Every day I hear the same complaint: “I am 40 years old and breaking out with acne. Why?”
Adult female acne refers to women in their 20s, 30s and 40s who experience acne, often in a ‘hormonal’ distribution around the chin and jaw line. Some of these women had acne as a teenager, and simply never outgrew their acne, while others had clear skin in high school and then inexplicably developed acne as an adult! All too often, I encounter women that are baffled as to why they have acne at the age of 40 when they cannot remember having acne when they were younger.
A recent survey of one thousand women reported the following estimates of adult female acne:
   Age –  Prevalence of acne
| 20 to 29 years | 51% |
| 30 to 39 years | 35% |
| 40 to 49 years | 26% |
| 50 years and older | 15% |
Many of these women are embarrassed, perplexed, and frustrated. Flaring of acne around the time of the menstrual cycle is quite common. Many women seek camouflage and cosmetics to cover up their acne. Others seek over the counter options. Seeing a dermatologist for a proper skin care regimen is recommended.
What causes adult female acne?
The two main underlying causes for adult female acne are genetics (i.e., family history) and hormones. Most women with adult female acne have normal circulating levels of hormones when tested. My personal belief is that women with adult acne have a genetic predisposition with some sort of hormonal flux that triggers these repeated breakouts. Those women with an implantable birth control, or IUD containing progestin only contraceptives, are more prone to adult female acne. A small percentage of women truly have an identifiable hormonal trigger such as PCOS or late onset congenital adrenal hyperplasia. Signs of abnormal hormones include: irregular menstrual cycles, excessive hair growth on the chest/abdomen/ sides of the face, acanthosis nigricans, and female pattern hair loss.
Treatment of adult female acne
In general, a gentle skin care regimen, with gentle non-medicated skin cleansers and moisturizers that do not clog pores are recommended.
Unfortunately, there are limited studies that specifically look at the treatment of adult female acne. Therefore, therapy is individually tailored to the needs of each patient, based on experience.
For those women with garden-variety comodonal and inflammatory acne, we will often proceed with traditional acne therapies. In cases of adult female acne distributed around the chin and jaw line, we place more emphasis on taking a hormonal approach.
I have personally found that treating the hormonal component of adult female acne is critical to long term success and control. This includes oral spironolactone (which will be addressed in a future blog) along with newer topical hormonal blockers which have no internal side effects. Topical dapsone is an effective treatment as well.
Craig Singer MD Dermatology offers a safe and effective topical prescription therapy for adult female acne: Acne DS Clarifying gel.â„¢ This is a unique preparation containing both topical spironolactone and dapsone. We have seen outstanding results in most patients. It is well tolerated, even for sensitive skin types. No internal side effects have been reported.
If you are bothered by your acne, you should see your dermatologist. Multiple treatment options are available.
References:
Collier CN, Harper JC, Cafardi JA, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58:56-59.
Status Report From the American Acne & Rosacea Society on Medical Management of Acne in Adult Women, Parts 1, 2 and 3:
Cutis. 2015 October, November, and December
