Myth: Acne only occurs in teenagers
Acne typically is associated with teenagers and puberty, and many adult patients may not be aware that acne can persist beyond adolescence or even develop for the first time in adulthood. As the prevalence of adults with acne increases, it is important to educate this population about factors associated with postadolescent acne development and let them know that effective treatments are available.
There are 2 types of adult acne: persistent acne, which refers to adolescent acne that continues beyond 25 years of age, and late-onset acne, which develops for the first time after 25 years of age. Adult acne generally is mild to moderate in severity and may be refractory to treatment. Unlike adolescent acne, which is more prominent in adolescent boys and manifests as the more severe forms of the disease, adult acne primarily affects women and is more inflammatory in nature, making these patients more susceptible to scarring. In one study, acne prevalence among 1055 adult participants (age range, 20–60 years) was estimated at 61.5%; however, only 36.8% were aware of their condition and only 25% sought treatment. The most commonly affected area was the malar region, which differs from acne seen in teenagers. In addition to the cheeks, adult acne generally is more prominent on the lower chin, jawline, and neck, and lesions more commonly present as closed comedones.
Fluctuating hormone levels are a common cause of adult acne, particularly in women during menses or pregnancy, menopause, or perimenopause; women also may experience breakouts after starting or discontinuing birth control pills. Acne flare-ups in adults also have been linked to chronic stress, family history, hair and skin care products, medication side effects, undiagnosed medical conditions, steroid use, increased calorie intake, whole and fat-reduced milk consumption, and tobacco smoking. Adult acne also has been found to be associated with other dermatologic conditions including hirsutism, alopecia, and seborrhea.
Early diagnosis and treatment of adult acne is crucial to ensure good cosmetic outcomes and minimize disease burden. When treating adult acne, particularly in women, dermatologists should consider a variety of factors that set this condition apart from adolescent acne, including the predisposition of older skin to irritation, possible slow response to treatment, a high likelihood of good adherence to treatment, and the psychosocial impact of acne in the adult population. In adult women, it also is important to consider whether patients are of childbearing age when selecting a treatment. Patients also should be encouraged to read the labels on their personal care products to ensure they are noncomedogenic and will not clog pores.