Dealing With Female Adult Acne
Hello! Today I thought I would share with you some information about a topic that I am sure a lot of you can relate to you. Adult Acne. And yes, that IS in fact me in that picture below!
So many patients come into our practice with adult acne and all of the stories are alike… most of them go a little something like this: “I never had skin issues until I hit (insert age here) and everything went to shits (pardon my language)”. It is then followed up with something of the sort that perhaps something is wrong with them (an allergy, an “imbalance” in nutrients, etc) because they shouldn’t be getting acne at THIS age! The thing is…although it IS frustrating, it is very normal (and VERY common) to get acne in your later years. It can be a source of a lot of frustration and anxiety. I know this because I see many patients day in and day out with this issue and as is evident in that anxiety-provoking picture of myself above: I myself went through it.
When I was a teenager, I had acne, much like many teenagers. My acne was probably a little bit more severe than most but it was controlled with topicals and oral antibiotics. I eventually “grew out of it”. My skin was pretty good in college and in PA school. Out of nowhere last summer…my skin got out of control. I could not get through a week without hormonal inflammatory cystic breakouts along my chin, upper lip, and lower cheeks. I especially broke out a week before my menstrual cycle. Combine that with stress and lack of sleep and you got yourself a nice face full of acne! I was especially sensitive to this issue because THIS IS MY JOB! I work in the dermatology field and my face looked like this (photo above). I can’t lie, I even cried a few times over it (ask Harry, he can attest to that…poor Harry… ha!). I constantly felt anxious about my skin.
Of course I know how to treat acne. I treat patients with acne (successfully) everyday! Hormonal acne, however, can be very resistant and difficult to deal with. What you should know, though, is that in the end, SOMETHING will help you. You just have to find what works for YOU and be patient with it.
Oh one more thing…I know that for me this was the case… family/friends saying to you… “oh your skin is fine” or “its not that bad”. For starters, I ALWAYS covered things up with make up (oil-free, of course). So what was hiding underneath it all was much worse than what meets the eye. Secondly, it doesn’t matter how good or bad your skin is. If it is affecting YOU and bothering YOU, that is all that matters. Of course its always important to make sure you don’t get yourself too worked up and too over-analytical but you know yourself the best and if you are not happy and you are anxious because of your acne (no matter how severe), it IS a problem.
haha please excuse my "after" photo I took it within 2 minutes of waking up today! haha! I wanted to give you a "real" photo of me. no makeup just Christina in the flesh haha
WHAT WORKED FOR ME
- Photodynamic Therapy (also known as “PDT”)
- 3 sessions about a month apart plus 4 blue red light treatments scattered throughout
- I will write more about PDT in another post!
- Intralesional Kenalog (steroid) injections for cysts (when needed)
- Clindagel (topical Clindamycin) only for breakouts
- Atralin (Tretinoin 0.05%) nightly
- Spironlactone 50 mg once daily
- started at 25 mg and increased to 50 mg
- Solodyn (Minocycline) 65 mg
- was on this for about 3-4 months and then discontinued
- Chemical Peels, Microdermabrasion, and facials
IMPORTANT POINTS TO KNOW ABOUT SKIN-CARE AND TREATING ADULT ACNE
- Use only oil-free // non-comedogenic face products (including makeup)
- Avoid picking or squeezing pimples. Although tempting, it often times does more damage than it is worth.
- The cause of acne is multifactorial. It is caused by overactive sebaceous glands. When androgen levels increase, the sebaceous glands release sebum. When cells from the lining of hair follicles shed too quickly—clumping together and clogging pores—sebum is trapped beneath the skin causing whiteheads and blackheads. Sebum can then mix with the trapped cells and cause Propionibacterium acnes (P. acnes)—bacteria normally found on the skin–to grow in the clogged follicles. P. acnes can cause inflammation and pus and can result in papules or pustules. When the follicles expand as much as they can, bumps called nodules are formed under the skin. I found that from THIS website- I thought they worded it quite well! so besides hormones, acne is also caused by bacteria (p. acnes) and other things such as food and stress.
- Dairy, simple carbs (the bad for you stuff…), and protein supplementation has been proven to exacerbate acne. If you eat a lot of these two things, consider decreasing consumption
- Figure out your cause and effect. Although there are NOT a lot of studies out there to prove that a certain food product causes acne (besides dairy, simple carbs, and protein…which have been shown to add to acne)…if you see a cause and effect….avoid it! If you notice that when you are stressed out or lack sleep, you break out…consider developing some stress relieving techniques and start to sleep more! If you eat a cookie and you breakout, avoid that, etc. (exaggerating a little bit but you know what I mean)
- Consider medical reasons for your acne. PCOS (polycystic ovarian syndrome) could be the reasoning behind your acne. Many people have this condition and many people also have no idea that they have it. It is important to consult with either an endocrinologist, OBGYN or dermatologist to get the proper blood work and testing to see if you could possibly have this. One important thing to consider with blood work— it matters WHEN (in terms of what part of the menstrual cycle you are in) you get it done so make sure you talk to your doctor about this. This topic of PCOS is a big one…a whole other blog post can be spent just talking about this…I will write a post one day. Sidenote: I tested myself for this: bloodwork came back negative. Still not convinced though.
- To piggyback on PCOS- consider starting a OCP (oral contraceptive pill). If you are already on a OCP, consider changing to a new one. MOST dermatologists, do not like to write for OCP. OBGYNs know the ins and outs of this…let them write it for you! I myself am seeing my doctor on Friday about this!
- Do not go crazy with a ton of harsh products. Cleaners, for instance, are designed to cleanse. Do not buy things with a harsh gritty, texture (i.e. St Ives Apricot scrub). Use something gentle with NO Salicylic Acid or Benzoyl Peroxide (assuming that you are going to be using another topical medication on your skin). Examples: Cetaphil, CeraVE, Neutrogena. You can get away with exfoliating once a week but do not overdo it. Besides cleansers, people also have the tendency to think well if I put MORE medication on my face, I will get better that much faster. The opposite is true…you end up just causing a ton of irritation and making the situation look even worse. Besides putting too MUCH of a certain product on your face, you can also DO too much to your skin (I am certainly guilty of this at times). You should consult with a doctor or other health care professional and determine a regimen for you and stick to that and only that.
- Give it time. I know it is frustrating and you want the acne gone yesterday but you HAVE to give your regimen time to work. It takes about 6-8 weeks to even START to see improvement. You cannot “give up” on a regimen unless you have tried it for this long.
- To piggyback again off the last point… everyone is different. What works for Person “A” may work horribly for person “B”. It is all about finding the magic combination that works for YOU. Sometimes the very first regimen you try works (yay!) but other times, it takes some tweaking. Be patient.
- Consider Spironolactone. This drug decreases circulating androgen (i.e. Testosterone) levels, which in turn decreases sebaceous gland activity and size. This is a great medication for hormonal acne. You have to be patient with it as well since you must start at a small dose and work your way up. It also takes about 3 months to fully kick in. On top of this, you have to get blood work to check potassium levels (they can increase) and keep an eye on the blood pressure (it can drop). This drug is a diuretic so it can make you urinate more, as well. It is actually a blood pressure // heart medication that has been used secondarily (for YEARS AND YEARS AND YEARS) for hormonal acne. It is worth a shot.
- Consider PDT- Photodynamic Therapy. PDT is used to treat pre cancer spots called Actinic Keratoses but it can also be used for acne! Below is a little bit about this treatment option taken from this website. I will write another blog post about this as well. I just had my first PDT treatment and have 2 more to go. When I get my second treatment done, I plan to take pictures (it won’t be pretty) and to document my “journey” with this treatment.
- Since “photo” means light and “dynamic” means action, photodynamic therapy is the use of light or laser energy to act against skin disease, in this case sun damage, precancerous cells (actinic keratosis), acne, and inflammatory rosacea. Your affected skin must first be coated with a prescription solution called Levulan, which makes the target cells or glands more sensitive to light. The combination of Levulan and light not only treats the diseased skin cells or glands, it also makes your skin more healthy, smooth, and clear, possibly even preventing skin cancer.
- This treatment often results in redness and scaliness, similar to having a sunburn for 1 day to over a week. You cannot go in the sun AT ALL for 2 full days.
- This treatment is NOT covered by insurances for the treatment of acne. It is considered “cosmetic”
- People always ask about facials/chemical peels/microdermabrasion and whether or not to do it. My view of it is that if you go to someone who knows what they are doing, fine, do it. Otherwise, they can end up jabbing at your skin a LITTLE TOO MUCH and make it worse. If you ask 10 doctors or healthcare providers each may give you a different opinion. This is just my opinion on the matter. If you do it…go to a place that knows their stuff. Some docs even have their own aesthetician!
- If all else fails…there is ALWAYS Accutane that can be pulled out of the back pocket. This is a serious medication but the results are worth it. More about this in another post.
I know. A lot of information. Any questions, just ask!