Acne vulgaris in adult women, may persists from the teenage years or occur as adult-onset acne. In the latter case, women often feel upset and puzzled by the onset and persistence of acne later on in life. Hormonal acne treatment and management for adult women must taken into account lifestyle factors, family planning and underlying causes of androgen excess.
Adult Hormonal Acne
Although acne is most common during the adolescent period, it can affect all age groups. Some studies have shown that prevalence of acne in adult women from 20 to 29 years and 30 to 39 years, is about 50% and 35% respectively.
Acne in adults have a wide range of clinical skin appearance. They range from inflammatory acne vulgaris to blackheads and whiteheads, and even cystic acne. Often enough, there is a mixture of acne spots, and may affect the face, jawline, and back areas. In females, a U-shaped pattern that affects the sides of the face, jawline and chin is typical of adult hormonal acne.
Acne scarring is also common in adult onset acne. This further exacerbates the psychological impact the condition has on women. Higher rates of depression, anxiety and stress have been reported.
What Triggers Acne?
- Acne may flare up before, during and after menses.
- Inappropriate use of skin care products e.g. comedogenic (blackheads & whiteheads forming), acnegenic (acne forming) and oil based skin care products.
- Dietary factors. Although there is no firm evidence, some individuals find that food rich in sugar and dairy products may worsen their acne.
- Certain medical conditions such as Polycystic Ovarian Syndrome.
What can lead to Androgen excess?
The vast majority of women with adult onset acne do not have increased levels of the hormone, androgen in their blood streams.
The most common cause of acne that is driven by an excess of androgen is a condition known as Poly-Cystic Ovarian Syndrome (PCOS). In PCOS, women may notice excess facial hair, irregular menses and a sudden onset of severe acne.
Women with PCOS may also notice scalp hair loss, hyper pigmentation of the skin, increased libido and obesity. The acne may not be treatable with standard medical therapies. Further evaluation with a blood test, and/or ultrasound scan may be needed to help diagnose the condition.
Hormonal Acne Treatments
Hormonal acne treatments in adult women are well established. A treatment program must taken into account age, lifestyle factors, family planning and existence of underlying medical conditions.
For mild cases, topical prescription acne creams are suitable. Although there is a wide range to choose from, your doctor will guide you to the best choice.
For moderate to severe cases, an oral antibiotic is often added to the program to bring the inflammatory component of acne under control. However, there is an emerging trend of antibiotic-resistant acne worldwide.
In severe or resistant cases of acne, oral isotretinoin is a well established treatment option. Oral isotretinoin effectively shrinks down the oil glands, and clears up whiteheads and inflammation associated with acne. This is strictly not suitable if you are planning for a family or are pregnant.
Hormonal acne treatment works by decreasing the amount on androgens and testosterone in your blood stream. Anti-androgen medications and oral contraceptive medications may be prescribed in women with adult onset acne. Low dose Spironolactone, a diuretic with an anti-androgen effect, has shown to be safe and effective for hormonal acne in women. Possible side effects of spironolactone may include dizziness, diarrhoea, breast pain, dry mouth and irregular periods.
Importantly, there are certain medications, both oral and topical that are unsafe during pregnancy. These include some oral antibiotics, topical and oral retinoids, and hormonal treatments. Acne during pregnancy is a treatable condition, where safe and effective options are available.
- Villasenor J, Berson DS, Kroshinsky D. Treatment guidelines in adult women. In: Shalita AR, Del Rosso JQ, Webster GF, eds. Acne Vulgaris. London, United Kingdom: Informa Healthcare; 2011:198-207.
- Fisk WA, Lev-Tov HA, Sivamani RK. Epidemiology and management of acne in adult women. Curr Derm Rep. 2014;3:29-39.
- Shaw JC. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol. 2000;43:498-502.