The Ultimate Guide to Adult Acne

Acne vulgaris is the eighth most common skin condition in the world. Although it usually occurs in teens, more than 60 per cent of acne sufferers develop the condition into adulthood. Around five per cent of adults even develop their first acne symptoms after the age of 25, some until the age of 40.

Acne, also known as acne vulgaris, is a common long-term skin disease which usually starts during puberty. However, it can also be caused after our teenage years by stress, genetics, hormonal changes, air pollution and oil-based make-up - to name but a few!

It is estimated to affect over 600 million people globally, making it the eighth most common skin concern worldwide. Nearly 80 per cent of people aged 11 to 30 suffer from acne... or another way of putting it is that only 2 people in every 10 don't have acne.

Although a person's symptoms usually disappear during their mid-twenties, adult acne is common. It can be either a continuation of teenage acne, or can begin for the first time in adulthood – this is known as “adult-onset acne”. While most people continue to get the odd spot (or mild acne) well into their 30s, severe adult acne is believed to affect around 5 per cent of women and 1 per cent of men over the age of 25.

Though it can affect almost any part of the body, generally the areas with the highest number of oil glands are more likely to show acne blemishes - this includes the face, back and chest. Most sufferers will present signs of facial acne, with more than half also experience some degree of back acne. Chest acne is less common affecting around 15 per cent of sufferers.

If you are unsure whether you should speak to a Dermatologist about your skin, you can find answers to some common acne questions below. However, if you notice any signs of severe acne, or have any serious concerns, you should consult a skin care specialist immediately to prevent persistent symptoms and later scarring

What are the causes of acne?

This can be one of the hardest questions to answer as acne is caused by many factors. Quite simply acne vulgaris occurs when the skin produces too much sebum; a natural oil that prevents the skin from drying out. Hair follicles can become clogged when sebum and dead skin cells combine, which then leads to inflammation. This becomes more complicated when looking at the cause of the sebum generation. 

The are numerous causes of acne some are short-term, including hormonal changes due to pregnancy or as a result of medication, and others are more long-term. While short-term acne can effect confidence, people generally understand why they're experiencing it and know their symptoms will reduce when their circumstances change. Long-term acne can have more of a psychological impact as there is no clear end-date to their skin concerns, these include:  

Puberty

This is unquestionably the most common time for acne to develop. The sebaceous (oil-producing) glands are most sensitive to testosterone during this time, leading to the production of excess oil in the skin. Hormonal changes during a woman’s menstrual cycle have similar effects on the skin. Acne lesions over the jaw-line and chin usually indicate hormonal acne.

Stress

On-going high levels of stress can cause the body to increase the generation of the hormone ‘cortisol’. Cortisol is a steroid hormone that regulates a wide range of processes throughout the body, including metabolism and the immune response. Overproduction of this hormone can inflame and irritate the skin.

Genetics

It's often said that models won the genetic lottery, perhaps they did. The genes we inherit from our parents can dictate whether or not we develop acne symptoms. Thick, oily skin could be part of your genetic makeup, which in turn, could increase your chances of developing acne. 

Pollutants and oil-based makeup

Using the wrong skin care products for your skin type or using heavy makeup can aggravate the skin and cause acne by trapping dirt in pores and encourage inflammation. This is why we often see actors and performers with poor condition skin, it's the result of their heavy stage makeup. Forgetting to take your makeup off at the end of the day can block pores too, so remember make cleansing your face part of your bedtime routine, even if you're half asleep when you do it!

Polycystic Ovarian Syndrome (PCOS)

Unless you, or a friend, have it there is a strong chance that you don't know what PCOS is. Polycystic Ovarian Syndrome is an incurable hormonal disorder which affects women, usually after the age of 25. Acne develops due to n insensitivity to insulin, which leads to acne marks along the jaw-line, cheeks, chin and upper neck area. Other symptoms include excess hair growth If you think this is the cause of your adult acne, we have for 20% off PCOS laser treatments.

How to prevent acne

In many cases, acne sufferers exacerbate the severity of their condition by cleaning skin incorrectly. This can irritate skin flora, leading to infection and inflammation of the problem area. In turn they clean their faces more to treat the symptoms thereby making them worse. 

Some of the simplest ways to prevent acne are:

• Wash acne-prone skin only twice a day; over-washing may irritate the skin and increase inflammation.
• Use mild soap or acne cleanser, lukewarm water and fragrance-free products.
• Avoid squeezing spots or touching lesions, as you may inadvertently pick up bacteria and scar the skin.
• Choose your makeup carefully - do some research. Oil-based makeup increases oil production in the skin and, in turn, blocks hair follicles, which increases inflammation. Non-comedogenic water-based products such as specialist acne moisturisers from the DermaQuest range help with opening the skin and reducing inflammation.
• Keeping hair out of the face will help to prevent the build-up of oil, as will regular washing.

One thing that must be understood is that acne is treatable, not curable. If you find a skin care routine that works for you then stick with it. If you're acne symptoms aren't receding within 6 weeks of your starting your new routine, it takes approximately 6 weeks for new products to take effect, or if your acne symptoms are coming back then you need to review your skin care routine or talk to a skin care professional, such as a Dermatologist for alternative options. 

Types of acne

Depending on symptoms, acne vulgaris is classified as being mild, moderate or severe:

• Mild acne cases tend to have greasy skin on the nose and forehead, which can lead to clogged hair follicles. Acne spots most commonly associated with mild acne include blackheads (caused by open skin follicles which have become clogged, turning brown when exposed to air) and whiteheads (similar to blackheads, but firmer and shouldn’t be squeezed).
• Moderate acne occurs when inflammatory lesions, papules and pustules develop on other areas of the face, resulting in red or yellow spots. Papules (small red bumps which may feel tender) and pustules (similar to papules, but caused by a build-up of pus) are most commonly associated with moderate acne.
• Severe acne occurs when inflammatory nodules (painful bumps under the skin) and cysts (large nodules which hold fluid) extensively cover the face and body. This degree of acne can be extremely painful to touch.
• ‘Severe nodular acne’ or ‘cystic acne’ carries the highest risk of permanent scarring. If you are suffering from severe nodular acne you must seek professional help. 
• Acne conglobata is a form of severe acne which usually persists until the person is around 40 years old.
• Acne rosacea shares certain similarities with acne, but is classified as a separate condition.  Symptoms of acne rosacea include red flushing skin, which is triggered predominantly by stress, strenuous exercise and caffeine.

Our dermatology team explain how they differentiate between acne vulgaris and acne rosacea:

We look for black or whiteheads with the spots to help differentiate for example from rosacea. Some patients have mainly whiteheads, so-called comodonal acne. The treatment for this will be different to acne that has more pustules and cysts and is more likely to scar the skin.

Which is the best acne treatment?

A mentioned before there is no known acne cure at present, but it can be managed. For mild forms of acne there are several over-the-counter products which can help curb the condition.

Start with a skin care range specifically designed to treat acne symptoms. While you may want to combine anti-ageing products with your acne range they can counter each other. When looking at a new skin care range do your research, does it have the ingredients that will benefit you? You should always talk to someone if you're looking at changing your routine, they know their products and will be in the best position to advise you. Don't be scared to ask questions when spending your money! 

Acne creams such as benzoyl peroxide and topical retinoids can help to reduce the number of bacteria on the skin. Alternatively tea tree oil is an excellent natural inflammatory which treats blackheads, whiteheads and even some pustules. It is naturally antibacterial, preventing pores from becoming infected and dries up excess sebum from the skin. 

Other natural ways to reduce acne include eating a healthy diet, embarking on regular exercise and reducing stress. Our dermatology team explains:

Eating balanced meals which incorporate plenty of fruit and vegetables will help. Antioxidants, in my view, reduce inflammation in the skin. We also know vitamin A improves acne. Cruciferous vegetables, such as carrots and broccoli, and leafy greens, such as kale and spinach, are main sources of vitamin A.

If home remedies for acne are not effective, then you should visit a medical professional who may prescribe a product or treatment for your condition. At The Harley Medical Group we offer various treatments for acne. Options include the only FDA approved, clinically proven PRP injection treatment, acne laser treatment, skin peels ranging in strength from mild to intensive, Obagi Nu Derm, acne masks and products for acne from the DermaQuest Skincare range.

Our dermatologist will prescribe antibiotics for acne if they feel it is necessary. Results can take at least six weeks to show, and some courses last up to six months. If you develop nodules or cysts you will need to visit a medical professional, as these can result in scarring if not treated properly. Side effects, though uncommon, can include minor skin irritation, redness and peeling of the skin.

How to remove acne scars

Acne scars are caused when the dermal layer of the skin is inflamed and abnormal healing takes place. The most common type of acne scar is “altrophic”, also known as “ice-pick scars”, “boxcar scars” and “rolling scars”.

Many cases of acne scarring appear because of cysts and nodules on the skin, however squeezing and picking at blemish also play a part. It is estimated that 95 per cent of those with acne vulgaris will experience acne scars.

At The Harley Medical Group we offer three non-surgical acne scar treatments: Dermaroller™, Dermapen and Medical Microdermabrasion (MMD). Dermaroller™ stimulates blood supply and regenerates cells by rolling medical micro-needles on the skin. Similar to Dermaroller™, Dermapen encourages cell regeneration but on very localised areas of the face and body. MMD exfoliates deep into the skin using a flow of medical-grade crystals to remove the outermost (dead) layer of the skin.

Speak to a medical professional if you are concerned about your skin or would like to know more about treating acne. We also recommend booking a consultation with one of our dermatology team; they will carry out a thorough skin analysis before recommending the best acne treatment for you.

This article was written in conjunction with Dr. Justine Hextall, a renowned Consultant Dermatologist, with expertise in skincare, non-surgical treatments, laser hair removal, skin cancer and Botox. She has been a skin care specialist for over five years and is chair of the Skin Network Site Specific Group (NSSG) division in Sussex. For more information about her work, browse Justine’s complete profile on the Harley Medical website.

Additional Sources

https://en.wikipedia.org/wiki/Acne

http://www.webmd.boots.com/skin-problems-and-treatments/guide/acne

http://www.britishskinfoundation.org.uk/SkinInformation/AtoZofSkindisease/Acne.aspx

http://www.nhs.uk/Conditions/Acne

https://www.bupa.co.uk/health-information/directory/a/acne

http://www.healthyandnaturalworld.com/tea-tree-oil-for-acne/