TYPES OF ACNE
What is Acne Tarda / Adult Acne / Hormonal Acne?
Acne tarda (adult acne) is defined as acne that develops (late-onset acne) or continues (persistent acne) after 25 years of age. In addition, 1/3 of adults affected with facial acne also have acne on their back and body. Adult acne usually stems from the same root causes as adolescent acne, but adult acne affects women more often; it tends to be more inflammatory in nature, and it appears more often around the mouth, cheeks, chin, and jaw. The featuees of acne tarda are quite specific: inflammatory acne in the lower facial region (also known as the U-zone) or macrocomedones (microcysts) spread over the face. In men with acne tarda, involvement of the body is common.
There are 2 types of adult acne:
- Persistent acne begins during adolescence and continues into adulthood.
- Late-onset acne begins during adulthood, affecting people who did not suffer from acne during adolescence.
Overall, persistent acne is more common than late-onset acne.
Adult Acne in Males & Females
If a man experiences adult acne, this is usually a case of persistent acne which is stubborn and has been present intermittently since adolescence. Few men experience adult onset acne. If a man does experience adult onset acne, it is likely due to some sort of prolonged irritation of the skin or comedogenic product he is using (acne mechanica or acne cosmetica).
Unlike men, many women experience adult onset acne—a sudden upsurgence of acne well into her 20s or beyond. For these women, hormonal factors may play a greater role. Female hormones tend to fluctuate more than male hormones, and unlike men, hormonal treatment is an option for women, in addition to the other medications commonly used in adolescent acne or acne in men.
What causes Adult Acne?
Adult acne is caused by a combination of reasons. The basic cause of adult acne is similar to acne in adolescence – excessive sebum production, formation of comedones, P. acnes bacteria proliferation and inflammation are the key features of adult acne as well.
Fluctuations in hormone levels greatly contribute to adult acne. Increased androgens (male hormones found in both males and females) can cause acne in both sexes. Other important influencing factors include a genetic predisposition, smoking, inappropriate skincare, make-up and stress.
Hormones are responsible for the maturation of the oil glands in our skin and only once matured do these glands develop the capability of becoming acne lesions. (This is why children do not experience acne!)
Androgens (such as testosterone and DHEA), trigger acne primarily by increasing the production of skin oil. On the other hand, “female hormones” such as estrogen counteract the effects of male hormones in the body, thereby decreasing the production of skin oil and reducing acne. Females experience greater fluctuations in estrogen levels due to the menstrual cycle; this may explain why some females report a relationship of their acne with the menstrual cycle.
How should adult acne be treated?
At Aeras, we always aim to treat the cause and ensure that it does not return after treatment. Long term treatment of adult acne may be required in some cases.
Treatment of adult acne adopts generally similar principles to that of acne in adolescence. Women with adult acne and other symptoms of hyperandrogenism (such as excessive facial and body hair, irregular menstrual cycles) should be evaluated by a doctor as they have a higher probability of hormonal abnormalities such as polycystic ovary syndrome.
Persistent adult acne usually presents with macrocomedons (clogged pores which are inflamed) and therefore requires more exfoliation together with the reduction of inflammation. Late-onset adult acne causes fewer comedones, but more inflammation than persistent acne, hence most of the treatments of late-onset acne may be geared more towards decreasing skin inflammation and balancing of hormonal levels, and then exfoliation to reduce clogged pores and sebum.
The objectives of treatment include;
- Reducing inflammation and bacteria count
- Reducing sebum production
- Correcting Hormonal imbalance
1Reducing Inflammation & Bacteria Count
The reduction of bacteria and inflammation can be achieved through in-clinic procedures and topical/oral medication. Oral medication is often required due to the nature of nodular/cystic acne being situated deeper in the skin. Daily skincare routine to reduce sebum production and inflammation is also crucial in reducing nodular/cystic acne.
Procedures to help treat nodular/cystic acne by reducing severe inflammation include;
- Aeras Hypertec Q-switched and Quasi-long pulsed Laser
- Aeras Healite II Light Therapy
- ProYellow Laser
- Steroid Injections
These procedures not only reduce bacteria count, but also specifically aim to reduce acne inflammation with heat energy or steroid injections.
2Reducing Sebum Production
P-acne, the acne-causing bacteria, grows optimally in the presence of sebum. Increased sebum production attracts the bacteria into the hair follicles. Sebum production can be reduced and controlled with in-clinic procedures.
Procedures we do that help reduce sebum production include;
- Carbon Laser Peel
- Aeras Clinical Acne Peel
- Aeras Healite II Light Therapy
- Aeras Ultra-Healing Acne Facial
Exfoliation/extraction is achieved through in-clinic procedures, and daily skincare. This ensures that the pores are less clogged over time and reduce the appearance of whiteheads and blackheads. Extractions, when performed properly and skilfully, reduce existing blackheads to prevent further inflammation on the acne.
Procedures we do that help exfoliates and reduces clogged pores include;
- Aeras Deep Cleansing Acne Facial
- Carbon Laser Peel
- Aeras Clinical Acne Peel
Lastly, a blood test can sometimes be performed if the doctor finds it necessary. Blood tests can be used to confirm hormonal imbalances and the cause of adult acne.
Medication & Skincare for treating Adult Acne
Our Aeras skincare range is specifically designed to include different products for different types of acne.
Because adult acne can be a combination of different types of acne, the skincare and medication for adult acne will depend on which symptoms you are experiencing.
The following list of medications can be used to treat adult acne but your doctor will decide which would be best suited for you.
Topical antibiotics kills and reduce bacteria on the skin surface and in the pores. This helps reduce inflammation and also prevents clogged pores from getting inflamed. Antibiotics are a mainstay in the treatment of inflammtory acne.
Topical Benzoyl Peroxide
Benzoyl peroxide, or BP, is commonly known as Oxy in Singapore. BP is used to treat mild to moderate acne. It is best used with topical antibiotics and it helps break down the outer protective film of a bacteria to allow topical antibiotics to destroy these bacteria.
BP also dries up and reduce small papules to reduce acne.
Differin Gel/Topical Retin A
Both Differin and topical Retin A contain retinoids. Topical retinod is a keratolytic agent that softens and causes desquamation of the epithelium. This means that these agents slough off the dead skin cells and promotes skin renewal. This aids the natural exfoliation of the skin and unclog pores. These topical medications are used to prevent clogged pores and in turn reduce inflammative acne.
Aeras Acne Spot Treatment Gel
Aeras’s doctor-compounded Acne Spot Treatment Gel combines topical antibiotics, BP, and ingredients such as Niacinamide and others to reduce redness and soothe the skin. This fast-acting topical acne gel reduces papules and pustules quickly and reduces the chances of acne scarring.
For more severe inflammation, oral antibiotics can be used to reduce inflammation. Oral antibiotics can be taken for about 1 – 6 months, depending on the condition. Oral antibiotics for acne have few or mild side effects, and is safe to take long term for most people.
More commonly known as Accutane or Nimegen, oral isotretinoin is an oral Vitamin A. Oral Vitamin A (or retinoids), work by greatly reducing the amount of sebum produced by the skin. Oral isotretinoin helps treat severe inflammation by reducing the amount of sebum that the bacteria acts on. However, there are precautions and side effects associated with oral isotretinoin and professional healthcare advice is needed before starting on a treatment.
Oral hormonal medication/birth control pills
Oral medication to reduce androgens (hormones that increase sebum production), or to increase female hormones is commonly used to treat adult acne in women. Oral medication like spironolactone helps
Sometimes, oral supplements like zinc or probiotics are given to boost the immune system. These supplements do not work well on their own, but rather in conjunction with other medication or skincare products.
Adult acne should also be controlled and reduced with our daily skincare.
For Persistent adult acne which manifests mainly as macro comedones, we recommend skincare ingredients that helps exfoliate and moisturise:
AHAs and BHAs are mild acids that are widely known to help unclog pores and exfoliate the skin. Examples of AHAs and BHAs used in our various skincare products fro comedonal acne include Salicylic acid, Glycolic acid, Mandelic acid, Lactic acid, and Lacobionic acid.
Products that contains AHA/BHA include Clarifying Cleanser, Multi-action Cleanser, Multi-action moisturiser, DoubleaAct toner, Bionic lotion, 15% gel plus.
PHAs are the latest generations of AHAs. PHAs not only delivers the full benefits of AHAs, but has added benefits of moisturizing the skin, strengthening skin barrier, and anti-oxidative properties. PHAs, like Gluconolactone and Lactobionic acid, is a 2nd and 3rd generation AHA that also exfoliates the skin, while at the same time moisturising it due to its water-attracting properties. These unique PHAs, carefully combined with the usual AHA/BHAs are what make our skincare product effective and standout from the rest.
Products that contains PHA include Clarifying Cleanser, Bionic lotion.
Being able to hold 1000x its weight in water, Hyaluronic acid is a key ingredient in many moisturisers. Formulated with low molecular weight Hyaluronic acid (LMW HA), our moisturising products ensure deep penetration of the HA molecules to hydrate the skin.
Products that contains Hyaluronic acid include Intensive moisturiser, serums.
For Late-onset adult acne, we recommend skincare ingredients that help exfoliate, reduce inflammation, reduce oil production, and reduce bacteria count.
AHAs and BHAs are mild acids that are widely known to help unclog pores and exfoliate the skin. Examples of AHAs and BHAs used in our various skincare products for comedonal acne include Salicylic acid, Glycolic acid, Mandelic acid, Lactic acid, and Lacobionic acid.
Products that contains AHA/BHA include Clarifying Cleanser, Multi-action Cleanser, Multi-action moisturiser, Chest and Back acne spray, DoubleaAct toner, Bionic lotion, 15% gel plus.
Triethyl Citrate helps reduce excessive sebum production and also reduces bacteria activity on sebum to prevent inflammation. Triethyl Citrate also helps destroy bacteria by breaking down acid molecules to help kill bacteria.
Products that contains Triethyl Citrate include Multi-action Cleanser, Multi-action moisturiser, Chest and Back acne spray.
Ethyl Linoleate is broken down by the skin to form Linoleic Acid, Linoleic Acid reduces sebum production on the skin and reduces bacteria activity. It also helps renews the skin and prevent post-acne marks which are more common in moderate to severe inflammative acne.
Products that contains Ethyl Linoleate include Multi-action Cleanser, Multi-action moisturiser, Chest and Back acne spray.
GT peptide 10
GT peptide 10 has the ability to break down the outer membrane of bacteria. This kills the bacteria or allows medication such as antibiotics to further destroy the bacteria. GT peptide 10 works best together with Triethyl Citrate in combination to reduce inflammation as it reduces the skin response to oil-producing hormones to control sebum production.
Products that contains GT peptide 10 include Multi-action Cleanser, Multi-action moisturiser, Chest and Back acne spray.