I’ve struggled with acne in every decade of my life – as a teenager, in my 20s, in my 30s and again, when I turned 40. Shortly after giving birth to my daughter, my acne and “back-ne” returned. I’d already been through the acne circuit – topical antibiotics, ingested antibiotics, light therapy, diet change, drink more water, consumer less or zero dairy – nothing worked. Except for Accutane. Even though I had already used it (twice), it seemed scary. I resigned myself to just having acne until I die and then my usually quiet husband who rarely intervenes said it out loud: “You should just go back on Accutane.”
He was right. I knew it, but I was still hesitant. So I turned to my favorite dermatologist Dr. Erin Moore for a Q&A to share her insight on acne and why we all wrongly believe it’s just a problem for teenagers.
According to Dr. Moore, acne is one of the most common reasons for visiting a dermatologist.
“Every day I see several patients with acne, and many of these are adult women. It’s a myth that only teenagers suffer from acne. About 35% of women will suffer from acne at some point in their adult life, which just isn’t fair – to be fighting acne and wrinkles at the same time!”
It’s so unfair. What’s going on? Is it the environment?
“Why do we (I say we because I am part of the unlucky 35%) get acne as an adult? The theory is that most adult female acne is related to fluctuating hormones. If you think about it, our hormones fluctuate as adults frequently. There are normal monthly fluctuations and then you add fluctuations due to birth control, pregnancy, post pregnancy, pre-menopause and menopause. It’s a wonder that anyone has clear skin!”
So, what can we do?
Fortunately, there are many treatment options for acne. When considering treatments in adult women, it is important to remember that our skin is aging and traditional acne medications may be too harsh.
One category of topical treatment, Retin A, is very good for light acne and is also anti-aging, win-win! With Retin A, I am very careful to prescribe the appropriate strength as it can be drying and irritating. I usually prescribe a low dose and recommend applying a small amount (such as a fingertip) over a moisturizer, starting with application every other night.
Other topical treatments that are commonly used for acne are topical antibiotics and medicated washes (salicylic and glycolic are my favorite for mature skin).
If your acne is cystic (those big deep red ones), scarring or more severe, then we consider oral medications. Oral antibiotics can be used to clear the skin, and then creams are used to keep it clear. Oral antibiotics are not meant to be used long term. If someone needs a longer term treatment, an oral medication called Spironolactone can be very helpful. Spironolactone is a blood pressure medication that is used off-label for acne, it works by blocking the effect of male hormones (women have male hormones too and they are part of the reason we get acne) at the level of the skin. Spironolactone works very well for some women, but it is not a cure – it only works when it is being taken.
Which leads me to our most powerful medication for acne, Isotretinoin (commonly called Accutane). Accutane is our only cure for acne. Most people who complete a course of Accutane are cured of acne. Accutane can be a difficult medication to take due to lab testing and office visits, but it can be life changing for people whose acne is severe, scarring, resistant to other treatment or just persistent for many years. I prescribe Accutane frequently for both teenage and adult patients.
There it is – Accutane. And it’s true. It’s the only thing that I’ve found to combat my acne. After spending weeks reading about the pros and cons online, I completed a 4-month course last year and despite a crazy break out during the first month, super dry skin, bloody noses and frequent doctor appointments, I’m grateful to have done it. With clear skin, I can now focus on having a healthy, gracefully aging appearance.
Want to know more about Dr. Moore? Check out her blog.
Disclaimer: This information is not intended to diagnose or treat medical conditions. It should not replace evaluation from a medical professional.