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It's bad enough when you're a teen, but having acne as an adult can be embarrassing and frustrating. Affecting over 17 million Americans, acne is the most common skin disorder in the United States. Dermatologist Dr. Debra Wattenberg explains what acne is and what you can do about it.

What is acne?
Acne is the most common skin condition, and it is estimated that more than 17 million people are affected by acne. Nearly 80 percent of people ages 11 to 30 have acne. Acne is a disorder of the skin's oil glands or the "pilosebaceous glands." When these glands produce too much oil or "sebum" the skin produces pustules, cysts and blackheads. In addition, a skin bacteria called P. Acnes can multiply in the oil gland, causing irritation and inflammation. Acne presents most commonly when our hormones become unbalanced — specifically during puberty, pregnancy, menopause and when discontinuing birth control pills.

How is teenage acne different from adult female acne?
In the teenage years, acne begins with blemishes on the forehead and around the nose. As you age the acne tends to migrate down your face, often being worse on the chin, jaw and neck in adult females. Breakouts are frequent during the premenstrual period in both teenage and adult acne. Adult acne, however, tends to be more low grade and more chronic. The only good thing about adult acne as opposed to teenage acne is that it comes with a sense of perspective: Adults tend to address the issues because of the cosmetic associations and because it is no longer OK to have acne. Adult acne tends to hit in the 20s and 30s and may continue until menopause. Raging hormones cause adolescent acne. In adult acne, hormones continue to be the culprit, but stress and the environment aggravate them.

Is Acne Rosacea the same as adult female-hormonal acne?
This hormonal-induced acne should not be confused with the other form of acne commonly seen in women. Acne Rosacea is a very common skin problem often called adult acne. Fair skinned and menopausal women are more likely to get rosacea. It causes redness in the central part of the face, pimples and dilated blood vessels.  Women with rosacea may complain about pimples and dry, sensitive or irritated skin all at the same time. Women with rosacea often note their skin worsens with spicy foods, alcohol, hot drinks extreme weather and sun exposure.

How do I know if I have adult acne?
Women with adult acne tend to note that their acne worsens as they get older. It often flares premenstrually, and the acne tends to appear on the chin, jawline and neck.

What are the myths about acne?

  • Does stress cause acne?No, stress does not cause acne, but it can aggravate acne in those predisposed towards it. Stress has been shown to cause an increase in cortisol, a hormone released by the adrenal gland, which does increase oil in the oil glands.
  • Does the sun help clear up acne?No, many patients think sunlight improves their acne, but sunlight is not a proven modality and it increases skin cancer.

What makes adult female acne worse?

  • Hereditary factors
  • Increased male hormones found in females
  • Discontinuing birth control pills
  • Stress
  • Oil and grease in some cosmetics
  • Some medications — cortisone, some anti-seizure medication.

Treatment optionsTreatment choice will depend on the correct diagnosis and the severity of the disease. Some medications used for the more hormonal type of adult acne may aggravate Acne Rosacea. Mild acne can be treated with topical products, including over the counter products containing benzoyl peroxide, salicyclic acid and glycolic acid. Prescriptions containing antibiotics, Retin A and azeleic acid are helpful. More aggressive disease may require systemic antibiotics (Tetracycline, Minocin, Erythromycin), anti-androgen therapy like Aldactone, or even Accutane. Newer modalities like chemical peels, microdermabrasion and lasers are also available to help eliminate the active lesions as well as the marks and scarring that may be present.