Dermatologist probes why acne in adults becoming more commonly recognized
Dr. Bhandarkar says patients may need to try a few acne treatments before they find one that works. (Photo by Duane Stork)
It’s yet another dermatology visit for Latasha.
She has been to four other dermatologists and talks about how her face has been clear all her life, and now in her 40s — when her children are teenagers — she is the one getting acne!
Her previous dermatologists prescribed different creams, gels and a few courses of antibiotics, but she feels like nothing makes a difference. Latasha, whose name I’ve changed to protect her privacy, gets tearful when she tells me, “I feel so embarrassed about my skin, I don’t feel like going to work or meeting people.”
Acne, often categorized as a teenage problem, is increasingly being recognized as a disease that affects adults. Adult onset acne affects 12 percent of men and 26 percent of women in their 40s, according to a study published in the Journal of the American Academy of Dermatology. Patients with adult onset acne can have varying degrees of severity, and many have moderate to severe acne that can lead to scarring.
The causes of adult acne include overproduction of oil from enlarged oil glands, blockage of hair follicles with oil or growth of bacteria in hair follicles. Hormones can exacerbate the intensity, corresponding to menstrual cycles or flares with progestin-only contraceptive pills. Outbreaks also can be attributed to stress, medications like corticosteroids and a genetic predisposition.
In my practice, I pursue an open discussion with my patients about long-term treatment, compliance and expectation management. Acne regimens are time-consuming, and benefits of treatment are not immediate. Patients who get better are those who are committed to taking medications as prescribed.
Acne regimens differ based on severity of acne. I typically treat mild acne with a combination of topical creams and face washes, moderate acne with a combination of oral antibiotics and topical products, and severe acne with antibiotics or isotretinoin (popularly known as Accutane). Unfortunately, my patients sometimes must try a few regimens before finding the one that works best, which can prove frustrating and expensive for them.
Americans spend more than $2 billion a year on acne care, including doctor visits, prescriptions and over-the-counter treatments, according to research by the American Academy of Dermatology and Society for Investigative Dermatology.
Approximate costs without insurance may range from $100 to $150 for an exam and $150 to $200 for each prescription. Insurance coverage varies so check with your provider.
Dermatologists use various quality of life tools to assess the impact of acne and to help patients decide how aggressive to be with treatments. Acne focus groups report feelings of anger, sadness and frustration in patients, so assessing a patient’s perception becomes an important part of treatment.
Latasha’s face has cleared up after being on spironolactone, a form of hormonal treatment. After three visits over six months, she’s more confident, and feels she has her life back. She will be tapered off spironolactone eventually, but may need to continue some form of topical treatment for several years.
Of course, she wishes she had been offered that treatment to begin with so she wouldn’t have had to struggle for so long. My answer to that: “If only acne were that simple!”
About the author: Dr. Sulochana Bhandarkar is a board-certified dermatologist at highly rated Emory Clinic Dermatology in Atlanta and an assistant professor of dermatology at Emory University School of Medicine. She is a member of the American Academy of Dermatology and the Society for Investigative Dermatology.