Adult / Hormonal Acne aka Acne Tarda
“Why am I still having acne when I am way past my teens!?” – This must be one of the most common questions among my adult patients with adult acne.
Truth is, while acne is especially common among adolescents, adult acne, also known as acne tarda, affects 20% of adult men and 30% of adult women at some time in their adult lives. It is definitely not as uncommon as we might think!
What is adult 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.
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.
It happens more often in females than males
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 as well—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?
For a combination of reasons, people seem to be struggling with acne into their 20s, 30s, 40s and beyond. The basic pathogenesis 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.
Adult acne is also thought to be associated with hormones and fluctuations in hormone levels. Other important influencing factors include a genetic predisposition, smoking, inappropriate skincare and make-up and stress.
What have hormones got to do with adult acne?
Hormones are necessary for acne to begin. Increased androgens (male hormones found in both males and females) can cause acne in both sexes.
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 do I know if I have adult acne?
The clinical features 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 trunk is common.
How is adult acne treated?
Treatment of adult acne adopts generally similar principles to that of acne in adolescence. Long-term treatment over years or decades may be required. Women with acne tarda 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 acne can be treated similar to adolescent acne. Late-onset acne causes fewer comedones, but more inflammation than persistent acne, hence some of the treatments of late-onset acne may be geared more towards decreasing skin inflammation.
In view of the strong hormonal component in adult acne, your doctor may recommend medications which target these in your treatment regime. Do browse our Acne Treatments to understand more about your options.