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Adult Acne

Adult acne first develops in the twenties or later. The strict definition of Adult Acne is Acne that first develops after 25, but definitions vary slightly.

Adult acne is common. In America 50% of adult women has Acne in their twenties, 35% in their thirties, 26% in their forties and 15% in their fifties.

Teenage and adult acne is due to excessive sebum production from oil (sebum) glands. The increased sebum production leads to changes in the mouth of the hair follicle, the infundibulum, which enlarges and becomes plugged with open comedones (black heads) and closed comedones (white heads). A bacterium that normally occurs on the skin, Propionibacterium Acnes, proliferates in the excess sebum, which leads to inflammation, pimples and worse blackheads and whiteheads via biofilm formation.

Adult Acne is common around the jaw line area and is mostly inflammatory (pimply), whereas teenage acne occurs more in the T-panel and is often a mix of inflammatory lesions (pimples) and comedones (blackheads and whiteheads).

In the teenage years increased sebum production is due to the natural surge in hormones that occurs at puberty. This clearly cannot be the cause of Adult Acne.

The causes of Adult Acne include unnaturally increased testosterone levels from a variety of sources, a genetically increased sensitivity to testosterone, increased insulin-like growth factor 1 (IGF-1) that mimics the effect of testosterone, oral medication, cosmetics, smoking and possibly raised insulin levels.

Causes of unnaturally increased testosterone levels:

  • Polycystic ovarian disease
  • Overproduction of testosterone from a tumor of the ovaries or testis
  • Overproduction of testosterone from adrenal gland hyperplasia or an adrenal gland tumor
  • Overproduction of testosterone in the skin, due to stress induced increased release of Corticotrophin Releasing Hormone (CRH) from the brain
  • a Relative excess of testosterone versus estrogen around the middle of the menstrual cycle
  • a Relative excess of testosterone versus estrogen around the menopause

Causes of increased Insulin-like growth factor (IGF-1):

  • High glycemic index foods causes a spike in IGF-1
  • Pregnancy

Oral medications that can cause Adult Acne:

  • Oral Contraceptive pills (OCP’s) that contain 1st generation progestins, like norgesterol
  • OCP’s that contain 2nd generation progestins, like norethindrone, ethynodiol diacetate, and levonorgestrel
  • OCP’s that contain third generation progestins, like norgestimate or desogestrel
  • Vitamins B2,B6,B12 and D2
  • SSRI’s, like Prozac
  • Lithium
  • The Tuberculosis drugs, Isoniazid and Ethionamide
  • The epilepsy drugs, Phenytoin and Phenobarbital
  • Glucocorticosteroids, like Prednisone
  • Anabolic steroids
  • Corticosteroid creams and ointments
  • Iodides and Bromides. Iodides are found in cold and asthma preparations, kelp and vitamin & mineral supplements. Bromides are found in sedatives, analgesics and cold remedies

Other causes of Adult Acne;

  • Cosmetics, especially occlusive petroleum bases moisturizers
  • Smoking
  • Increased insulin levels (hyperinsulinemia) can stimulate sebum production.

Often, what appears to be Adult Acne, is in fact another condition mimicking acne. These Acne mimics include:

The diagnosis of Adult Acne requires a detailed history and careful examination. In addition to Adult Acne an irregular or absent menstrual cycle, excess hair on the face and body (hirsutism), loss of hair from the scalp (androgenetic alopecia), oily facial skin (seborrhea), a milky discharge from the breasts (galactorrhea), enlargement of the clitoris (cliteromegaly), a coarser voice and infertility are all signs of raised testosterone levels.

If the diagnosis is Adult Acne the next step is to identify and treat any underlying cause. If there is an identifiable cause for the Adult Acne, eliminating it will most likely clear the Acne.

Laboratory blood tests for FSH & LH (brain/pituitary gland origin), DHEA-S (adrenal gland origin) , Free Testosterone & Total Testosterone (ovarian origin), Prolactin (brain/pituitary gland origin), SHBG (liver origin), delta-4-androstenedione (adrenal gland origin), 17-hydroxyprogesterone (adrenal gland origin) and insulin might be requested. In women blood tests must be done within a few days of menstruation, when hormonal levels are naturally at their lowest, to avoid confusing results and women should also not be on the oral contraceptive pill. Abnormal hormone values might require closer examination of the ovaries, adrenal glands or pituitary gland.

Oral medication, vitamin supplements and cosmetics might be stopped or changed. Adult acne patients need to stop smoking. A low glycemic index (low carbohydrate/high fat – LCHF) diet to lower IGF-1 release and insulin levels might be required. Lower stress levels, to reduce Corticotrophin Releasing Hormone (CRH) levels, could be helpful.

Some patients will have no identifiable cause for their Adult Acne. Also, patients that have eliminated possible causes of Adult Acne, might still get Adult Acne. These patients will require general anti-Acne therapies, as used for Acne in puberty.

10 thoughts to “Adult Acne”

  1. Hi Dr,

    I am a 31 year old female with PCOS, I have always had milia, which I have removed by a dermatologist on occasion. But lately (past year) I am getting bad breakouts. I also noticed that it gets worse if I eat any citrus fruit. I have asked for Acutane but they wouldnt prescibe it as I cant take any Contreceptives…(bad side effects, I have been on a couple with no luck…)

    Is there anything that I can use that will help clear up my skin?

    Thank you

    1. Hi Marjorie

      Topical Retanoids is an alternative treatment option. Alternatively you can discuss the option of an Intra uterine device with your Gynaecologist as a means of contraceptive.

  2. Hi Dr
    I have got black spots on my face as a result of pimples cos every pimple that dries leaves a black spot on my face..any cream you would advise me to use? Thanks

  3. Good day, Dr Louw.

    I am a 20 year old male. I have been suffering from oily skin and moderate acne from the age of 14. When I was 18, I underwent a 9 month course if roaccutane. Six months after completion of that course, I relapsed. Thereafter, I underwent a 6 month course of oratane, that ended in June 2014.

    In August, I started to relapse, again but at a slower rate. I am using the Eucerin dermopurifyer range but I am still not satisfied. I have mild acne now, and excessively oily skin. I also have a dramatically receding hairline, and visible hair loss over my crown area.

    Please advise me.

    1. Dear S. You do get people whose Acne just cannot be cured, even with multiple courses of Isotretinoin. You might therefore be a candidate for low dose maintenance treatment with Oratane. The dose can be as low as Oratane 10mg 3 x per week, or even lower. The medical treatment options for Male pattern baldness is 5% Regaine and/or oral Finasteride.

  4. I am.32 years old and about 3weeks ago I went on the 3month injection,after a week I started getting pimples in the whole of my face,it’s terrible,my self esteem went out the door,I don’t know what I should do,what do u recommend I use to get rid of these sore terrible pimples,please help me Dr

    1. Hi Samantha. I’ll have to see you to make a diagnosis first, before I can decide on the appropriate treatment.

  5. Good day Dr. Louw

    Ive got acne,ive had it since my teens and im 23years old now. I recently went to a GP who prescribed Acnetane along with Tetralysal for me. Please tell me if it is safe to use those two medications simultaneously because im a little sceptical of using them together after reading that in severe cases it can cause swelling of the Brain,not sure if its true. Im on a low dosage 20mg acnetane per day and 2*150mg tetralysal per day.

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