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Women: Coping with persistent adult acne

Learning what causes acne can help you choose the best treatment.

With modern photo-editing software, we can all have perfect skin—on Facebook. But in real life, skin is three-dimensional—from the depths of pores to the heads of pimples—and problems like acne can't be fixed by airbrushing.

Fortunately, there are many real-world treatments for acne.

If you're looking to clear up blemished skin, it helps to start by learning a bit about the reasons acne develops.

Why women get acne

Acne is often thought of as a problem that teenagers face. But for many women, pimples and blemishes crop up in adulthood as well. For teens and adults alike, the causes of acne are the same—and hormones often play a key role.

"At certain times in our lives—at puberty and again in our 30s and at menopause—women go through hormonal changes," says Amy Derick, MD, FAAD, instructor of clinical dermatology at Northwestern University's Feinberg School of Medicine.

As androgen hormones increase, glands in the skin produce more oil. That's why women may see skin changes when they get pregnant or stop taking hormonal birth control pills.

As the oil production increases, pores can become plugged and inflamed, leading to comedones (whiteheads or blackheads), pimples, or deeper nodules or cysts.

"Often people mistakenly think they just aren't cleaning their skin well enough," Dr. Derick says. "That's just not true. It's not usually surface dirt causing the acne; it's inflammation underneath the surface of the skin."

Though the cause of acne is the same at any age, adults may experience it a bit differently.

"Adult women typically get a different distribution and kind of acne than teenagers," Dr. Derick says. It's often on the chin, jawline and around the mouth, and it can cause nodules that are deeper and more painful than just blackheads or whiteheads.

Treatment options

Persistent adult acne usually requires medical treatment to resolve, Dr. Derick says. According to the American Academy of Dermatology (AAD), options include:

Topical therapy. Topical treatments can be either prescription or over-the-counter. They usually contain one of the following: salicylic acid, benzoyl peroxide or retinoids (medicine derived from vitamin A). For more severe cases, an antibiotic gel or lotion may be necessary.

Oral medicines. Birth control pills or hormone therapy may help regulate hormones and control acne related to hormonal changes. The antiandrogen medicine spironolactone may also help.

In some cases, an oral antibiotic may help—especially used in combination with a topical retinoid.

Another option is the prescription acne drug isotretinoin.

"With isotretinoin treatment, after four or five months, 75% of people have a semipermanent remission from acne," Dr. Derick says.

Isotretinoin and some other acne drugs are unsafe to use during pregnancy, so be sure to let your doctor know if you are pregnant or breastfeeding, or if you might become pregnant.

Physical procedure. A corticosteroid injection may help reduce the size and pain of deeper nodules or cysts.  

Taking care of your skin

Although clearing persistent acne usually requires the help of a dermatologist, there are things you can do to help your skin look its best. The AAD recommends:

  • Using noncomedogenic (non-pore-clogging) cosmetics.
  • Cleaning your skin with a mild cleanser twice daily and moisturizing once daily.
  • Not picking, squeezing or popping pimples. This can cause scarring and infections.

It's also important to your overall health that you eat a balanced diet. The AAD reports that acne may be linked to inflammation caused by spikes in blood sugar. And some foods (including alcohol and spicy foods) can trigger rosacea—a condition that causes redness and pimples in the center part of the face, especially for fair-skinned and menopausal women. In general, Dr. Derick recommends avoiding or limiting any foods that seem to worsen acne or rosacea.

"I think the No. 1 thing is: If you have a chronic problem, talk to a dermatologist about it," she says. "Don't get discouraged if your skin doesn't clear up with a topical, over-the-counter medicine. Sometimes it requires more than that. And there are so many treatment options; you don't have to live with acne if you don't want to."

Reviewed 8/11/2023

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