Adult Onset Acne

Adult-onset acne affects millions of women in America between the ages of 30 and 55, and women are becoming the fastest growing segment of those affected by acne. Over half of these women do not respond to traditional acne therapy, and doctors believe hormonal imbalance is a major contributing factor. Hormonal changes during menstrual cycles and menopause effect the emergence of acne. Therefore, it becomes easy to understand why hormonal therapy works so well when other therapy(s) fails.

The hormone androgen, commonly known as a “male hormone,” has masculizing effects, but is equally important to women as well. Androgens effect the growth of the skin, muscle, bone and organs. Women who suffer from polycystic ovary syndrome produce excessive androgens and have thicker skin, more body and facial hair and acne. Women with treatment resistant acne should be tested for elevated levels of androgens.

What Is Acne?

Acne is a disorder of the skin's oil glands (sebaceous glands) that results in plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Nearly 17 million people in the United States have acne, making it the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring, which can be upsetting for people who suffer from the disorder.

How Does Acne Develop?

Doctors describe acne as a disease of the pilosebaceous units. Found over most of the body, pilosebaceous units consist of a sebaceous (oil) gland connected to a hair-containing canal called a follicle (see figure 1). These units are largest and most numerous on the face, upper back, and chest -- areas where acne tends to occur. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle.

Figure 1: Normal Pilosebaceous Unit

Acne is believed to result from a change in the inner lining of the follicle that prevents the sebum from passing through. For reasons not understood, cells from the lining of the follicle are shed too fast and clump together. The clumped cells plug up the follicle's opening so sebum cannot reach the surface of the skin. The mixture of oil and cells causes bacteria that normally live on the skin, called Propionibacterium acnes (P. acnes), to grow in the plugged follicles. These bacteria produce chemicals and enzymes that can cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the plugged follicle can no longer hold its contents, it bursts and spills everything onto the nearby skin -- sebum, shed skin cells, and bacteria. Lesions or pimples develop as a result of the skin's being irritated.

People with acne frequently have a variety of lesions, some of which are shown in figures 2, 3, and 4. The basic acne lesion, called the comedo (kom'-e-do) or comedone, is simply an enlarged hair follicle plugged with oil and bacteria. This lesion is often referred to as a microcomedo because it cannot be seen by the naked eye. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo or whitehead. Whiteheads usually appear on the skin surface as small, whitish bumps. A comedo that reaches the surface of the skin and opens up is called a blackhead because it looks black on the skin's surface. This black discoloration is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Figure 2: Microcomedo

Figure 3: Open Comedo (Blackhead)

Figure 4. Closed Comedo (Whitehead)

Other Troublesome Acne Lesions Can Develop, Including the Following:

Macule- a temporary red spot left from a healed lesion.  They are generally light red or pink and they can last from anywhere between a day to a few weeks.

Pustule- Something likened to an inflamed, pus-filled lesion:  a small inflamed elevation of the skin that is filled with pus; a pimple.

Papule- A small, solid, usually inflammatory elevation of the skin that does not contain pus.

Nodule- Like a papule in that it is white and dome-shaped.  Characterized by inflammation.  Nodular acne is very severe and doesn't respond well to many forms of therapy.

Cyst- an abnormal membranous sac containing a liquid or semi-liquid substance consisting of white blood cells, dead cells, and bacteria.  Often very painful and they extend to deeper layers of skin.  Nodulocystic acne is when nodules and cysts appear together.

Typical Causes of Acne, Acnegenicity

Acnegenicity means the ability to cause acne breakouts. This medical condition is caused by four key factors:

• Hormones, especially during menopause
  
• Enlargement of sebaceous glands attached to hair follicles
  
• Increased sebum (oil) production
  
• Bacteria
  
• Stress
  
• Poor Dietary Habits, especially excessive consumption of sugar and refined carbohydrates

Acne Prevention Techniques

Clean Skin Gently

People with acne may try to stop outbreaks and oil production by scrubbing their skin and using strong detergent soaps. However, scrubbing will not improve acne; in fact, it can make the problem worse. Most doctors recommend that people with acne gently wash their skin with a mild cleanser, once in the morning and once in the evening. Patients should ask their doctor or another health professional for advice on the best type of cleanser to use. The skin should also be washed after heavy exercise. Patients should wash their face from under the jaw to the hairline; rough scrubs or pads should not be used. It is important that patients thoroughly rinse their skin after washing it. Astringents are not recommended unless the skin is very oily, and then they should be used only on oily spots. Doctors also recommend that patients regularly shampoo their hair. Those with oily hair may want to shampoo it every day.

Avoid Frequent Handling of the Skin

People who squeeze, pinch, or pick their blemishes risk developing scars. Acne lesions can form in areas where pressure is frequently applied to the skin. Frequent rubbing and touching of skin lesions should be avoided.

Shave Carefully

Men who shave and who have acne can try electric and safety razors to see which is more comfortable. Men who use a safety razor should use a sharp blade and soften their beard thoroughly with soap and warm water before applying shaving cream. Nicking blemishes can be avoided by shaving lightly and only when necessary.

Avoid Suntanning

A suntan or sunburn that reddens the skin can make blemishes less visible and make the skin feel drier for a little while. But the benefits are only temporary. The sun can seriously damage skin, promote aging of skin, and cause skin cancer. Furthermore, many of the medications used to treat acne make a person more prone to sunburn.

Choose Cosmetics Carefully

People being treated for acne often need to change some of the cosmetics they use. All cosmetics, such as foundation, blush, eye shadow, and moisturizers, should be oil free. Patients may find it difficult to apply foundation evenly during the first few weeks of treatment because skin may be red or scaly, particularly with the use of topical tretinoin or benzoyl peroxide. Lip products that contain moisturizers may cause small, open and closed comedones to form. Hairstyling products that come in contact with the skin along the hairline can cause burning or stinging in people with acne. Products that are labeled as noncomedogenic (do not promote the formation of blemishes) should be used; in some people, however, even these products may cause acne.

Keep Your Hands and Hair Away From Your Face

At all times try to keep your hands and hair away from your face. Your hands and you hair may contain oils and dirt. If contacted on your face it can contaminate the pores and cause acne.

Never Squeeze or Pick Your Spots

We all know this maybe very tempting, but it would only makes matters much worse. Most spots will heal on it's own. Picking at spots will just increases the chance of it spreading the bacteria or even worst permanently scarring your skin. So remember never to pick on it.

Alleviate Stress

Trying to reduce stress in your daily routine wherever possible is a great way to prevent acne. More sleep, exercise (including yoga and light cardiovascular activity), massage, warm baths and a balanced diet will all help to contribute to physical well being and, hence, prevent acne.

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