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How is moderately severe adult acne treated?

Adult acne in women, also known as postadolescent acne, is very common. We do not understand why patients develop this condition, but hormones likely play a role. Cigarette smoking is also known to be associated with adult female acne.

There are many ways to treat these patients. The same medications that work for teenage acne can be used in adults. These may be used in different combinations and dosing regimens than they are used in teens. Topical medications and oral antibiotics can help. Hormonal therapies can be tried, especially in women who flare around the time of their periods. An oral vitamin A derivative called isotretinoin may be needed in some patients. Finally, lasers and light sources help as well. Fractionated lasers can also help smooth out the skin and improve the appearance of acne scars and irregularities of the texture and tone of the skin.
Dr. Ellen Marmur, MD
Dermatology
Adult onset acne can be very complex and confusing for people. Some people have sensitive skin which, when becomes dry or red or irritated—forms pimples. These respond best to anti-inflammatories such as benzoyl peroxide plus resolving the cause of the sensitivity. Dry skin needs a nice moisturizer (Aveeno, Strivectin SD, Oil of Olay, etc). Sensitive red skin may need a patch test to discover any allergies to preservative or fragrances. Often people with adult acne from irritation are the same people who have tried dozens of new products on their skin and now have very confused skin. For these people, I recommend a detox of all products except for daily sunscreen (try water babies or coppertone or Nia 24) and gentle moisturizer for 3 weeks. Always see your dermatologist for guidance.

The other main causes of adult acne are either medical or external. Medical causes include hormonal changes and should be investigated with lab tests for PCOS, thyroid problems, and an ANA for autoimmune issues.  External causes are common culprits. Stress is the biggest. Plus lack of sleep (get a good 7-8 hours a night for at least 4 nights a week). Plus diet (despite studies stating otherwise, food does lead to acne!) Also, habits such as holding your chin in your hand (sweat and dirt on skin around the mouth can cause irritation) or pressing your cell phone on the skin  (same reasons). My #1 least favorite cause of adult acne is self surgery. Picking. Pickers are addicted to “cleansing” their skin but each time they pick or squeeze, it makes a mark that lasts for months. This is the hardest habit to kick and the most frustrating for patients who really want to fix their skin themselves! Please stop, and help your skin heal by using approved products to help your acne resolve quickly. Again, see your local dermatologist! We are here to help.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)

Adults with more than 20 acne lesions have moderately severe acne and may need prescription medications. A dermatologist can prescribe prescription-strength medicines that are either put on the skin or taken by mouth. Many of the prescription medicines applied to the skin are stronger versions of the ones you find over the counter. These creams, lotions, or gels contain ingredients that get to the heart of acne by reducing oil, dead skin cells, swelling, and pus. Doctors usually recommend a combination of products that contain one or more ingredients such as benzoyl peroxide, an antibiotic, azelaic acid, nicotinamide, and retinoids, which help to unplug oil-filled pores so other medicines can get inside.

People with severe acne may need to take an antibiotic by mouth. The most common antibiotics for acne are clindamycin, erythromycin, doxycycline, minocycline, tetracycline, and metronidazole. Isotretinoin is a retinoid taken by mouth that is only given when all else fails, because it has some potentially dangerous side effects. If acne is caused by a hormone condition, your doctor may recommend hormonal therapies to restore balance. For example, women with fluctuating hormones sometimes find relief from acne when they take birth control pills, which deliver a fixed amount of hormones every month.

Seek a physician’s assistance for medical concerns.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.