While teenage boys usually outgrow acne by their early 20s, women can face a lifetime of flare ups through their 50s. In fact, dermatologists are finding that adult acne is becoming increasingly common in women. A recent study found that acne affects more than 50% of women between the ages of 20 and 29 and more than 25% of women ages 40-49.
While there is often no single cure that works for all women with acne, dermatologists can recommend specific regimens that can help control acne and minimize future breakouts.
As you might expect, hormone fluctuations or imbalances are often responsible for women’s acne woes. Hormones, particularly androgens drive many of the primary causes of acne:
- Excess sebum (oil) production (influenced by hormones)
- As skin cells shed, they become sticky with sebum and accumulate in the hair follicle (influenced by hormones)
- Increased amounts of acne-causing bacterium: propionbacterium acnes (P. acnes)
- Skin inflammation
Androgens, the male hormones present in men and women, can contribute to acne flares by overstimulating the oil glands that produce sebum which leads to clogged pores that promote the growth of P. acnes. Most women have normal androgen levels, but hormonal testing is recommended for females who have acne accompanied by excess facial or body hair, deepening voice, or irregular or infrequent menstrual periods.
Treatment Considerations for Women:
- Therapy should be tailored to your specific type and severity of acne.
- Several oral and topical medications should not be used when trying to conceive or during pregnancy.
- Topical acne medications may cause more skin irritation in women with dry skin or other skin conditions like rosacea. This might make some topical acne medications harder to tolerate.
- The first-line therapy for mild-to-moderate acne for any patient is topical retinoids. These medications, which contain derivatives of vitamin A, are also the preferred therapy for long-term acne prevention.
- For women with a hormone imbalance, combination oral contraceptives either alone or in conjunction with anti-androgen medication, such as spironolactone, can be effective. As hormone therapy comes with risks, women should be screened for any contraindications of oral contraceptive use which include:
- Personal history of breast cancer
- Heart attack, stroke or blood clots
- Uncontrolled high blood pressure
- Abnormal vaginal bleeding
Women who choose oral hormonal therapy should also be monitored regularly.
- Use skin products that are “non-comedogenic” or recommended for “sensitive skin” to help prevent new acne lesions and to minimize skin irritation.
- Mild cleansers should be used twice a day. Avoid harsh cleansers as they can actually stimulate oil glands to produce more oil.
- Avoid cleansers or other skin care products with scrubbing particles or a gritty texture, as they can irritate the skin.
- Use a non-comedogenic moisturizer daily.
- When applying topical acne medications, use only enough for a very thin layer to the skin. (Generally a pea-sized amount is enough for the face.) Using more medication than is recommended will not produce better results, but may cause more irritation or dryness.
- When starting treatment with topical retinoids, apply three times a week for the skin to get accustomed to it. Over time, the frequency of the medication should be gradually increased with the goal of using a topical retinoid every night.
- Remember the biggest “no-no.” Avoid the temptation to pick, squeeze, pop or otherwise manipulate acne lesions or you will increase the risk of scarring and secondary bacterial infections.
It can take eight to ten weeks before you see the full benefit of acne treatments so you must be patient. Once the breakouts are under control, maintenance therapy may be required to keep your skin clear of acne over the long-term.
American Academy of Dermatology