Acne – Adults vs. Teens, Spring/Summer 2016 Newsletter

Acne is one of the most common complaints in the dermatology clinic. It is most common during the teen years, but in many individuals, acne develops during adulthood. In fact, some people deal with acne from the pre-teen years all the way into middle age. Although teens and adults are both commonly diagnosed with acne, there are important differences between the two groups when considering causes and potential treatments.

During early adolescence, the onset of puberty brings about many hormonal changes in both sexes. Hormones, especially testosterones, cause development of oil glands in the skin and an increase in oil (sebum) production. Oil glands are particularly predominant on the face, neck, back, and chest. The oil that our oil glands produce helps to moisturize and protect our skin. However, when oil combines with dead, sticky skin cells, pores and follicles can become clogged and congested. A blocked pore creates an opportunity for bacteria to thrive. Subsequently, increased bacterial growth within the pores can drive an inflammatory response from the immune system, leading to redness, swelling, pus, and discomfort. Ultimately, excessive inflammation can lead to acne scarring.

In comparison to teenage acne, adult acne is generally less driven by clogged pores, but instead tends to have more varied causes. The causes of adult acne may include adult-type hormonal changes or disorders, stress hormone responses, medications, and perhaps a genetic tendency toward inflammation in the skin (rosacea). Additionally, adult acne tends to be less severe overall, and often involves the jaw line or cheeks instead of central face as in teens.

The treatment of teenage acne involves reducing oil and clearing clogged pores, reducing acne-causing bacteria, decreasing inflammation, and helping to even out the skin tone as the acne clears. There are several approaches to assist in clearing out clogged pores. These include the topical application of medicines known as retinoids, the use of natural plant acids such as Epionce Lytic ($54), the use of at-home exfoliating devices such as the Clarisonic® brush (starting at $99), and the employment of in-office procedures such as Acne SilkPeel™. By relieving the congestion of dead skin and oil in the pores, the acne-causing bacteria are less likely to thrive. In addition, topical and/or oral antibacterial medications are used to further reduce the bacterial population within the pores.

Another important angle to consider when treating acne is the direct reduction of inflammation in the skin. Though inflammation will generally secondarily decrease as clogged pores and bacteria clear, there are medications and treatment that can directly reduce redness and inflammation in the skin. The treatment of adult acne will often focus more on the anti-inflammatory approach. This may include the use of topical or oral anti-inflammatory agents, as well as in-office procedures such as treatment with lasers and light sources. As adults generally have drier and potentially more sensitive skin than teens, when choosing topical agents it is important to avoid medications that are overly drying or too aggressive.

In addition, for both teenage and adult females, acne treatment sometimes involves the use of oral medications that decrease the negative hormonal influence on the skin. These include birth control pills or other oral prescription medications that block the effects of testosterones on the production of oil by the oil glands. These drugs are not useful in males, but may prove very beneficial in women with hormonally driven acne. Lastly, acne-prone patients of all ages may be candidates for treatment with isotretinoin, which is a high oral dose of vitamin A given over a six-month period. The course of treatment requires close monitoring and is quite a bit more involved in comparison to other simpler treatments. However, most patients will remain free of acne after a course of isotretinoin.