I love the newness and feelings of endless possibilities with the start of every New Year. It’s a clean slate where a person can lay out their intentions no matter how big or small. Exercise more, drink less, try a new hobby, travel somewhere new, take care of oneself better – these are all great goals.
Having clearer skin is one goal I know a lot of my clients desire this year. Who thought that acne would still be an issue after adolescence? All of those people who kept saying “you’ll grow out of it” were liars. There appears to be an increase in post-adolescent acne, and the disease is lasting longer and is requiring treatment well into the mid forties. (HE Knaggs, 2004) According to one study, 50% of women between the ages of 20-29 are affected by it; so are 25% of women 40-49. (American Academy of Dermatology, 2012) It just isn’t fair! We have enough to deal with as we get older; acne shouldn’t be one of them!
Acne stems from a few different avenues. One of the main causes is excess oil (sebum) production by the body. For whatever reason, be it hormones or just the genetic luck of the draw, many people affected with acne secrete more sebaceous lipids onto the surface of the skin. (Peter Pugliese, 2005) The excess oil acts like glue and begins to collect shedding skin cells, sticking them together. This eventually clogs follicles, creating open or closed comedones. Add some bacteria into the mix and an inflammatory response is triggered and a pimple is born.
Hormones are another major culprit for adult acne. Periods, pregnancy and menopause all affect our skin with varying levels of hormones. Androgens, the male sex hormones, are found in both men and women but for aging women, the estrogen to androgen ratio becomes unbalanced. Androgens increase oil production and can lead to those annoying breakouts. (Aguirre) Also, don’t underrate the role of mental stress on acne, either. The entire endocrine system is controlled by the pituitary gland in the master control center of your brain. While it sends out hormonal messages throughout the entire body, it also receives them. “An important consequence of this system is that psychological stress can affect the body.” (Peter Pugliese, 2005)
Finally, women with polycystic ovary syndrome (PCOS), an endocrine system disorder that results in elevated androgen levels, may have issues with irregular periods, excessive hair growth (especially on the face), obesity and, yes, acne.
Treating acne, be it adolescent or adult, is tricky because what works for one person can have little or no effect on another. At our clinic we give the disclaimer that an acne patient may feel a bit like a science experiment while we try to find what works best for them. Whatever course of treatment is decided upon, it will be customized to the patient’s type and severity of acne. One thing that should be kept in mind is that older women typically have drier skin (especially those of us that live at a high altitude). Some of the typical active ingredients in topical acne treatments, like benzoyl peroxide, may over-dry and irritate the skin. This makes selecting the right product key.
At the American Academy of Dermatology’s 70th annual meeting, Dr. Bethanee Jean Schlosser presented on hormonal factors and acne in women. She suggested that a good first line of defense is an at-home retinoid like Retin-A. Not only will this help to reduce comedones that can lead to more breakouts, it also helps to reduce and soften fine lines. Who wouldn’t like that!
Oral contraceptives as a way to help clear up skin was also brought up during her talk. Birth control pills, especially those with estrogen and progesterone, help to alter hormone levels, decreasing the effects of androgens in the form of breakouts. (U.S. National Library of Medicine, 2013) In studies, both inflammatory and non-inflammatory acne have shown improvement while using oral contraceptives. It’s very important to talk to your doctor in order to find one that will work best for you.
Another option can sometimes be treating acne using oral medication. Spironolactone is a medication that was originally given to cardiovascular patients but was also found to block androgen receptors and help sufferers of hormonal acne. As an acne treatment, it’s been used since the 1980s as an off-label use. (Bankhead, 2015) It’s recommended that anyone using Spiro have periodic blood tests to monitor potassium levels.
Whether it’s one medicinal treatment or a combination of meds and in-office treatments, there are many ways to treat adult acne. You don’t need to suffer with it. A consultation is key to really plot out your plan of action. Like any New Year’s resolution, it’s all about the long-term game. It can take upwards of 12 weeks to see marked improvement, so be patient and in the meantime, take a hands-off approach… That means no picking or popping.
Give our office a call today to set up your acne consultation to get you on the road to a clearer New Year.
Written By: Sarah Rutherford, PMA.