti-inflammatory effects
• Can be used, or combined with other topicals
• These agents help “plump” the skin and make enlarged pores less obvious
• May produce sun sensitivity
• Should not be used during pregnancy or breast-feeding (although no studies have
shown them to be harmful to fetus).
A: Topical antibiotics: clindamycin and erythromycin:
• Antibacterial action and anti-inflammatory to help clear inflammatory acne lesion
• Drug resistance has been reported with these antibiotics
• By combining these agents with benzoyl peroxide, bacterial resistance can be avoided
Q: What are the systemic (oral ) treatments?
A: Patients with moderate to severe acne that is unresponsive to topical, and tends to scar,
must be given systemic treatments. Significant acne on chest or back, generally require oral
Tetracylines: (e.g., Achromycin and Terramycin)
• Staple of systemic acne therapy
• Stains teeth in children younger than 9 years, and may temporarily stain teeth of older
• May cause gastrointestinal irritation, increase tendency to sunburn, and vaginal
• Minocycline (another form of tetracycline), more expensive, but more effective than
• Doxycycline (less expensive and less effective than minocycline)
Erythromycin: (drug is useful as second-line alternative when tetracycline fails or is not
Q: What are the hormonal treatments?
A: Oral contraceptives are used in women in whom hormonal treatment may been an
effective alternative or assistance to antibiotics and oral retinoids. Hormone treatment is an
option when conventional topical and systemic therapies are not working, or when hormone
imbalance is found.
Accutane, also known as isotretinoin, is a derivative of Vitamin A that promotes long-term
remissions in severe acne. This is reserved for patients who do not respond to conventional
therapy. Side effects are common, and are usually tolerable because the drug is so effective
that patients want to continue despite any dry skin, nose bleeds, dry eyes, itching, mucous
membrane inflammation and peeling of skin. Before treatment therapy, it is important to
discuss all precautions and side effects of this drug with the physician first. Routine blood work
is required due to systemic abnormalities in lipid levels.
Adult acne is often more persistent than teenage acne.