For most people, acne is associated with adolescence, but many adults also experience troublesome and embarrassing acne later in life. Adult acne is a term for patients over the age of 25 with permanent or new acne problems. This mainly concerns patients in their twenties and thirties, but can also be seen in the elderly. The most common variant is acne that debuts in adolescence and continues into adulthood, often referred to as "persistent acne". Acne that first debuts in adulthood, "late-onset acne", is more unusual and accounts for approx. 10-20%.
There is a certain gender difference with regard to the frequency of adult acne, with women being more often affected. Studies have shown that approximately 10% of women in their forties have permanent acne problems.
The face is the most common location for adult acne. The lower part of the face, especially the chin, is a typical problem area. This form of acne is often referred to as "adult female acne" in English literature. In around half of patients with adult acne, the neck and upper body are also affected.
Adult acne often shares the same triggering and maintaining factors as juvenile acne, including: 1) increased sebum/oil production in the skin, 2) clogged pores, 3) bacteria and 4) inflammation.
In addition, hormonal factors are often important in adult acne, for example in connection with menstruation, pregnancy or menopause. Women with adult acne typically experience a worsening just before menstruation. It is mainly androgens ("male sex hormones") that cause acne through the stimulation of sebaceous glands. Such hormones can, among other things, increase with stress. Many women with adult acne, on the other hand, have normal levels of androgens. In such cases, the sebaceous glands are often more sensitive to androgens. Lower hormone levels are therefore needed to stimulate the skin's sebum production.
Other factors that may be important in adult acne are genetics, cosmetics, medicines, diet and smoking. Rarely, adult acne is caused by an underlying disease, such as hormonal disorders. Polycystic ovary syndrome (PCOS) is an example of an underlying condition associated with acne. Hormonal examination may be indicated among adult women with acne if several potentially hormone-related complaints are detected, including: male pattern baldness/hair loss, menstrual disorders, infertility, voice changes, etc. Birth control pills should be paused 4-6 weeks before such an examination.
The treatment of adult acne is largely similar to other acne treatment: First, a review of the patient's skin routine is carried out, and it is important to uncover and eliminate any triggering and maintenance factors. Cosmetics and skin products must be "non-comedogenic" and thus not clog pores. This includes sun creams and moisturisers, as well as hair products. As for active treatment, prescription creams/gels are often used, sometimes combined with tablet treatments, as with normal acne. It is important to have long-term maintenance treatment, usually with lubrication, to avoid relapse.
Despite the fact that the vast majority of people experience an effect from such acne treatment, some patients with adult acne will be plagued with fairly treatment-resistant skin problems. In such cases, there is often a significant underlying genetic and/or hormonal component. Treatment with isotretinoin may be appropriate here.
Among women with hormonal acne, there may also be an indication for more hormone-directed treatment, such as birth control pills (with antiandrogenic effect) or spironolactone. Progesterone-only contraception (for example mini-pills, contraceptive sticks and contraceptive injections) should be avoided, as it may be a contributing factor.
Rosacea and perioral dermatitis are common conditions among adults and can resemble adult acne. Rosacea is seen in both sexes. Perioral dermatitis is more common among women. Men can also develop acne-like skin changes in connection with shaving, so-called pseudofolliculitis barbae.
