When Adults Get Acne
Acne, one of the most common of all skin problems, is
considered a rite of passage for adolescents. While an estimated 70 million
people suffer from acne, it generally clears up after a few years. However, many
adults find, to their chagrin, that acne is not just a teenage condition. "In my
practice I am seeing more cases of adult acne, particularly among women in their
late thirties and early forties. Some of this is peri- or post-menopausal, and
some of it may be related to increased stress," says Alice B. Gottlieb, MD,
director of the Clinical Research Center and chief of the Division of Clinical
Pharmacology, Robert Wood Johnson Medical School. "
While there is nothing new on the horizon for treatment of acne, the medications currently available are very effective," Gottlieb continues. "There is absolutely no reason why anybody child or adult should have to suffer from acne."
Mild cases of acne can be kept under control by washing the skin with a mild soap, avoiding oily face and hair creams, and using cosmetics and other skin products labeled oil-free or noncomedogenic. While over-the-counter ointments containing benzoyl peroxide can be helpful, prescription medications are much more effective in eliminating acne, says Gottlieb.
Topical antibiotics and antibacterials, including benzoyl peroxide (in higher concentrations than over-the-counter preparations), erythromycin and clindamycin, can be applied to the affected area to reduce bacteria. Oral antibiotics such as tetracycline, erythromycin and minocycline may also be taken at the same time to decrease bacteria. The length of time on these medications is approximately two months, depending on the severity of the acne. As with other antibiotics, resistance may develop when taken over a long period of time.
In other cases, oral contraceptives may be prescribed to help regulate hormonal changes which contribute to acne formation. The estrogen in birth control pills balances the effects of the androgens. Ortho tri-cyclen is one such drug approved by the FDA for treatment.
Topical retinoids, which include adapalene and tretinoin (Retin-A), are the next step up in the war against acne. Their function is to clear the pores. Oral antibiotics may be taken with topical retinoids.
Isotretinoin (Accutane), taken orally, is by far the strongest acne-fighter on the market. It is effective in clearing up even the most severe cases that are resistant to other treatments. "Accutane is a miracle drug, but it's not for everybody," says Gottlieb. "Because it has been associated with an extremely high rate of birth defects, it can't be taken by pregnant women or nursing mothers. Some doctors will not even prescribe it to any woman of childbearing age." Accutane has also been associated with bone changes. Women taking Accutane are advised to use two forms of birth control simultaneously for at least one month before therapy, during treatment, and for one month after treatment has stopped.