Most of us will suffer from acne at some point in our lives, often in adolescence as we go through puberty. But for some, acne continues to be a problem into adulthood. Estimates vary, but it is believed that up to 20% of women over the age of 25 have adult acne. And it is more of a problem for women than men: according to research, around four in every five cases of adult acne (80%) affects women. This is thought to be due to changing hormone levels during pregnancy, periods, the menopause and so on, and the effects of medication such as the oral contraceptive.
Here at The Clinic, I often work with people who are suffering with adult acne. There are various options available that can help to improve the condition. If you have ever suffered from this problem, or are experiencing acne now, read on to find out more.
Adult acne: so much more than “just a few spots”
Depending on its severity, adult acne can be upsetting and distressing to live with. In this 2017 piece in The Guardian newspaper, an adult acne sufferer describes how much it is impacting on her daily life. “I cannot remember the last time I ventured outdoors in public without makeup”, she confesses.
Sometimes those suffering from severe acne can become depressed. If you feel this way, or believe you might, it is important to speak to your GP, who will be able to help. You may also find the Talk Health Partnership online forum, TalkAcne, helpful. It offers advice and support for all those with acne, from teens upwards.
Adult acne sufferers sometimes report that they don’t feel that the problem is taken seriously enough by health professionals. This can lead to them feeling that there is nothing that can be done.
What causes acne?
Acne happens when the hair follicles becomes blocked. This is often due to an excess of sebum, the oily substance our skin secretes to prevent dryness. Sebum production is at least in part controlled by our hormones.
When the hair follicle is blocked, it fills with skin debris (keratin squamae), bacteria, and more sebum. Bacteria are present in everyone’s skin, but in these conditions they can multiply. The immune system then responds to the bacteria, causing inflammation.
It is the inflammation that causes damage to the skin, rather than the bacteria. Inflammation near the surface of the skin causes a pustule (a pimple containing pus) to form. Inflammation deeper in the skin can cause a papule (pimple) to form. Inflammation at an even deeper layer can become a cyst.
Papules and cysts can be painful and tender to the touch, and are more likely to cause scarring after they heal.
The bacterium that colonizes the skin and hair follicles, contributing to many cases of acne, is called Propionibacterium acnes (P.acnes). Research suggests that some individuals are more sensitive to P.acnes bacteria than others, and are therefore more likely to develop acne symptoms.
The after effects: scarring and PiH
Unfortunately the problems of acne do not begin and end with the spots. Even when the spots have healed, they can leave behind scarring. The scars can be raised, flat or depressed, and fall into three main types:
- Rolling scars are caused by the scar tissue that forms under the skin, giving the surface an uneven appearance
- Boxcar scars are the oval or round depressions (“craters”) most commonly associated with acne
- Ice pick scars are small but deep holes in the skin’s surface – so-named because they look as if a sharp object has punctured the skin
And whereas acne can be treated on the NHS, treatments for the resultant scarring are usually classified as cosmetic surgery, so do not qualify – unless the scarring is causing serious psychological distress.
Post inflammatory Hyperpigmentation (PiH) can also be a significant problem: this is when the inflammation from the acne causes changes in the pigmentation of the skin. Although PiH can occur in all skin types, it is more common in people with darker skin tones.
The four different levels or grades of acne
Acne can be graded at four different levels, according to its severity. The likelihood of scarring or post inflammatory hyperpigmentation (PiH) increases with each grade:
Grade I
The mildest grade, with whiteheads and/or blackheads and small pimples only, and little to no inflammation. Spots are mainly limited to the nose and forehead.
Grade II
Moderate: larger numbers of whiteheads and/or blackheads, which can be larger in size, and with slight inflammation. Spots appear on a larger area of the face, affecting areas like the cheeks and jaw. Breakouts are more frequent.
Grade III
Severe: more inflammation and reddening, and a larger number of pustules (pimples containing pus). Infection can spread and the risk of scarring is high. The skin can be painful to the touch.
Grade IV
This is the most severe grade. The medical name for this grade is cystic acne, where there are large numbers of pustules (pimples containing pus) and papules (small pimples or swellings). The skin will also have pus-filled cysts, where the infection goes deep into the skin. Inflammation is severe, and the acne is painful. Infection may now spread beyond the face onto areas such as the chest and back. This deeper infection is likely to cause scarring.
You may already be identifying with some of the symptoms described here. Read on to find out how these can be tackled.
Treating adult acne: my top tips
Treating adult acne means tackling three different problems; the plug in the pore that is causing a blockage, the subsequent inflammation, and the bacteria that then add to the problem.
Depending on the severity of your acne, your treatment plan will aim to address each of these issues:
1: Remove the plug
Salicylic acid is great for this. Essentially, it dissolves the skin debris clearing the blockage. I use a number of products that contain salicylic acid, including Blue Peel Radiance, isClinical Active Cleanse, and Exoderm (in Obagi Nu-Derm). Note that salicylic acid does not change sebum production or kill bacteria: for these problems we need a different approach.
2: Reduce the inflammation
Benzyl peroxide (BPO) is my go-to ingredient to soothe inflammation. It’s really potent, and penetrates the skin beautifully. BPO is present in the Obagi skincare range [LINK]. Phototherapy can also help to treat inflammation. Dermalux red light therapy [LINK], for example, has been shown to have anti-inflammatory properties. When delivered to the skin at the correct wavelength, it triggers the anti-inflammatory processes, reducing irritation and redness and accelerating repair.
3: Deal with the bacteria
There are a variety of topical creams that will help to tackle bacteria. Oral prescription antibiotics can also be very effective, and I encourage anyone already taking a prescription to complete the course, alongside any other therapies. Dermalux blue light therapy [LINK] is also effective in killing bacteria. Blue light at the correct wavelength destroys p.acnes bacteria, for example. It also helps to balance sebum production, reducing future outbreaks.
4: Tackle scarring and PiH
If scarring is also an issue, treatment should be targeted at a deeper level of the dermis to stimulate healing and regeneration. Dermaroller is an excellent option, as are courses of deeper peels such as the Obagi Blue Peel.
Post-inflammatory Hyperpigmentation (PiH) can also be improved with regular skin peels. The Obagi Nu-Derm system is also ideal for PiH with its active skin lightening compounds. Light therapy such as Dermalux can also be effective in treating hyperpigmentation.
Things to avoid
I do not recommend mechanical exfoliation (e.g. skin scrubs) for acne-prone skin. This type of abrasive treatment can actually cause further problems in sensitive skin.
Take care when choosing makeup and SPF products, as some can contribute to blocked pores. At The Clinic we are happy to recommend products that are suitable for acne-prone skin.
Don’t forget your nutrition!
And one final thing: don’t forget the role of nutrition! A balanced, healthy diet is important not just for your overall health, but the health of your skin too. For example, dark circles under the eyes can be a sign of iron deficiency, and a lack of Vitamin C can lead the skin to bruise more easily and heal more slowly.
Vitamin A has been shown to help change the levels of sebum production in the skin, and can be applied topically or taken as an oral supplement. For example, the ANP supplement Skin Accumax is formulated specifically for this purpose. I will be happy to talk through the variety of different supplements available to help with common skin complaints.
Formulating a treatment plan that is right for you: my approach
I start by taking a full history, so that I have a good understanding of your individual symptoms and any previous treatments you may have had.
For some patients, the resultant scarring and/or hyperpigmentation are just as much of a problem as the active acne, so it’s important to assess this too.
Putting together a carefully planned treatment regime will help to address both the causes and the effects of adult acne. While I advise clients not to expect overnight results, there is much than can be done to improve the problem.
If you would like to find out more, why not book in for a consultation with me? Contact me here to find out more, or to book, or call us at The Clinic on 020 8699 9496.
