Feature Archive

Acne ... Again?

Just when you thought your "bad skin" days were over, adult acne strikes. Fight back with adult-strength treatment.

By Daniel DeNoon
WebMD Feature

Reviewed By Cynthia Haines

It's not fair. Just when you've successfully navigated the ravages of adolescence on your skin, you wake up and find acne. What can you do?

As most dermatologists will tell you, "bad" skin isn't just for teens. The good news is that new treatments are now available to help fight adult acne.

The Problem

The acne of your teen years has an ugly medical name: Acne vulgaris. That's to distinguish it from acne rosacea -- more often called rosacea. But regular old acne isn't just for kids; adults can get it, too.

"Adult acne is a very common problem, but an under-recognized one," says Jeffrey Weinberg, MD, director of clinical research at St. Luke's-Roosevelt Hospital Center, New York. "Acne can occur later in life. It can be one or both types. People think it doesn't happen in adults, but it does."

At the heart of acne lies the pimple -- what doctors call a comedo. It's a plug of fat, skin debris, and keratin (the stuff nails, hair, and skin are made of) stuck in a hair duct. When it's open, we call it a blackhead. When it's closed over, we call it a whitehead. Whiteheads often cause the walls of the hair duct to rupture. This leads to redness, infection, and the papules, pustules, nodules, and cysts of acne.

Boys are more likely to suffer acne scarring than girls. But girls are more likely to have adult acne.

Nearly everybody thinks that acne results from poor hygiene. That's just not so. Adult acne and teen acne are caused by a combination of several factors: hormones leading to excess oil secretion, faulty closing of the hair duct, and infection. Gentle face washing twice a day is much better than more frequent washing.

The Solution

When adult acne is treated in a doctor's office it's called "acne surgery". When done at home, it's called squeezing pimples. It gets immediate results -- but when you squeeze pimples at home, you are begging for infection and scars. And squeezing or picking at pimples is a great way to get your acne to spread. Don't do it! Doctors use a special sterile instrument to prevent scarring, infection, and acne spread.

Or you can check out the skin care products aisle at your local drug store. If you've ever tried to buy acne remedies, you know the drug store is loaded with all kinds of products. Which ones should you use? It's not an easy choice, says dermatologist Julie Anne Winfield, Mill Valley, Calif.

"Which treatment is best depends on which type of acne you have," Winfield tells WebMD. "It may well be worth a visit to dermatologist. They often have samples they could give you to try. People can spend a fortune on over-the-counter medicines when there is maybe one single prescription drug that could solve the problem. Be sure to use oil-free, non-comedogenic lotions or sunscreens. Use something very simple to wash your face with, as well as low-strength benzoyl peroxide. But it would be best to see a doctor to prevent possible acne scarring."

The biggest breakthrough in acne treatment has been the development of topical retinoic acid, a form of vitamin A. New slow-release forms of this medicine greatly reduce the irritation it can cause.

Other acne treatments target the various causes of acne. They're often used in combination. These acne treatments include:

  • Azelaic acid cream
  • Alpha-hydroxy acids (including glycolic acid, lactic acid, and gluconic acid)
  • Benzoyl peroxide
  • Topical antibiotics (gels, lotions, and solutions) 
  • Antibiotic pills (haphazard use may lead to antibiotic resistance)
  • Birth control pills for women
  • Accutane or Sotret for severe acne

One caveat: Accutane and Sotret can cause birth defects. Women who opt for this treatment must use foolproof birth control. Despite this and other concerns, these drugs are the treatment of choice for severe acne.

Originally published August 2003.
Medically updated Aug. 25, 2004.


SOURCES: The Mount Sinai Journal of Medicine, September/October 2001. Jeffrey Weinberg, MD, director of clinical research, St. Luke's-Roosevelt Hospital Center, New York. Julie Anne Winfield, MD, private practice dermatology, Mill Valley, Calif. The American Academy of Dermatology.

©1996-2005 WebMD Inc. All rights reserved.
Last Editorial Review: 1/31/2005 6:42:05 AM