Late adult acne in females: what can be done?

We all experience acne at certain points in our lives, as we become adults though, it often has different causes than when we are in our teenage years. In 2020, many have been experiencing mild cases of ‘maskne’ — acne caused by face masks. However, for some people, acne will appear regardless and it can be persistent, causing scarring.
 

In this recent article, we spoke with leading consultant dermatologist, Dr Ravi Ratnavel , about how acne affects women, how acne in adult years differs from when we are in our teens, what the main causes are and what treatment can be used.
 

What is late persistent acne in females?

This is a common problem affecting up to 1 in 6 Women and varies in severity. In its mildest form, patients experience a pre-menstrual flare up affecting the chin and jawline in the run up to their period, which is self-resolving but cyclical. Nodules and cysts occur in more severe cases which can lead to severe scarring.
 

Why does it continue into adulthood?

There are hormonal factors and anatomical factors within the skin which predispose some individuals to acne. These are genetically determined.
 

What are some causes of this?

The main drivers are hormonal (particularly progesterone) either endogenous (from within) or from contraceptives including pills, implants and hormone based coils.

Oil-based make ups and over-zealous exfoliative cleansing regimes are secondary factors of importance.

A minority of women will have polcystic ovarian syndrome (PCOS) with symptoms of irregular periods, unwanted hair (hirsutism) and acne, characteristics which overlap with what may be considered normal physiology.

The condition can of course be an extension of teenage acne in young women, sometimes temporarily helped by the combined contraceptive pill.
 

How is it different to adolescent acne?

The variation in severity tends to be the same, but older women suffer more nodules and papules (blind spots) than comedones (blackheads) and pustules seen in teenagers.

There may be a clearer association with stress and periods owing to underlying hormone changes.
 

What treatments or therapies are available to stop this?

In addition to combination retinoid / salicylic acid based products, many patients benefit from oral Isotretinoin, which is also used to treat scarring teenage acne. This is a drug which requires careful supervision and is licensed for prescription only by qualified dermatologists worldwide.

There are other hormonal and non-hormonal options which may be suitable in some circumstances, but require careful clinical assessment.
 

In order to treat persistent acne, it is recommended to consult with a leading dermatologist who will be able to help determine the root cause and offer appropriate treatment. Visit Dr Ravi Ratnavel’s Top Doctors profile today for information on appointment availability.