Adult Acne: Why You Get It, How to Fight It

Adult acne is more common than you think – and fairly easy to treat.
By Charlotte Libov
WebMD the Magazine - Feature
Reviewed by Brunilda Nazario, MD
Adult acne can really put a crimp on your life. Last year, for instance, Christine Janssen considered posting a new photograph of herself on her business web site but ultimately resisted the idea. “With my acne, I just wanted to put a paper bag over my head,” says Janssen, 41, who runs a Manhattan marketing research company.
Skin problems afflict almost everyone growing up, but some never outgrow it, says Jonette Keri, MD, PhD, assistant professor of dermatology at the University of Miami Miller School of Medicine and chief of dermatology at the Miami VA Medical Center. She estimates that nearly 30% of women and 20% of men ages 20 to 60 (and beyond) are troubled by breakouts.
What Causes Adult Acne?
Adult acne is caused by sebum, an oily substance produced by the skin’s sebaceous glands. Sebum clogs pores, which attract bacteria and become inflamed. For most adults, breakouts are a result of hypersensitivity to androgens (male hormones). But an imbalance in both male and female hormones (estrogen) can also cause breakouts. For women, this can happen during pregnancy, perimenopause, and menopause. Some medications, such as corticosteroids, and cosmetics are also triggers.
How Is Adult Acne Treated?
Treating adult acne is tricky. Most acne medications are geared to teens' oily skin, a bad choice for drier adult skin. Effective treatment often requires a trial-and-error approach that takes time, Keri says. Her recommendations include:
Cleansers: Cetaphil and Aquanil are the most gentle. Avoid too-strong gels and products containing beads or granules, which are abrasive and can irritate and worsen sensitive skin.
Creams and lotions: Use an over-the-counter retinol product to clean pores and help reduce fine wrinkles. Prevent discoloration and fade acne scars with products that contain salicylic and glycolic acids. And to spot-treat a breakout, use a product with benzoyl peroxide, which helps kill bacteria.
Prescription medications: The topical antibiotic clindamycin helps fight bacteria in the skin; so does tetracycline, another antibiotic, taken orally. Oral contraceptives and spironolactone, a blood pressure drug, can help balance hormones.
High-tech solutions: Laser and intense pulsed light treatments mainly target scars, but blue light therapy treatments kill acne-causing bacteria. These treatments are costly, though, so explore your other options first.
A Skin-Care Regimen for the Acne Prone
Believe it or not, there’s a trick to skillful face washing. To start, try to keep your face clean during the day. Then wash your face twice daily with the cleanser (if your skin is dry, try using water the second time). Use only warm water (hot water is drying). Wash for just 1-2 minutes (more can irritate your skin). And use your hands instead of a rough washcloth. (If you must wash with a cloth, choose one made for babies, so it’s as soft as possible.)
As for Janssen, she found that a doctor-prescribed regimen of gentle cleansing, oral antibiotics, and a retinol cream did the trick, and her new photo is now proudly posted on her web site. She says, “All my friends comment on how clear my skin looks.”

Acne

Acne - Topic Overview
What is acne?
Acne, or acne vulgaris, is a skin problem that starts when oil and dead skin cells clog up your pores. Some people call it blackheads, blemishes, whiteheads, pimples, or zits. When you have just a few red spots, or pimples, you have a mild form of acne. Severe acne can mean hundreds of pimples that can cover the face, neck, chest, and back. Or it can be bigger, solid, red lumps that are painful (cysts).
Most young people get at least mild acne. It usually gets better after the teen years. But many adult women do have acne in the days before their menstrual periods.
How you feel about your acne may not be related to how bad it is. Some people with severe acne are not bothered by it. Others are embarrassed or upset even though they have only a few pimples.
The good news is that there are many good treatments that can help you get acne under control.
What causes acne?
Acne starts when oil and dead skin cells clog the skin's pores. If germs get into the pores, the result can be swelling, redness, and pus. See a picture of how pimples form .
For most people, acne starts during the teen years. This is because hormone changes make the skin more oily after puberty starts.
You do not get acne from eating chocolate or greasy foods. But you can make it worse by using oily skin products that clog your pores.
Acne can run in families. If one of your parents had severe acne, you are more likely to have it.
What are the symptoms?
Symptoms of acne include whiteheads, blackheads, and pimples. These can occur on the face, neck, shoulders, back, or chest. Pimples that are large and deep are called cystic lesions. These can be painful if they get infected. They also can scar the skin.
How is acne treated?
To help control acne, keep your skin clean. Avoid skin products that clog your pores. Look for products that say "noncomedogenic" on the label. Wash your skin once or twice a day with a gentle soap or acne wash. Try not to scrub or pick at your pimples. This can make them worse and can cause scars.
If you have just a few pimples to treat, you can get an acne cream without a prescription. Look for one that has benzoyl peroxide or salicylic acid. These work best when used just the way the label says.
It can take time to get acne under control. Keep using the same treatment for 6 to 8 weeks. You may even notice that it gets worse before it gets better. If your skin is not better after 8 weeks, try another product.

Acne - Treatment Overview
Acne treatment depends on whether you have a mild, moderate, or severe form. Sometimes your doctor will combine treatments to get the best results and to avoid developing drug-resistant bacteria. Treatment could include lotions or gels you put on blemishes or sometimes entire areas of skin, such as the chest or back (topical medicines). You might also take medicines by mouth (oral medicines).
Mild acne
Treatment for mild acne (whiteheads, blackheads, or pimples) may include:
• Gentle cleansing with a mild soap (such as Dove or Neutrogena).
• Applying benzoyl peroxide (such as Brevoxyl or Benzac).
• Applying salicylic acid (such as Propa pH or Stridex).
If these treatments do not work, you may want to see your doctor. Your doctor can give you a prescription for stronger lotions or creams. You may try an antibiotic lotion. Or you may try a lotion with medicine that helps to unplug your pores.
Moderate to severe acne
Sometimes acne needs treatment with stronger medicines or a combination of therapies. Deeper blemishes, such as nodules and cysts, are more likely to leave scars. As a result, your doctor may give you oral antibiotics sooner to start the healing process. Inflammatory acne may need a combination of several therapies. Treatment for moderate to severe acne may include:
• Applying benzoyl peroxide.
• Draining of large pimples and cysts by a doctor.
• Applying prescription antibiotic gels, creams, or lotions.
• Applying prescription retinoids.
• Applying azelaic acid.
• Taking prescription oral antibiotics.
• Taking prescription oral retinoids (such as Accutane).
Treatment for acne scars
Treatment may improve and even remove acne scars. Sometimes a combination of treatments works best. These treatments include:
• Collagen injections, which smooth the skin by plumping the skin under the scar.
• Dermabrasion, which uses a whirling wire brush to skim off scar tissue.
• Laser resurfacing, which uses a carefully controlled laser to burn away scar tissue.
• Chemabrasion, which uses chemicals to peel away top layers of skin.
What To Think About
• Most treatments for acne take time. It often takes 6 to 8 weeks for acne to improve after you start treatment.1 Some treatments may cause acne to get worse before it gets better.
• If your acne still hasn't improved after several tries with other treatment, your doctor may recommend that you take an oral retinoid, such as isotretinoin (Accutane). Doctors prescribe this medicine as a last resort, because it has some rare but serious side effects and is expensive.
• Certain low-dose birth control pills may help control acne in women who tend to have flare-ups before menstruation.

Shingles - Topic Overview

What is shingles?
Shingles (herpes zoster) is a viral infection of the nerve roots. It causes pain and often causes a rash on one side of the body, the left or right. The rash appears in a band, a strip, or a small area. Shingles is most common in older adults and people who have weak immune systems because of stress, injury, certain medicines, or other reasons. Most people who get shingles will get better and will not get it again.
What causes shingles?
Shingles occurs when the virus that causes chickenpox starts up again in your body. After you get better from chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus "wakes up" when disease, stress, or aging weakens the immune system. It is not clear why this happens. But after the virus becomes active again, it can only cause shingles, not chickenpox.
You can't catch shingles from someone else who has shingles. But a person with a shingles rash can spread chickenpox to another person who hasn't had chickenpox and who hasn't gotten the chickenpox vaccine.
What are the symptoms?
Shingles symptoms happen in stages. At first you may have a headache or be sensitive to light. You may also feel like you have the flu but not have a fever.
Later, you may feel itching, tingling, or pain in a certain area. That’s where a band, strip, or small area of rash may occur a few days later. The rash turns into clusters of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4 weeks for the blisters to heal, and they may leave scars. Some people only get a mild rash, and some do not get a rash at all.
It’s possible that you could also feel dizzy or weak, or you could have long-term pain or a rash on your face, changes in your vision, changes in how well you can think, or a rash that spreads. If you have any of these problems from shingles, call your doctor right away.
How is shingles treated?
There is no cure for shingles, but treatment may help you get well sooner and prevent other problems. Call your doctor as soon as you think you may have shingles. The sooner you start treatment, the better it works. Treatment may include:
• Antiviral medicines to help you get well sooner and feel less pain.
• Medicines to help long-term pain. These include antidepressants, pain medicines, and skin creams.
Good home care can help you feel better faster. Take care of any skin sores, and keep them clean. Take your medicines as directed. And use over-the-counter pain medicines to relieve pain.