November 2021 

A common skin condition

Acne is a very common skin condition, so much so that in teenagers it is almost thought of as the norm. The expectation is that acne is simply a rite of passage and that people just “grow out of it”. So, what happens when they don’t? 

Persistent or new onset acne is very much a reality for a lot of adults and has been on the rise for at least the past decade. When training in dermatology over 10 years ago, nearly all my acne patients were teenagers. Nowadays at least half of the patients I see with acne are adults.  

Acne in adults

The reasons for the rise in adult acne are unclear. The inherent causes seem to be much the same as for acne in teenagers; a perfect storm of genetics, hormones, excessive oil production, pore blockage (follicular occlusion), and bacteria causing inflammation. Acne is found predominantly in westernised societies, indicating that our modern ways of life may be contributing. Adult women are more affected than men, and this could in part be due to the ongoing fluctuation in their hormonal profile, whether it be through cyclical changes associated with their menstrual periods, the addition or discontinuation of hormonal contraception, or during the menopause.  

The mental health implications of adult acne

A lot of people who have never experienced acne first-hand might wonder what the big deal is. It’s just spots, right? And yet we know that acne is more than skin deep. There is a higher incidence of mental health issues among acne sufferers, including anxiety, depression, poor self-esteem, and even suicidal ideation.  

While both teenage and adult acne sufferers may be affected by these issues, adults with acne have been found to be at much higher risk of severe depression than their teenage counterparts and face additional challenges. This is in part because their acne is no longer “expected” or “the norm”.  

“I was supposed to grow out of it by now!”, I hear from a lot of my adult patients. They feel upset, embarrassed and frustrated by their condition. This can in turn affect their social and work interactions, their confidence and self-esteem, and their perception of how others view them. Adults are much more prone to social isolation, as they can lack the support network of younger acne sufferers. They will readily turn down invitations or make up excuses not to see friends and relatives if they are having a bad skin day.  

“I look like a teenager!” is what I am often told by my adult patients. They report being mistaken for being younger, and generally feeling as though they are not being taken as seriously in the workplace as their peers with clear skin. They feel that unless they can finally clear their skin, they can’t do this presentation or put themselves up for that promotion. They worry that others are focused on their skin and judging what it looks like while interacting with them. 

Treating adult acne

Adults often blame themselves for their acne persisting, thinking that they must be doing something wrong with their diets or their skincare regime. Not uncommonly, some will have spent thousands of pounds on skincare products and salon treatments with minimal or temporary improvement. There is also a feeling of helplessness and wanting to give up as they are unable to control this aspect of their lives.  

Acne is in fact very treatable at any age and stage of life, with options ranging from topical preparations to oral medication. Medical treatment is important as over the counter skincare is unlikely to be able to fully address this condition. Acne treatment is not only important in addressing the physical aspects of acne, but it can also result in significant improvement in the mood and confidence of affected individuals as their skin clears.  

The psychosocial impact of acne in adults is great and should not be ignored or underestimated. When their acne is finally addressed, the effect on their emotional wellbeing can be transformative. 

If you are worried about adult acne, remember to seek advice from your GP who may be able to refer you on the NHS or a Consultant Dermatologist. Don’t suffer in silence.  

Dr Penelope Pratsou  
Consultant Dermatologist  

Find Dr Pratsou on Instagram here 

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