Adult acne

March 7, 2020

Adult acne

Acne is often mistakenly considered a disease of adolescence. However, almost half of women suffer from it and men can also be affected. Even discreet, this form of acne is often very badly experienced on the psychological level. The treatments are generally the same as for adolescent acne, apart from a few specific features for adults.

young woman with acne
What adults are affected by acne?
Adult acne is common and affects both men and women. In the majority of cases, it succeeds juvenile acne. More rarely, it can settle from the age of 25, without the person having had significant acne before. In recent years, the frequency of adult acne appears to be increasing, especially among women.

acne pimples diagram
The different types of acne pimples

In adult acne, as in the juvenile form, three mechanisms are closely linked and occur in the sebaceous hair follicles (cavities in which the hairs arise) of the face and / or chest:

Seborrhea (excessive sebum secretion, lipid film secreted by the sebaceous glands of the skin) is due to the stimulation of the sebaceous glands by androgenic hormones (produced by the testes, ovaries and adrenal glands). It depends on the sensitivity of the sebaceous glands to these hormones.
Sebaceous retention is associated with hyperkeratosis of the hair follicle canal (thickening of the wall of this canal), which causes a plug obstructing the evacuation of sebum. The latter then accumulates in the follicle with dander, hair fragments and bacteria. The comedo is thus formed.
Inflammation of the hair follicle is caused by the presence of the bacteria Propionibacterium acnes in the comedo and by the attraction of white blood cells in the blocked follicle. The comedo then evolves into a microcyst.

Characteristics of adult acne
dermatologist: back acne In adults, acne progresses chronically, but most often remains discreet, with differences according to gender:

In women, it preferentially sits at the level of the lower face, extending towards the neck. The lesions are few, but inflammatory.
In men, the lesions are generally concentrated in the back and are therefore less visible.
To explain the occurrence of acne in adults, several hypotheses have been formulated by specialists:

Hormonal disorders (thyroid hormones);
Hyperparathyroidism (excessive secretion of androgenic hormones);
Unsuitable estrogen-progesterone contraception;
The stress.
Adults find it very difficult to tolerate this form of acne, which has significant psychological consequences, particularly in relation to the professional context. Women suffer more than men, due to the different location of lesions. Anxiety disorders and even cases of depression can occur in association with adult acne.

Adult acne treatments
The diagnosis of acne is simple, due to the specific nature of the skin lesions. The treatments available in adults are identical to those used in adolescents:

Local treatments (external or topical);
General treatments (oral);
Non-drug treatments.
Local treatments
jar of cream Several topical medications (external use) can be prescribed for acne, in the form of creams, ointments, gels or toilet rolls.

Topical retinoids (analogs of vitamin A) are indicated in acne with blackheads and microcysts, inflammatory or not.

Three drugs are available in France:

Tretinoin 0.05%, alone or combined with erythromycin (local antibiotic);
Isotretinoin, alone or in combination with erythromycin;
Adapalene, alone or in combination with benzoyl peroxide (local antiseptic).
Generally, retinoids associated with another drug are more effective than alone. These treatments are formally contraindicated with pregnancy and therefore cannot be prescribed in a woman of reproductive age without effective contraception. If a pregnancy is discovered during treatment, it should be stopped immediately. Retinoids frequently cause skin irritation at the start of treatment, which should not be confused with an allergy.

Benzoyl peroxide
Benzoyl Peroxide (antiseptic) is indicated in mild to moderate inflammatory acne, before the prescription of a local antibiotic.

Available in cream or toilet roll, it can only be applied in the evening. It is likely to cause skin irritation, less significant than retinoids.