Identifying Adult-Onset Acne

Adult-onset acne is a type of acne that turns up after the age of 18 —
somewhat later than the typical teenage variety of acne. It can crop
up during a woman’s 20s, 30s, or even later in life. Adult-onset acne,
sometimes referred to as female adult acne or post-adolescent acne,
is overwhelmingly a condition of females.
The fluctuating nature of adult-onset acne tends to make the influ-
ence of hormones more obvious than with the typical case of
teenage acne vulgaris (see Chapter 4); however, teenage girls often
begin to note those premenstrual pimply “ups” and “downs” as
they approach adulthood. As many woman are aware, the lesions
have a propensity to come and go more readily than they do with
teenage acne, and their appearance and disappearance is often
linked to their menstrual cycle (see the “Acne and your menstrual
cycle” section, later in the chapter).
Describing the symptoms
The appearance of post-adolescent acne differs from that of teenage
acne:
 Blackheads and whiteheads (comedones) are less commonly
seen.
 Breakouts are usually mild to moderate.
 Significant scarring is unusual (but the term “significant” is a
relative and in the in eyes of the person who has acne, it can
be very significant).
 Lesions more often appear on the lower cheek, the chin, and
along and below the jaw line. Although some women may
have breakouts on the chest and back, most have blemishes
exclusively on the face.
Breakouts are usually limited to inflammatory papules (pimples,
bumps, zits), pustules, and small inflammatory nodules. (Check
out the color section of this book for the typical appearance of
adult-onset acne.) The papules and pustules can be superficial or
deep. Many women describe certain papules as “deep ones,” the
ones that feel like they come from under the skin. (If you get ’em,
you know what I mean.) The deep ones are often more palpable
(you’re able to feel, or palpate them) than visible. They represent
papules and pustules that haven’t reached, and may never reach,
the surface of the skin.
When these deep lesions grow even larger, they’re called nodules
(or cysts). Nodules are tender, firm lumps that may hang around for
weeks or months. They may grow to an inch or more in diameter
and can leave scars after they heal. Fortunately, nodules and sub-
sequent scarring are infrequently seen in women who have adult-
onset acne. (In Chapter 3, you can find out more about nodules. In
Chapter 16, I discuss scarring.)
The diagnosis of adult-onset acne isn’t always clear-cut. Your
healthcare provider may easily confuse adult-onset acne with
other acnelike disorders:
 Rosacea: Symptoms of rosacea include facial lesions that
consist of acnelike red papules and pustules. Moreover, both
rosacea and acne can appear together. (I talk about how to
distinguish between the two in Chapter 18.)
ditions involve hair follicles, and can sometimes be acne
look-alikes. (I cover these acne impostors in Chapter 19.)
 Endocrinopathy: Sometimes what appears to be a simple
case of acne vulgaris or adult-onset acne can be due to an
underlying hormonal abnormality, called endocrinopathy
(pronounced en-de-krin-op-ath-ee). At times like this, acne
may be difficult to get under control, and other measures
such as blood tests to look for higher or lower than normal
hormone levels should be evaluated by your doctor. (I discuss
this relatively infrequent but serious situation in Chapter 20.)
Taking an emotional toll
Having acne can be just as trying for adults as it is for teens. Job
hunting, social events, and dating can be negatively impacted by a
few pimples. Even mild acne that might seem insignificant to an
outsider can force some people to miss out on opportunities and
relationships that otherwise they might have explored. I offer
some advice for managing the psychological burdens of acne in
Chapter 17. Whether you have rather mild or severe acne, effec-
tive treatments are available, and your condition can improve.
Look at the sidebars in this chapter for stories about patients with
varying degrees of acne. The patients discussed may have the
same type of acne you have.