Acne as an adult? It really isn’t fair

    9 May 2015

    At some time in our lives we all hark back to blissful, carefree teenage years. We conveniently forget the tricky parts like the awkwardness, the embarrassing unrequited love — and those horrendous spots. While most of us leave all of that thankfully in the past, a growing number of adults are revisiting one of the more painful parts of adolescence: acne. In fact as many as 44 per cent of women in the UK are now thought to be suffering from adult acne, as Professor Rino Cerio, consultant dermatologist at the Royal London Hospital, explains. ‘Adult acne is increasing in prevalence in women in particular,’ he says. ‘I’m seeing people come to me tearful, frustrated and with very poor self-esteem.’

    It is no surprise that in a recent survey by skincare experts Eau Thermale Avène, 44 per cent of sufferers felt they were too old to be dealing with this problem. However, adult acne is actually a different condition to the teenage form. Adult acne mainly affects the face and the jawline, and causes large, deep red spots rather than the fine bumps and blackheads teenagers sport on their foreheads. The main causes seem to be an overproduction of sebum or grease in the skin as well as an excess of dead skin cells: both of these feed the skin bacteria P. Acnes, allowing it to overcolonise and cause inflammation and spots.

    Traditionally treatment of teenage acne has concentrated on abrasive topical treatments or antibiotics to clear the overgrowth of bacteria. The topical lotions we all bought as teenagers, such as benzoyl peroxide, work well for mild teenage acne but do little for the larger cystic spots that adult acne sufferers get. Adult acne sufferers need to look further, but help is available in both high street and prescription treatments.

    Targeting the overgrowth of P. acnes, newer treatments for adult acne block the feeding cycle of the bacteria, preventing the formation of large inflammatory spots. The science is clever: the creams contain a stealth ingredient called Diolenyl which the bacteria mistake for their usual sebum-derived food. On contact, antibacterial and anti-inflammatory agents are released, killing the bacteria rather than feeding it, and reducing the spots. This technology is uniquely available from Eau Thermale Avène who appear to understand the fine balance between treating the acne without stripping the underlying healthy skin. One common complaint among acne sufferers is that treatments are too harsh for daily use.

    A very visible skin disorder such as adult acne has a multitude of psychological and social effects, causing depression and low self-esteem and even going as far as to impact on employment and relationships. There is an added layer of embarrassment when one is suffering from a teenage condition at a time when wrinkles should be the concern and this is a strong impetus to seek professional help. Doctors need to be very careful not to underestimate this, seeing ‘just a skin condition’.

    Adult acne can be very responsive to mainstream prescription medications. These would include antibiotic-based creams or long-term antibiotic tablets. These decolonise the skin removing the harmful bacteria. But more and more we are seeing resistance in acne bacteria and patients can find themselves trialling a number of different courses before one works.

    Because of the huge impact adult acne can have, it leads many to bypass the GP surgery and head straight to the dermatologist for a serious solution. Whereas teenage acne is often belittled as something we all go through in adolescence, adult acne is viewed by dermatologists as something that warrants significant treatment. This explains why the controversial acne drug Roaccutane plays a role in adults with acne. Roaccutane is a drug used for severe cases of acne and is very useful in adult acne, particularly when other treatments have failed.

    It is an effective but very toxic medication, sometimes cited as being responsible for suicides among patients taking it. However, it is difficult with a condition where there is a huge psychological burden to separate what is caused by the condition itself and what is caused by the treatment. No studies have proved a causal link between Roaccutane and depression, but clinicians are aware of an association. The fact that patients are willing to use the medication despite the reports perfectly illustrates what a huge burden adult acne can be. Roaccutane is a chemical similar to Vitamin A, and it is not clear why this could cause depression. It is an effective treatment but prescribing it is a balancing act for clinicians and patients. The benefits and the risks have to be carefully weighed up: for the majority of patients, the side effects are minimal and the improvement in their skin significant. For someone entering their forties covered in ‘teenage’ spots, this is a very worthwhile consideration.