When Acne Shows Up (Un)Fashionably Late: Current Trends for Treating Adult Acne in Women
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By Caroline Raftopol, PA-C

        Like poufy bangs and neon makeup, women outgrow many outdated trends when moving from adolescence into adulthood.  Unfortunately, acne does not seem to be one of them.  In fact, in the U.S., one third of all dermatology office visits for acne are made by women over the age of 25 years1.  However, the misconception remains that acne is solely a teenage problem.  Having acne as an adult woman then is particularly distressing if the expectation is that acne should be a thing of the past, much like that old pair of acid washed jeans.  So since you were fashionable enough to ditch those questionable outfit choices, it would be equally en vogue to think about giving your skin an age appropriate makeover too.  Do the trendy thing and go to your dermatologist for treatment of your adult acne!

        While acne in women may be the continuation of adolescent acne into adulthood, some women report new acne when they previously had not suffered with it during puberty.  Some female acne sufferers do not go to the dermatologist because they think that acne is a cosmetic issue; but in fact, it is a medical condition that warrants treatment.  Adult women with acne are more likely than men to suffer from long-term persistent acne, which carries a higher risk of permanent scarring2.  They are also twice as likely as men with acne to report symptoms of depression, and there are higher rates of eating disorders in female patients with acne than without acne3.

        Like the variety of styles in your closet to suit your mood, there are treatment choices available to address the underlying cause of acne in adult women.  Although some adult female acne sufferers improve with standard therapies such as oral antibiotics or medications applied to the skin, many others still do not find relief or find that their acne is poorly-controlled even with these treatments.  This may be owed to the fact that the disease process leading to acne in adult women is complex, like unwearable haute couture that should never leave the runway.  Acne is thought to occur due to a mix of genetic, hormonal, immunologic, and environmental factors; and it is important to treat the underlying cause of acne in order to achieve the best results.

        In adult women, acne may form in part because of hormonal fluctuations.  These fluctuations may occur during the normal cycle of the menstrual period, but they may also be triggered by stress or by starting or stopping birth control medicines.  Oil glands in women may be particularly sensitive to circulating hormones in the blood that are called androgenic hormones, including testosterone which is the classic “male” hormone.  Androgens in women are produced in the ovaries, adrenal glands, and other tissues such as fat and skin, which is why hormonal acne flares right before your period or if taking medications that affect hormonal balance.  Acne in adult women may also be an important sign of an underlying hormonal condition such as Polycystic Ovary Syndrome (PCOS), which not only can cause acne but can also cause increased hair growth, menstrual irregularities, and predispose to infertility.

        Treatments may be targeted to address hormonal causes of acne in women.  These may include certain types of birth control pills that are indicated for the treatment of acne, and other systemic therapies such as spironolactone, an oral blood-pressure lowering pill that has been studied and tried with success to offset the effect of androgenic hormones on oil gland receptors.  Please schedule an appointment with your dermatologist to discuss treatment options and decide with your provider which one(s) may be right for you.

References:

    4 Shaw, James C. (2000).  Low-dose adjunctive spironolactone in the treatment of acne in women: A retrospective analysis of 85 consecutively treated patients.  Journal of American Academy of Dermatology, 43(3); 498-502.

    1,2,3 Zeichner, J. (2013).  Evaluating and Treating the Adult Female Patient with Acne.  Journal of Drugs in Dermatology, 12(12); 1418-1427.

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