So your teenage years are a memory, you’re at university or perhaps in a full time career with children, and your still suffering from acne. If you’re an adult afflicted by acne you’re probably wondering why after being pimple free for years you are now experiencing a skin condition often associated with teenagers. Or mabye your acne has got worse or remained the same long into your 20s and 30s or even older. If your one of those people, chances are you’re probably female.
Adult acne and female acne go hand in hand with more females than males affected. This is why it is sometimes referred to as female adult acne or female post-adolescent acne.
According to the International Journal of Cosmetic Science, recent studies show an increase in post-adolescent acne with treatment required well into the mid-forties.1. An explanation for the increase in the disease in women could be increasing stress levels with increasing levels of acne found in women in fast paced jobs1
Adult acne does not just affect females. Male acne affects some men but the causes are usually different.
Symptoms of Adult Acne Include:
- Propensity to come and go in females
- Lesions can be seen but blackheads and whiteheads are less common
- Lesions tend to appear on the lower face (around the mouth, chin and lower cheek)
- Less likely to result in scaring like teenage acne
It is important not to confuse adult acne with endocrinopathy, rosacea, and pseudofolliculitis barae. Even health care professional can get the diagnosis wrong as these conditions can look similar to acne. Endocrinopathy is caused by a serious hormonal abnormality and can be diagnosed with a blood test.
Causes of Adult Acne
If you are an adult female and your acne fluctuates, a hormonal explanation is the most likely cause. Indeed adult female acne is strongly linked to the menstrual cycle and the onset of this can be seen in girls approaching adulthood.
While adult acne is largely caused by a women’s own hormones, external factors such as use of certain cosmetics, ingestion of drugs, and endocrine abnormalities should all be considered2. While the menstrual cycle or hormonal changes after pregnancy are often the culprit, Endocrine abnormalities can sometimes be a factor.
It is possible that food allergies may play a role in adult acne, and people may want to avoid foods that appear to make their symptoms worse. Some doctors may suggest a low glycemic diet, which helps keep blood sugar stable and under control.3.
The vast majority of female acne is not caused by increased levels of androgen like in teenagers; rather, they seem to have an increased response to normal levels of androgen. Higher than average levels of Estrogen can reduce acne and low levels of estrogen can make an outbreak of acne more likely.
A Strong Genetic Link
According to a study 80% of the variance of the disease was attributable to additive genetic effects4
The risk of adult acne occurring in a relative of a patient with adult acne was significantly greater than for the relative of an unaffected individual
Acne and your Menstrual Cycle
It may be common for pimples to appear about two to seven days before your period. This is when estrogen levels fall and progesterone levels rise and stimulate the sebaceous glands to produce extra oil. It is this extra oil that cause inflammatory acne.
Post-Menopausal is less common but again is caused by hormonal changes. Estrogen levels can decline in older age and testosterone can become the dominant hormone in women resulting in mild acne.
Acne and Pregnancy
Acne can occur during and after pregnancy. Pregnancy causes significant hormonal changes in the body. Estrogen and progesterone increase and the skin can become more sensitive to the hormonal changes within your body. The increased progesterone levels are more androgenic than estrogen and cause the secretions of your skin glands to increase.
It is best to avoid anti-acne drugs to treat acne when pregnant or breastfeeding as these can be harmful to a developing fetus or baby. Topical anti-acne treatment is a safer option as these are applied to the skin. However you should still consult your doctor about any possible side effects.
Topical treatment for acne during and after pregnancy include Benzamycin Gel applied to the skin or the anti-biotic Erythromycin which should be applied topically rather than injected. Azelaic acid is another gel or cream from a natural chemical produced by a yeast.
You should try to avoid all oral anti-acne drugs while you are pregnant. However if your acne is severe your doctor may prescribe erythromycin taken orally.
Treating Adult Acne in Females
If you are not pregnant and the usual anti-acne creams and gels do not work, like the ones mentioned above then it may be necessary for something more powerful. Androgenic hormones such as testosterone play a major role in the development of acne in women and some oral contraceptives can help block the effects of androgens on your sebaceous glands. Other acne treatment can include birth control pills as they inhibit androgens from stimulating the sebaceous glands thereby reducing the oils that fuel your acne. If you suffer from acne caused by excessive amounts of androgens it is possible you also have excessive amounts of body hair as this is another symptom of high levels of androgens. Hormonal therapy, anti-androgen’s and birth control pills can be used in combination to treat these conditions. Oral contraceptives contain estrogen which can help increase levels of estrogen thereby reducing acne.
The oral contraceptives Estrostep, Ortho Tri-Cyclen, and Yasmin are the best ones to take if you have acne. It can take upward of 3 months before the pills take effect so don’t expect results anytime soon.
Anti-androgen treatment is another option for women if you do not wish to take a birth control pill and when you have an abnormal level of endocrine leading to high levels of androgens. It is best to take the oral contraceptive while taking most anti-androgens as anti-androgens can negatively affect a fetus should you fall pregnant. You should always consult a doctor before you take these treatments.
- Knaggs He, Wood EJ, Rizer RL, Mills OH, "Post-adolescent acne, International Journal of Cosmetic Science, 2004 Jun;26(3):129-38. [↩] [↩]
- Williams C, Layton AM, Persistent acne in women : implications for the patient and for therapy, American Journal of Clinical Dermatology, 2006;7(5):281-90 [↩]
- Acne University of Maryland Medical Center [↩]
- Bataille V, Snieder H, MacGregor AJ, Sasieni P, Spector TD, The influence of genetics and environmental factors in the pathogenesis of acne: a twin study of acne in women, The Journal of Investigative Dermatology, 2002 Dec;119(6):1317-22. [↩]
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