As an Online Esthetician working exclusively with Adult Acne for people 30+ for the last decade or so, many clients come to me after being disappointed by doctors. From differing hormone levels to greater dead skin cell buildup as we get older to a plethora of anti-aging products, there are so many new issues that arise over the decades, it baffles me how often people seem to get treated medically the same, irrespective of age!
In general, I feel that throughout much of the medical profession, adult acne is not really well understood for one very simple reason - pore clogging and irritating ingredients in most skincare are not paid much attention to, and there is very little recognition of the differences between adult acne and teen acne. It's no accident that so much of the time a client will start out telling me that she never had a single pimple in high school - a definite indication her acne problem is not genetic! What this means is that bacteria, genetic overproduction of oil, or abnormally fast cell turnover may not be the key problems in most cases of adult acne.
So why prescribe medications to an adult ?
All prescription acne meds are designed to either cut oil production altogether, massively exfoliate dead skin cells, or kill bacteria - and here's where it gets complicated. If bacteria, excess oil production and/or dead skin cell build-up were all that were involved in the formation of adult acne, a string of prescriptions would likely do the trick for most people, and I would still be working in a fancy spa on the south side of Chicago doing fluff facials.
What is missing here? Why are these medications so often not helping?
Let's examine some of the typical
medications prescribed for acne and why.
Hormone Therapy
Examples : Yaz, Ortho-tricyclen, Spironolactone
The male hormone Testosterone is responsible for oil production in the skin. There are two main places this gets produced in women - the ovaries, where it's released right before our period, and the adrenal glands, where any time you have an adrenaline rush you get an accompanying testosterone rush. In balance with the female hormone Estrogen, when female hormone goes down, male hormone is now higher than female whether it goes up or not. When male hormone goes down, female hormone is now higher. Excess oil production can sometimes be blamed on this balance being off kilter due to too much male hormone being produced, or not enough female. Birth control pills are meant to balance the ratio of estrogen and testosterone. Spironolactone, either prescribed alone or included in birth control, such as in Yaz, is a diuretic usually prescribed for high blood pressure that also happens to suppress testosterone.
Antibiotic
Examples : Clindamycin, Doxycycline, Minocycline, Aczone
When bacteria inside a pore (which exist inside every pore in every person) get out of control, they produce a chemical that makes it easier for them to feed on the oil produced by the skin (called sebum). This chemical creates terrible inflammation which makes the pore swell up. Now, since the bacteria in pores are "anaerobic", that is, they get killed by oxygen, if the pore swells shut and air can't get in, the bacteria thrive even more. Antibiotic is supposed to kill the bacteria so they stop producing so much of this chemical; that is, IF the antibiotic in question even gets to the bottom of the pore, which many actually don't.
Tretinoin - aka Retin-A
Examples : Retin-A Micro, Retin-A Cream, Tazorac, Adapaelene
For pore clogging, tretinoin and other vitamin A derivatives are often prescribed because of the way they flush out pores and loosen impactions - the start of every blemish without exception is a microscopic blackhead known as a microcomedone. Retin-A helps to get rid of this by shutting down oil glands in such a way that dead skin cells having nothing holding them to the skin and far more of them fall off than normally would. This happens from inside the pores as well as outside on the surface.
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There are several prescription meds that combine some of these together, and a few that add Benzoyl Peroxide (BPO) to the mix. BPO is available without prescription, but it's actually quite effective when combined with other drugs, such as tretinoin (EpiDuo) or Clyndamycin (Acanya).
Benzoyl Peroxide (BPO) is a versatile, effective and rather misunderstood drug. First, it forces oxygen into pores, which kills the particular anaerobic bacteria involved in the vast majority of acne conditions, known as P. Acnes, that live inside almost every pore in every human being. Next, it dries up excess oil. Finally, it exfoliates from inside the pore out.
When used properly, these medications can clear up acne before switching to a long term regimen of maintenance, involving gentle but thorough cleansing, toning, non-clogging serums and moisturizers, with clay mask once or twice a week.
Next week, I'll go into a little more detail about the proper way to use some of these medications, and even more importantly, how good skincare can help you avoid dependence on, or even need of, these medications in the first place.
Let's get your skin clear together! Visit my web site for Adult Acne, or ask me questions in the comments below and let's see how we can get to the bottom of your acne issues.
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