You'd think pimples would be something you'd only have to deal with in your teens, but around three percent of males and 12 per cent of females over 25 experience adult acne, Melbourne-based Dermatologist Dr Matthew Palmer said.
"It can have a major impact on self-confidence…It's a very visible problem, and adults are often more self-conscious as [acne] is not as expected as when you're a teenager.
"Some [adults] may have had acne [since] their teenage years…though it can also present for the first time later in life." Acne becomes less common as you age, but can persist throughout life, the skin specialist said.
A family history of oily skin or hair might be to blame, Palmer said. Smoking, comedogenic skin products and certain medications can also contribute, as can stress, "though this is less clear-cut." In women, hormone abnormalities including those in polycystic ovarian syndrome can contribute.
Cutting back on beer, burgers and chocolate for your skin's sake? "The impact of diet is still being looked at, but it seems sugar or high GI foods, and dairy, particularly reduced-fat, may make acne worse…and low intake of fruit, vegetables, and fish may be associated with acne," said Palmer.
To squeeze or not to squeeze?
"Definitely don't squeeze. If you try squeeze the pus out the top of a pimple, it is also likely to burst under the skin surface, which can lead to scarring and increase the chance of infection.
"If it's a big painful cyst, we can inject corticosteroids to shrink it down, but this isn't commonly needed."
Finding the right treatment
"The treatment protocol depends on how much impact acne is having on the patient's day-to-day life, [and scarring-risk if left] untreated," Palmer said.
Some commercial acne products can be irritating and drying, so must be used correctly. For over-the-counter solutions Palmer recommends salicylic acid-containing products, "which help break down keratin and reduce blockage of pores," and benzyl peroxide, "which reduces the Cutibacterium acnes bacteria that is part of the problem."
While the pill and antiandrogenic medications can reduce hormonal acne in women, prescription treatment for men with moderate acne often starts with topical retinoids (vitamin A) and antibiotics.
"Oral isotretinoin (Oratane or Roaccutane) is a [vitamin A derivative] prescribed for more severe cases. This reduces the size and activity of the oil gland.
"Often with adult acne, the patient is well and truly sick of it and wants a long-lasting benefit. [A key benefit] of isotretinoin is that around 80 per cent of [patients] will have persistent clear skin, after a course of treatment."
What about the side effects of Roaccutane?
"We used to use much higher doses which could cause significant [skin dryness and discomfort, but today we [typically] use much lower doses, which means only mild dryness, comfortably managed with moisturiser and lip balm," Palmer said.
"Anything that reduces oil production [will make] your skin more sensitive to trauma and sun damage, as [your skin's oil] is naturally protective…so a little more care needs to be taken with sun exposure, and potentially harsh routines such as laser hair removal or waxing.
"The mood [changes associated] with isotretinoin, while potentially serious, are rare, and there is also a risk of depression associated with acne itself."
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