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Adult Acne: Manage Those Bumps, Minimize Scars, and Maybe Even Look Younger!

Sep 28, 2016 02:00PM ● By Cate Reynolds
By Lisa J. Gotto


Acne cannot be “cured,” but it can be effectively controlled in most cases.

More women experience adult acne than men, and many women present it on the lower half of the face or jaw.

Physicians are now reporting the likelihood of a correlation between dairy intake and development of acne.

The American Academy of Dermatology reports that approximately 50 million people suffer from acne in the U.S. annually, and it is the most common skin condition in the U.S.


It is the bane of every teen’s existence from an appearance standpoint—the pimple. Or worse yet, the acne that can often develop during the teen years. By the time most individuals enter adulthood, however, many of their pimple problems are behind them.

At the root of acne breakouts are over-active oil glands, which make the teen years with all their active hormone issues, the prime time for this condition to thrive. In adults, stress can act as a trigger creating over-active oil glands that clog pores and create the bacteria that presents itself on the skin as acne.

“Today society is stressed more than ever and all that stress causes our adrenal glands to increase production of androgen hormones, which increase oil production, which causes acne,” says Dr. Kelly Sullivan of Sullivan Integrated Aesthetic Center in Annapolis.

“When you’re under long term stress our hormone levels are constantly raised and acne becomes a constant problem. Also as we age our cell turnover and ability to heal slows down, which means acne will stick around longer than it did in our teens,” adds Sullivan.

There are two primary types of acne: comedonal, and nodular, or cystic acne. The former consists mainly of whiteheads and blackheads. These are basically the same type of pimple, but the blackhead has a larger follicle opening which leaves the dead skin cells, sebum and keratin exposed to the oxidation process which turns them black.

Cystic acne presents itself as a red bump on the skin under which a bacterial-type infection has formed from the excessive oil production that backed up under the skin. These bumps can be painful, they lay deeper beneath the skin’s surface and they can also form in clusters. Attempting to pop these bumps most always results in scarring, so physicians strongly warn against doing so.

It Takes Two: Topical & Oral Medications

While some of the methodology for treating adults differs from treating teens with this condition, all our queried physicians agree that combination therapies are the most effective.

“As our understanding of the causative factors involved with acne has evolved, we have come to appreciate the important role that combination therapies play in controlling the disease. Particularly with women, understanding hormonal influences allows us to pair traditional topical and oral acne treatments with hormonal ones, adds Dr. Tom Meskey of Annapolis Dermatology Associates.

Combination treatments have been around for decades, but many involved aggressive courses of oral antibiotics, which, in the long run, turned out to be less effective as the body becomes resistant to these medications over time. There has also been an overall “regrouping” within the medical community about the over-use and prescribing of antibiotics in general. A recent study reported in the Journal of the American Academy of Dermatology cited a much shorter duration to determine the efficacy of antibiotics before additional scripts are written.

If a patient’s acne is not well controlled after six to eight weeks of antibiotic therapy, dermatologists should begin to discuss this with their patients and create alternative treatment plans, relayed lead researcher for the study, Arielle Nagler, M.D., an instructor at Ronald O. Perelman Department of Dermatology at NYU’s Langone Medical Center.

Indeed, managing acne is clearly not a one-size-fits-all proposition. The medical community is using highly personalized regimens that can vary from practice to practice.

“There are a variety of treatments to choose from and identifying the most effective course of treatment can take some trial and error,” reports Laura Hardnett, owner of Effective Medspa and Wellness Center in Gambrills. “We often find a combination of treatments to be the most effective approach for many of our patients. Typically, we first address redness and inflammation by soothing and calming the skin with products containing aloe and bisabolol as well as salicylic acid to kill any bacteria in the skin. Then we often prescribe a glycolic acid to exfoliate the surface of the skin and tighten pores.” Harnett adds that they may also suggest the use of a retinol sparingly at night to stimulate cell turnover and prevent future breakouts.

Dr. Christine Ambro of Annapolis Dermatology Center says that acne treatment options and protocols have been greatly enhanced over the last 20 years thanks to improved formulations, the introduction of new topical products, and the use of lasers in therapies.

“Topical retinoids are now available in formulations that improve efficacy and tolerability. Additional treatment options like topical dapsone gel or IPL laser therapy are both safe and effective,” Dr. Ambro says. “Retinoids are an excellent topical choice for adult acne treatment. The upside is they can also improve discoloration, skin tone, fine lines and overall skin appearance.

Enhanced and targeted formulations are especially important because today’s treatments don’t dry out the skin entirely to address the problem of over active oil glands. In fact, physicians caution that it is imperative to hydrate or use moisturizer on the skin as part of an effective acne treatment plan. Just make sure your moisturizer is oil-free.

Dr. Sullivan explains while this might seem counter-intuitive, it really isn’t.

“Often times people think because they’re oily they don’t need to moisturize, well that’s the complete opposite if you don’t moisture your skin, your body produces more oil because it’s dry. This can be a vicious cycle.”

The emphasis in acne care and treatment has definitely shifted from systematic treatments like prolonged antibiotic use and harsher drying formulations to the use of more direct skin treatments like chemical peels and laser therapy. (Note: antibiotics are still seen as useful in some patients’ treatment protocols when well monitored.)

Should the patient not see improvement with any of these methods there is one drug that is being prescribed that doctors feel is worth taking for long-term cystic acne sufferers despite possible side effects.

“For those individuals with severe scarring acne, isotretinoin clearly and most consistently delivers the best results,” Dr. Meskey says.

Isotretinoin is also in the retinoid family but is taken by mouth.

The Up Side

Wait a minute; did we say improve fine lines and the skin’s overall appearance? Yes, we did and here is why. Available by prescription, tretinoin works by increasing the amount of collagen in the skin. It also stimulates new blood vessels in the skin providing it with a rosy appearance, it fades age spots, and reduces precancerous skin spots known as actinic keratosis. Perhaps, worth a try if you already have adult acne to treat.

And here’s where the good news is when it comes to scarring. There are things that both you at home and your doctor can do to minimize the scarring associated with acne. First of all, if you have existing scarring, apply sunscreen liberally to the affected areas. Increased sun exposure without sunscreen has proven to darken these already delicate areas.

Both laser light therapy, which is a non-invasive procedure that uses light energy to repair and regenerate damaged skin, and laser-resurfacing techniques, which removes layers of skin, have been successful in minimizing the appearance of acne scarring. Results vary from patient to patient based on the depth and severity of the scarring, and it is important to note that these procedures remain classified as “cosmetic” and therefore will be considered an out-of-pocket expense to the patient.

Another new treatment that could be a game-changer when it comes to scarring is employed with a micro-needling procedure.

“Micro-Needling with Collagen P.I.N. is one of our favorite treatments because it will not make skin light sensitive and is safe for all skin types,” says Laura Hardnett. “Our advanced micro-needling also requires little to no downtime following the treatment and provides incredible results in treating acne scarring, hyperpigmentation, and induces growth factors (collagen and elastin) that smooth the overall texture of the skin.

Clearly, with all the dermatological profession now has to offer to address adult acne and its subsequent and unsightly scarring, there is a light at the end of the tunnel and a road to a better, brighter, and bump-less complexion.

Retinoids Defined

Retinoids can be taken by mouth in the case of isotretinoin, or applied directly to the skin in the form of a prescription vitamin A derivative cream such as tretinoin, adapalene, and tazarotene. Tretinoin was the first retinoid approved by the FDA to treat wrinkles.

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