Acne in the over 40s

People often think acne only affects teenagers, but it’s all too common in the over 40s too.

AcneThe good thing is that it can be treated, whether it suddenly arrives out of the blue, or it’s been with us since our over-hormonal teenage years.

It’s got to be treated very carefully, and consistently. If it isn’t, it can leave scars, and make its sufferers feel socially awkward, distressed or withdrawn. In my experiences of dealing with suffers of late-onset acne (aged 25 years and over), I believe it’s on the increase.

The British Journal of Dermatology confirms this.

Why do women over 40 get acne?
It’s common in older women. A study of 2895 women aged 10-70 found that 12% of women aged 41-50, 26% aged 31-40 and 45% aged 21-30 had acne. Another study showed that over a quarter (26%) of women in their 40s and 15% over the age of 50 had acne too.

Some have persistent acne (which some specialists class as a chronic disease). Others get late-onset acne for no obvious reason, but it could be caused by an excess of androgens (which can happen when female ovaries make too much testosterone).

Here’s an account from one of my patients, aged 46.
Acne Photo Article“My friends have frequently heard how you sorted my acne for good, after years of being on and off antibiotics. In fact my beauty therapist thinks my skin is great (high praise).

Acne is misunderstood. My friends said that it didn’t look that bad, it was just the flare ups. But they were sore, made me feel unclean and when new ones broke out the old ones went red too. And with every flare up I got more elsewhere or it felt like it.

For me the diagnosis was a relief, I have a great doctor but had been told I had various skin infections then when I stopped antibiotics, they were back. If my beauty therapist hadn’t said enough was enough and referred me, I’d probably still be struggling.”

Diagnosis
The key to effective treatment is the diagnosis. There are several facial conditions that can be mistaken for acne, so sometimes it gets the wrong treatment.

Some patients report that their condition hasn’t been taken seriously; they’ve been told that “it’s only spots” or that it will go away by itself. Often it won’t. Until recently, we as dermatologists used to think of acne as an acute condition. Now, a greater understanding leads us to think of some patients as having a chronic condition that’s likely to continue for years, so it needs long term treatment.

Effective Treatment
Treatment for acne can be topical with creams, gels or solutions applied to the acne itself. Antibiotics can work on long term problems.

Isotretinoin / Roaccutane
This extremely effective drug has been prescribed to millions of acne patients worldwide, over the past 30 years. But there are worries about possible side effects, although these are usually mild.

Newspapers have reported possible depression or suicidal thoughts. However, the current research and evidence can’t prove one way or the other if these are absolutely related to Isotretinoin, or whether they are a result of the acne.

Most patients find that their mood actually lifts when they start this drug as they know that finally their condition is going to be sorted out. Some patients don’t get any side effects at all, at certain dosages. I have recommended it to a member of my own family.

There’s more information here in an article I wrote for Daily Telegraph.

http://www.telegraph.co.uk/health/wellbeing/7955862/Telegraph-readers-clinic-acne.html

Other (perhaps not as effective) treatments
I would like to see more clinical evidence from well designed trials on the effectiveness of laser treatment and chemical peels. Although in individual cases, these treatments might help, because of the lack of persuasive clinical data, I don’t recommend these treatments to my patients for now.

The British Association of Dermatologists’ guidelines (draft) for the management of acne vulgaris 2013 states, “Due to the lack of sufficient evidence, it is currently not possible to make a recommendation for or against treatment with … laser”.

There is no mention of chemical peels.(6)

When to get help
When your condition hasn’t improved of its own accord or with over the counter remedies, check with your GP. If you are getting scarring you might need further treatment. If your acne is still bothering you beyond teenage years or has become an issue later in your life, ask your doctor for help.

What you can do
Your GP can help. There are effective treatments that can be tailored to your grade of acne and your personal medical history and circumstances. You might be referred to a dermatologist.

Acne and roaccutane

 

More information here on Roaccutane:

 

 

 

References
(1) Gollnick HP, et al. Can we define acne as a chronic disease? If so, how and when? Am J Clin Dermatol. 2008;9(5):279-84.
(2) Goulden V, Clark SM, Cunliffe WJ. Post-adolescent acne: a review of clinical features. British Journal of Dermatology 1997; 136: 66–70.
(3) Perkins AC et al. Acne vulgaris in women: prevalence across the life span. J Womens Health (Larchmt) 2012; 21: 223-30
(4) Collier CN et al. The Prevalence of Acne in Adults 20 Years and Older. J Am Acad Dermatol 2008; 58: 56-59.
(5) Rademaker M. Isotretinoin: dose,duration and relapse. What does 30 years of usage tell us? Australasian J Dermatol 2013; 54: 157-162.
(6) Ormerod AD et al. Britsh Association of Dermatologists Guidelines (draft) for the management of acne vulgaris 2013

Dr Sandeep Varma

About Dr Sandeep Varma

I am a Consultant Dermatologist and Dermatological Surgeon working for 11 years in Nottingham. As such I see all skin problems but I specialise in the early detection and treatment of skin cancer and in the diagnosis and management of Acne and Rosacea. My website provides more details.