Adult acne, also known as post-adolescent or late-onset acne, is a widespread issue that often prompts many inquiries in dermatology consults worldwide. Patients diagnosed with this condition are usually puzzled and ask questions like, “Why do I still have acne at this age?” or “Aren’t I too old to get acne?” Others may say things like “I have never had acne before” or “I have always had perfect skin until now.”

Unfortunately, adult acne is an ongoing struggle that is difficult to treat, with a long and recurrent course. In recent years, leading dermatologists have questioned whether different factors are at play in adult acne as opposed to adolescent acne.

Adult acne is typically defined as acne that affects individuals aged 25 or older, and it is more common in women than men. It can either persist continuously from adolescence, recur after age 25, or even appear for the first time after the age of 25. Therefore, the answer to the aforementioned questions is “Yes, you can still have acne beyond adolescence” and “Yes, it can be for the first time.” In fact, only about 20% of cases of adult acne occur for the first time after the age of 25. Thus, the term “adult acne” seems more suitable than “late-onset acne.”

The conventional belief is that the primary factors contributing to adult acne are genetic and hormonal, with the lower third of the face being mostly affected. Flare-ups usually occur before menstruation, which supports the role of hormones. Most patients complain of deep-seated and painful nodules, with very few comedowns (blackheads and whiteheads). These acne nodules are usually sparse but can result in significant scarring.

The Two Main Forms of Adult Acne: Inflammatory and Retentional

There are two main types of adult acne that are now recognized: inflammatory and retentional. Inflammatory acne is the more prevalent type, accounting for 50-60% of cases. The skin may not always be oily, and in fact can be normal to dry, making it sensitive to topical treatments typically used for adolescent acne. Acne lesions can appear in various areas of the face, not just limited to the lower third. Retentional acne, on the other hand, is characterized by increased sebum production or oily skin, and the presence of multiple comedowns (blackheads and whiteheads).

Understanding the Causes of Adult Acne

Acne, whether it occurs during adolescence or adulthood, can be caused by several factors. Some of the primary factors that contribute to adult acne are:

1. Genetic predisposition: Studies have shown that up to 40% of acne sufferers have a family history of acne. This may be due to genetic determinants related to the size, number, and activity of sebaceous glands.
2. Hormonal changes: Increased levels of androgenic hormones like testosterone, dehydroepiandrosterone sulphate, and dihydrotestosterone stimulate the sebaceous glands, leading to oily skin. Oestrogen inhibits the secretion of androgenic hormones and sebaceous gland activity. With age, a decline in oestrogen levels can tip the balance towards androgenic stimulation.
3. Excessive sebum production: Androgenic hormones are not the only factors that stimulate sebaceous gland activity. Other factors can also lead to excessive sebum production.
4. Abnormal follicular keratinisation: This process leads to blocked hair follicles and the formation of comedowns. Skin cells in the hair follicles accumulate and, together with sebum, block the follicle opening, contributing to the inflammatory response.
5. Bacterial infection: Propionibacterium acnes or cutibacterium acnes, which normally live in the sebaceous glands, can proliferate with increased sebum production, worsening the inflammatory response and causing papules and pustules, commonly known as “pimples.”

Understanding the Factors and Triggers of Adult Acne

Ultraviolet Light Exposure:

Excessive sun exposure can thicken the stratum corneum and accumulate dead surface skin cells, stimulating the sebaceous glands to produce more sebum, resulting in comedowns and acne.

Stress:

A stressful lifestyle with poor sleep patterns can cause acne by affecting the pituitary adrenal axis and resulting in the release of corticotrophin-releasing hormone, neuropeptides, and proinflammatory cytokines. These substances stimulate the sebaceous glands and worsen the inflammatory response.

Obesity and Insulin Resistance:

Hormonal imbalance and acne are associated with obesity and insulin resistance.

Endocrine Disorders:

Numerous endocrine diseases can cause acne by increasing the activity of androgens, stimulating the sebaceous glands, or inducing abnormal keratinization. Polycystic ovarian syndrome (PCOS) is the most common cause, but other conditions such as congenital adrenal hyperplasia, hypothyroidism, Cushing’s syndrome, and various adrenal and ovarian tumors can also trigger acne. Acne also occurs in menopause due to the decline in estrogen and resultant increasing effects of male hormones.

Smoking:

Smoking can cause acne by stimulating the sebaceous glands and inducing abnormal keratinization, leading to a non-inflammatory, come domal acne with mainly blackheads and whiteheads and few papules and pustules.

Diet:

Although there is not much scientific evidence, studies have shown that high-glycemic index foods increase insulin and insulin-like growth factor 1 (IGF1), stimulating the production of androgens and sebum. Diets rich in dairy products, muscle building supplements with whey protein, and anabolic steroids used by weightlifters and bodybuilders can also worsen acne.

Damage to the Skin Barrier:

Over-washing the skin can damage the epidermal skin barrier, causing water loss through the skin and worsening the inflammatory cascade.

Greasy Cosmetics:

Occlusive makeup, Vaseline, and other thick greasy creams can block follicles and cause acne in those susceptible. Actors, models, and those requiring heavy make-up as part of their job may experience this problem. Hair products that spread onto the hairline can also cause acne in the affected areas.

Medication:

Some drugs, such as progesterone-only contraception (including commonly used injectable contraception), benzodiazepines, mood stabilizers like lithium, and blood pressure medication like ramipril, can cause acne as a side effect. Hormone-releasing intrauterine contraceptive devices and contraceptive implants may also trigger acne in some women who are predisposed. Anabolic steroids used by weightlifters and bodybuilders can cause severe scarring acne affecting the face and body.

Also read: Say Farewell to Maskne: 5 Tips to Combat It

Diagnosing Adult Acne: What Tests Are Needed?

Diagnosing adult acne is primarily a clinical diagnosis and typically does not require lab tests. While androgenic hormones are a key factor in causing acne, there is often no increase in hormone levels. Rather, it is the balance between androgenic hormones and estrogen that contributes to acne development.

In cases where endocrine disorders are suspected, further investigations may be necessary. However, these conditions typically present with additional signs and symptoms. For example, polycystic ovarian syndrome (PCOS), which is the most common cause of adult female acne, often presents with other signs of hyperandrogenism.

Diagnosing PCOS requires laboratory investigations, abdominal imaging, and consultation with a gynecologist or endocrinologist. While acne may be a symptom of an underlying endocrine disorder, it is important to note that acne is often a clinical diagnosis that can be made without extensive testing.

Treating Adult Acne: Challenges and Options

Acne is a complex condition that presents challenges in its diagnosis and treatment. For adult acne, the situation can be even more difficult. While treatments can be effective, acne frequently recurs after treatment is stopped. Additionally, the severity of acne can vary, making treatment decisions more complicated. Patients may also have drier skin, which can limit their ability to tolerate certain topical medications.

Treatment options for adult acne are diverse and may include topical, systemic, and procedural approaches, as well as skincare regimens. However, there is no one-size-fits-all approach, and each patient must be evaluated individually to determine the best course of action. Treatment also requires ongoing maintenance, which can involve rotating different treatment options to prevent recurrence.

While some patients may seek a quick fix, the reality is that there is no single, one-time treatment that can cure acne. Patients and dermatologists must work together to find the best combination of therapies for each individual, taking into account factors such as pregnancy or breastfeeding, which can limit treatment options. Despite these challenges, with the right treatment approach and ongoing care, many patients with adult acne can find relief.

A Guide to Topical Acne Treatments

Topical treatments are typically recommended for mild to moderate acne or occasional breakouts, and are an essential part of maintenance treatment. Let’s take a look at some of the most common topical treatments:

Retinoids

Retinoids such as 0.1% adapalene gel (Differin, Dapta) and tretinoin (Retin-A, Ilotycin-A, Retacnyl) cream and gel are not only effective in treating acne but are also known to have anti-aging and skin cancer prevention properties. However, they can cause skin dryness and irritation during the first few weeks of use and increase sensitivity to sunlight. A good moisturizer and sunscreen are recommended to help minimize these effects. Retinoids are not suitable for use during pregnancy or breastfeeding.

Topical antibiotics

Topical antibiotics like clindamycin and erythromycin work by reducing the presence of acne-causing bacteria and have an anti-inflammatory effect. They are safe to use during pregnancy. However, using antibiotics alone can lead to resistant strains of bacteria, so it is important to use them in combination with other topical treatments like retinoids or benzoyl peroxide.

Benzoyl peroxide

Benzoyl peroxide is a long-established acne treatment that is particularly beneficial for oily skin, but it can also cause dryness and skin irritation. This treatment can make the skin sensitive to sunlight and may bleach clothing and towels. Benzoyl peroxide (5%) is often recommended as a first-line therapy for mild adolescent acne and is safe to use during pregnancy.

Azelaic acid

A 20% azelaic acid gel (Skinoren) is effective in treating mild to moderate acne, and is especially suitable for individuals with dry skin as it is not irritating. This treatment is also effective in reducing post-inflammatory hyperpigmentation caused by acne lesions. Azelaic acid is safe to use during pregnancy and breastfeeding.

Topical combination treatments

Combining adapalene 0.1% with 2.5% benzoyl peroxide (Epiduo) is an effective treatment for mild to moderate acne, but it should be introduced gradually to minimize skin irritation. Benzoyl peroxide 5% and clindamycin 1% (Clindoxyl) is another popular topical treatment that combines an antibiotic with benzoyl peroxide, making it a suitable treatment option for inflammatory and non-inflammatory acne lesions.

Systemic treatments

Oral medication is often recommended for moderate to severe acne or widespread acne that cannot be treated with topical medication alone. Here are two common systemic treatments:

Antibiotics

Oral antibiotics are effective in treating facial acne, but recurrence is common once the course of antibiotics is completed. Using antibiotics in combination with topical treatments like retinoids or benzoyl peroxide can help prevent resistance and speed up the response to treatment. Tetracyclines like lymecycline (Tetralysal) and doxycycline are commonly prescribed for adolescent or adult acne.

Hormones

Hormonal treatments are highly effective in treating adult female acne, but cannot be used in men. They are also suitable for long-term use and can be an effective maintenance treatment.

When to Prescribe Hormonal Treatment for Acne: A Comprehensive Guide

Acne is a common skin condition that can have a significant impact on a patient’s quality of life. Hormonal treatments can be a helpful tool in managing acne, but they are not appropriate for every patient. Here are some key considerations when deciding whether to prescribe hormonal treatments for acne:

1. Pregnancy and Breastfeeding: Hormonal treatments are not recommended for pregnant or breastfeeding patients. Patients who are attempting to become pregnant should also avoid hormonal treatments.
2. Skin Oiliness and Premenstrual Flare-Ups: Hormonal treatments work best for patients with oily skin and premenstrual flare-ups of acne. They should ideally be combined with a topical retinoid, benzoyl peroxide, azelaic acid, or antibiotic.
3. Cyproterone Acetate: Cyproterone acetate is an anti-androgenic progesterone that can be found either combined with estrogen in the oral contraceptive pill (Diane-35, Minerva, Ginette) or alone at varying doses (Androcur). It works by blocking the androgen receptor on the sebaceous glands, preventing excessive sebum production. Side effects include mood swings, breast tenderness, fluid retention, nausea, and vomiting.
4. Spironolactone: Spironolactone is a potassium-sparing diuretic that also works by blocking the androgen receptors on sebaceous glands. It may cause increased potassium levels in those susceptible to renal failure. However, it is safe to use in young healthy women. It may be combined with the oral contraceptive pill, with the intrauterine contraceptive device, or topical retinoids for added benefit.
5. Other Combined Oral Contraceptive Pills: Other combined oral contraceptive pills with antiandrogenic progesterone (drospirenone) may also be used. It is important to exclude the risk of thromboembolism, i.e., heart attacks and strokes, when prescribing the oral contraceptive pill.
6. Isotretinoin: Isotretinoin (Roaccutane, Oratane, Acnetane, Acnetret) is usually reserved for severe or resistant acne where other treatments have failed. It works by reducing the size and activity of the sebaceous glands, improving keratinocyte shedding, and reducing inflammation. However, it has many side effects that make many patients reluctant to take it unless absolutely necessary. The biggest problem with prescribing it in females is the risk of teratogenicity, which makes contraception essential in females at least while on the medication and 2-3 months after stopping treatment. Other side effects include dryness of the lips, eyes, nose, and other mucous membranes, dermatitis, joint, and muscle pains. Isotretinoin can cause raised liver enzymes and raised cholesterol and triglycerides, so baseline blood tests are needed before treatment and during the treatment period. Isotretinoin may also be associated with depressed moods.
7. Cosmeceutical Skincare: Acne treatments frequently cause dryness and skin irritation and may damage the epidermal skin barrier. Cosmeceutical skincare can help maintain the integrity of the epidermal barrier and includes ingredients like salicylic acid, lactic acid, and glycolic acid to help shed dead surface skin cells, unblocking the opening of the hair follicle unit. Acne facewashes and toners can help reduce oiliness of the skin. Skincare can also assist with reducing and treating post-inflammatory hyperpigmentation and scarring, which often remains long after the acne has been treated.
8. Procedures: Steroid injection of acne nodules is used for resistant painful inflammatory nodules

Adult acne presents a daunting challenge due to its chronic nature and its significant impact on the quality of life of those affected by it. Furthermore, its prevalence appears to be on the rise. While we do not fully comprehend its underlying causes, the same pathogenetic mechanisms that cause adolescent acne seem to be involved, along with a variety of contributing factors. Seeking the advice of a dermatologist as early as possible is crucial to determine the most appropriate treatment approach for you. Although managing adult acne is complicated, and there is no one-size-fits-all solution, with the right guidance and tools, acne can be controlled and successfully managed.

Dealing with adult acne can be challenging, but with the right approach, you can achieve clearer and healthier skin. Whether you opt for OTC products, prescription medications, or professional treatments, it’s essential to consult with a dermatologist to develop a customized plan tailored to your specific needs. Remember that clear skin is achievable, and by following a comprehensive skincare routine and adopting a healthy lifestyle, you can regain your confidence and feel comfortable in your own skin.

Ageing is an inevitable part of life, and it often catches us off guard. It affects us both internally and externally, but our skin – the body’s largest organ – is particularly susceptible to the damaging effects of environmental factors.

Despite the fact that we may be dealing with other health issues, we tend to be more concerned about the visible signs of ageing on our face, neck, and chest. It’s no secret that a healthy and attractive exterior appearance is a reflection of overall well-being, and feeling good about how we look can have a positive impact on our mental and emotional state.

Interestingly, many people seek to look their best for their age rather than trying to appear younger than they actually are.

Although genetics play a significant role in how we age, it’s worth considering whether we can slow down the ageing process. No matter how old we are, there are always ways to make a difference in our appearance and well-being.

Starting with Skincare: Anti-Ageing Tips

When it comes to anti-ageing, taking care of our skin is a crucial step. As we age, our skin undergoes changes, and it’s essential to adopt a skincare routine that can help maintain healthy and youthful-looking skin. It’s worth noting that anti-ageing skincare can also help protect the skin from the harmful effects of skin cancer.

Ageing skin tends to be more prone to dryness and sensitivity, leading to a dull and wrinkled appearance. Using a suitable moisturizer can help prevent dehydration and shield the skin from allergens, irritants, and organisms that can cause inflammation.

To combat inflammation and hyperpigmentation, antioxidants and calming botanicals are effective. Chemical exfoliation with glycolic acids can help improve epidermal turnover, resulting in better texture and skin radiance. Additionally, glycolic acids can signal the dermis to produce more collagen and elastin, leading to healthier skin.

Advanced skincare formulations are designed to penetrate the dermis and work selectively on active ingredients that can prevent collagen and elastin breakdown and stimulate new collagen production, ultimately reducing the appearance of wrinkles.

Maximizing Sun Protection with Antioxidants: A Comprehensive Guide to Anti-Ageing Skincare

As we age, our skin requires more attention to maintain its health and youthful appearance. Fortunately, there are ways to slow down the ageing process, and one of the most effective methods is through skincare. In this guide, we will focus on the role of antioxidants combined with sunscreens to neutralize free radicals for optimum sun protection.

Antioxidants such as vitamins C, B3 (niacinamide), and E are known for their ability to penetrate the skin and scavenge free radicals. When combined, their antioxidant properties become significantly greater, making them ideal for anti-ageing skincare.

Niacinamide is a potent anti-ageing ingredient that regulates cell metabolism and regeneration, reduces redness, improves hyperpigmentation, and enhances skin elasticity. A concentration of 5% is optimal in skincare products.

Green tea polyphenols and other botanicals also have varying antioxidant properties that are beneficial for anti-ageing skincare.

Retinols (Vitamin A) are considered the gold standard for anti-ageing due to their ability to stimulate collagen and elastic fibre formation, reduce wrinkles and fine lines, improve skin elasticity, and regulate cell turnover. Retinols have antioxidant effects and reduce the signs of UV-induced sun damage.

Peptides and growth factors are also effective in stimulating collagen production, leading to a plumper dermis and a younger-looking skin.

Sun protection is critical in anti-ageing skincare. Sunscreens with at least SPF30 and responsible sun behavior are necessary to prevent photo-ageing, an accelerated form of ageing visible on sun-exposed areas of the skin. New sunscreens with DNA repair enzymes have been shown to reduce the number of precancerous lesions with regular use.

Anti-ageing ingredients are often combined to make skincare regimens more effective. Dermatologists and skincare therapists use a skincare pyramid as a stepwise method to introduce anti-ageing skincare. The pyramid starts with basics such as sunscreen, antioxidants, and DNA repair enzymes and gradually adds more active ingredients based on tolerance and response to individual goals.

Exploring Anti-Ageing Procedures for Youthful Skin

To achieve a more youthful appearance, there are several anti-ageing procedures available that can be tailored to your specific needs. Chemical peels are one option and can be classified as superficial, medium depth, or deep, depending on the concentration of acids used. Superficial peels are generally suitable for most skin types and have minimal downtime, but it’s important to seek treatment from a reputable therapist who can determine the best peel for your skin type.

Another option is dermal needling or collagen induction therapy, which involves using fine needles to penetrate the skin and stimulate the production of new collagen. Anti-ageing active ingredients can also be applied to the skin and ‘needled in’ for optimal benefit.

IPL, lasers, and radio-frequency devices are also effective at targeting specific skin structures to improve the appearance of ageing skin. Hyaluronic acid fillers can be injected into the dermis to stimulate new collagen production, while more robust fillers can be used to lift and volumize areas of the face, creating a non-surgical facelift.

Platelet-rich plasma (PRP) therapy is another procedure that involves injecting growth factors derived from whole blood into the skin to stimulate collagen synthesis.

Lastly, botulinum toxin injections can be used to prevent repetitive muscle contraction that leads to wrinkles and furrows. While it’s most effective on frown lines, forehead lines, and crow’s feet, the treatment must be repeated every 3-4 months to maintain its effect.

Anti-ageing procedures can be incorporated into your skincare regimen based on your individual goals and skin type. Chemical peels and dermal needling are often used as a course of treatments after preparing the skin with a proper homecare regimen, while filler treatments require a pre-discussed plan.

Is anti-ageing just about products and procedures?

While products and procedures can be helpful, a healthy lifestyle with responsible sun protection is essential in slowing down skin ageing. A well-balanced diet provides essential nutrients and oral antioxidants that benefit the skin. Regular exercise not only improves overall health, but also helps reduce stress, which is known to worsen diseases and accelerate ageing. Lower stress levels may also result in fewer wrinkles caused by frowning.

Smoking, on the other hand, increases the breakdown of collagen and elastin in the dermis, leading to more wrinkles. Additionally, atmospheric pollution has been shown to be detrimental to the skin and body, causing premature ageing, skin cancers, and hyperpigmentation.

While this is not an exhaustive list, it highlights the importance of taking a holistic approach to anti-ageing. Consult with your dermatologist or skincare therapist to develop a treatment plan that works for you based on your goals, time, effort, and budget. Remember, it’s never too early or too late to start taking care of your skin, so start simple and start somewhere.

Ageing is an inevitable and natural part of life, and it comes with its own unique set of challenges and rewards. While society often places a premium on youthfulness, there is incredible beauty in growing older and embracing each stage of life with grace and confidence.

1. Embrace Self-Care

Ageing gracefully starts with self-care. Caring for your body and mind is essential at any age, but it becomes even more crucial as you grow older. Prioritize self-care activities like regular exercise, a balanced diet, and quality sleep. These practices not only contribute to your physical health but also boost your mental and emotional well-being.

2. Stay Active

Physical activity is a key component of ageing gracefully. Regular exercise helps maintain muscle strength, flexibility, and overall mobility. It can also enhance your mood, reduce stress, and improve cognitive function. Find an activity you enjoy, whether it’s yoga, walking, swimming, or dancing, and make it a part of your routine.

3. Nourish Your Body

A healthy diet provides the nutrients and energy your body needs to function optimally. Emphasize a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Stay hydrated by drinking plenty of water, and consider reducing your intake of processed foods, sugars, and excessive salt.

4. Cultivate Relationships

Social connections are a vital aspect of ageing gracefully. Maintain and nurture relationships with family and friends, as they provide emotional support, companionship, and a sense of belonging. Building strong social networks can also ward off feelings of isolation or loneliness.

5. Mindful Mental Health

Your mental health is just as important as your physical health. Practice mindfulness and stress-reduction techniques like meditation, deep breathing exercises, or journaling. Seek professional help or counseling if you encounter emotional challenges or mental health issues.

6. Pursue Passions and Interests

Ageing gracefully means continuing to pursue your passions and interests throughout your life. Whether it’s a new hobby, travel adventures, or artistic pursuits, staying engaged in activities you love can bring joy, purpose, and a sense of fulfillment.

7. Embrace Change

As you age, your body and life circumstances may change. Embrace these changes with an open heart and a positive attitude. Accepting that change is a natural part of life can help you adapt more gracefully to new challenges and opportunities.

8. Prioritize Sleep

Quality sleep is crucial for overall well-being, including physical, mental, and emotional health. Aim for seven to nine hours of uninterrupted sleep each night to rejuvenate your body and mind.

9. Stay Curious

Ageing gracefully is about maintaining a curious and open mindset. Never stop learning or exploring new ideas. Engaging in lifelong learning can keep your brain active and your spirit young.

10. Practice Gratitude

Gratitude is a powerful tool for ageing gracefully. Take time each day to reflect on the positive aspects of your life, no matter how small. Expressing gratitude can boost your overall happiness and contentment.

Conclusion

Ageing gracefully is a holistic journey that encompasses physical, mental, and emotional well-being. It’s about embracing the wisdom that comes with age, appreciating the beauty of every stage of life, and cultivating a positive and nurturing relationship with yourself. By prioritizing self-care, staying active, nurturing relationships, and maintaining a curious mindset, you can age gracefully and enjoy the many rewards that come with the passage of time. Remember that true beauty shines from within, and each day is an opportunity to live your life to the fullest, no matter your age.