Persistent Adult Acne
The American Academy of Dermatology (AAD) states that acne that fails to clear before someone reaches their mid-twenties is called persistent acne. Persistent acne is different from late-onset acne, a condition characterized by acne that develops for the first time during adulthood or after years of blemish-free skin. Persistent acne usually begins during puberty and persists, becoming chronic and difficult to treat.
Persistent acne tends to develop along the jaw line and around the mouth, which makes it very noticeable and a significant cosmetic concern, especially for women. Without treatment, the condition may continue throughout life, affecting 20 to 50 percent of women and nearly 25 percent of men. Because persistent acne often fails to respond to traditional, over-the-counter treatments, many sufferers develop problems with self-esteem and experience social anxiety due to concerns about their appearance.
In most cases, persistent adult acne looks identical to the normal acne of adolescence. Blackheads, whiteheads and papules may develop on the face, neck, or body. Persistent acne may also appear as pus-filled pustules, which are deeper, painful cysts or nodules that form deep within the skin. Widespread inflammation and redness are often present, especially when harsh soaps, cosmetics or overuse of acne medications has irritated the skin.
In adults, persistent acne may result from fluctuating hormone levels associated with menstruation, pregnancy and menopause. Some women may develop acne for the first time after discontinuing use of birth control pills. The Mayo Clinic states that while hormonal problems are more common in those with adult acne, most people with adult acne have no hormonal imbalance. Some medications, including corticosteroids and anticonvulsants, may also cause or worsen acne in both men and women. Genetics also plays a role in persistent adult acne, with as many as half of adult acne sufferers having a first-degree relative with acne, according to the AAD.
According to the AAD, medications and other treatment options commonly used to treat acne during adolescence are often less effective later in life, with some even increasing skin irritation and blemishes. Effective treatment depends on uncovering the underlying cause of the acne and trying different medications and other treatment options until the skin clears. Hormonal medications may be stopped or started to improve the skin's appearance, and stress reduction may be beneficial when persistent acne is caused by overproduction of sebum due to high androgen levels associated with chronic stress. Topical salicylic acid creams, retinoids, gentle soaps and hypoallergenic cosmetics may all help improve mild cases of persistent acne. Severe cases often require the use of oral antibiotics or oral isotretinoin. Laser skin resurfacing and microdermabrasion procedures can help improve the texture of skin scarred or damaged by chronic acne.
The AAD warns that persistent adult acne may be a sign of an underlying medical condition that requires treatment. In some cases, especially when accompanied by thinning scalp hair, irregular periods,and excessive facial hair, acne may indicate the presence of polycystic ovarian disease or an adrenal gland disorder. These disorders require medical treatment.
In some cases, mild adult acne may actually be a condition called rosacea. Rosacea causes reddening on the nose, cheeks, and chin, sometimes with small bumps and pimples. Treatment for the two conditions is very different, according to the National Rosacea Society, and rosacea should be ruled out by a dermatologist in cases where persistent acne fails to improve with oral medications.
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