Facing Adult Acne -- Brandith Irwin, MD -- 04/01/03

Last Editorial Review: 10/23/2003

By Brandith Irwin
WebMD Live Events Transcript

You thought you would leave your acne behind when you hit adulthood, but somehow those blemishes keep coming back. Millions of adults, especially women, suffer from acne, and the treatments are not always the same as those for teens. Skin expert Brandith Irwin, MD, joined us to talk about it.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Hello Dr. Irwin. Welcome back to WebMD Live. Adult acne doesn't seem fair! Shouldn't we have all gotten over it in our teens?

Irwin: You are not alone in feeling this way. As you know, there are different types of adult acne. One type is rosacea, which starts in midlife. The other type is acne that starts in the teens or early 20s, and sometimes gets worse rather than better before you get over it.

Moderator: What is rosacea?

Irwin: It's a type of acne that often begins with flushing and blushing, and then progresses to a permanent red/pink color, with associated acne-like spots across the nose. Many people with rosacea also have permanently dilated blood vessels on the face. It's confusing because in some lay press, rosacea will be referred to as adult acne, but it's quite different.

Member: I feel weird getting acne at 35. I'm not going to put Clearasil on my dry skin. Help!

Irwin: Most acne medicines, particularly over the counter, are formulated for teenage skin. So you're right, using those will dry you out way too much. There are prescription acne medications that are available that are more gentle. You might want to see your dermatologist. Also, in my book, Your Best Face, Looking Your Best Without Plastic Surgery, there is a chapter on acne that discusses this problem.

Moderator: Are the causes of adult acne the same as the causes of teen acne?

Irwin: In the sense that acne is hormonally driven, yes. But our hormones change over our lifetimes between puberty and menopause, so the type of acne changes over that period also.

Moderator: What is the difference between teen and adult acne?

Irwin: There are four different types of acne. The four types are:

  1. Comedonal, which are basically blackheads and whiteheads.
  2. Papular, which are basically red bumps.
  3. Pustular, which are red bumps with puss on top.
  4. Cystic, which are those usually deep cysts, which can scar, or small cysts, which usually don't scar.

Teenagers have a range of all of those, but tend to have more comedonal acne. Adult acne is characterized by more papules and cysts. But anyone can have any type.

Member: I struggle with what I think is acne. I get itchy bumps that first appear to be like mosquito bites, but then later look more like a typical zit. Is this acne, or allergies, since they itch?

Irwin: Unfortunately, I can't diagnose skin problems over the Internet. You may need to see your dermatologist.

Member: Do certain food cause acne? My mother claims that chocolate, beer, and milk caused her to break out.

Irwin: This is an old wives' tale. However, each person is an individual, and it may be that in certain individuals certain foods may cause breakouts. But there is no scientific evidence for it.

Member: What about witch hazel? I've heard it's good for acne.

Irwin: There is no evidence that that is true.

Member: I have a red bump on the end of my nose. I thought it was acne but it doesn't go away. I'm 43.

Irwin: You should definitely be checked by your dermatologist. Because a red bump that doesn't go away after a month could be a sign of early skin cancer.

Member: I can't stand going into business meetings with zits. What can I cover them with?

Irwin: Try Dermablend. This is a cover-up brand that can usually be ordered over the Internet. Another makeup that covers red well that I like is Iredale mineral pigment makeup. You could also find this on the web.

Moderator: Does microdermabrasion help with adult acne?

Irwin: It depends on which type you have. If you have rosacea it will make it worse. If you have some comedonal acne, microdermabrasion is helpful.

Member: What about facial masks? Can they help?

Irwin: Usually no, because they are too superficial to do much good. You might try your aesthetician. They can do light peels and gentle extractions, which may be helpful for your acne.

Moderator: I'm sure you've seen the infomercials for various skin care regimens. Would you ever recommend trying one of those products?

Irwin: The only one I've seen is Proactive. That contains benzoyl peroxide and salicylic acid. I actually think that works pretty well if you have oily teenage skin. If you have cysts or scarring, though, you should see your dermatologist.

Member: Does drinking water help to flush the skin of impurities?

Irwin: Drinking water in general is good for you, but it won't flush impurities from your skin.

Member: Is body acne treated differently from facial acne?

Irwin: Yes, only in the sense that it depends on what type you have on your chest and back. If you have just blackheads and whiteheads on your face, for example, but cysts on your back, then the two areas would be treated differently.

Member: I've heard steaming is a good way to clean your face. What do you think?

Irwin: Steaming will open your pores a little temporarily, so cleaning right after that may be helpful. Aestheticians will often steam your face during facials and then clean afterwards or perhaps do gentle extractions.

Member: What do you recommend to battle chest acne on oily skin?

Irwin: If you're talking about over-the-counter products, then try the Proactive line. Any drugstore product with benzoyl peroxide will also be helpful and drying there. Be careful, though, the chest is also easily irritated.

Member: How is papular acne most commonly treated?

Irwin: As far as prescription medications go, I will usually use Azelex, Tazorac, or topical antibiotics. If you just get an occasional acne lesion, try over-the-counter products first.

Member: Please give your thoughts on the medications Retin-A and Cleocin-T. I have been prescribed both, but the Cleocin-T seems to have serious (possible) side effects. Should it only be used for serious cases?

Irwin: Usually Cleocin-T usually has no side effects at all. Usually Retin-A can be quite irritating. If you're having trouble, it's my guess it's the Retin-A that's causing the problem.

Member: Does stress factor into acne? Sometimes I can go a long time without breaking out, and lately I seem to have a new spot every day.

Irwin: It's difficult to know what role stress plays with acne.

Moderator: Dr. Irwin, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Irwin: I would like to say that if you have any acne that is scarring to see your dermatologist, because scarring is now largely preventable with good care. Thank you for chatting with me. Best of luck to everyone

Moderator: We are out of time. I'm sorry we couldn't get to all of your great questions. Our thanks to Brandith Irwin, MD, and thank you members for joining us today. For more information, please read Your Best Face, by Brandith Irwin, MD.

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