Until I turned 25, I thought acne was a problem for teenagers, and even then not for everyone. Once I had to be convinced of the opposite.
Two years ago, I first had a rash on my face. I started looking for information about acne in adults and learned that there is age-related acne.
See a doctor
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What is age-related acne?
Acne is a disease that manifests itself as inflammation of the skin. They appear as blackheads, discolored or red bumps with or without pus. Red sores on the skin are also called acne, although this is not a medical term.
Most often, inflammation occurs on the face, neck, chest, or back. Acne is considered age-related and occurs in people over 25 years of age. It can occur both at your 40s or 50s.
There is no exact criterion for how many comedones or acne must be on the skin to diagnose the disease. The onset of the disease is considered to be the appearance on the skin of colorless bumps, blackheads or pimples that do not go away on their own or take longer than usual.
The mechanism of acne formation
Normally, the secretion secreted by the pores comes out through their mouth to the surface of the skin, moisturizes it and prevents it from drying out. With acne, this process is disrupted. A favorable environment is created for bacteria that feed on them. If the pore is closed by skin particles, the secret accumulates, and bacteria begin to multiply, which leads to the formation of inflammatory elements.
Several processes occur simultaneously in the skin, due to which acne is formed:
- The skin produces more secretion than usual;
- Dead skin particles close the pores;
- The bacteria that feed on the secretion begin to multiply;
- An inflammation reaction is triggered;
- With an oily skin type, more secretion is secreted than with others. Therefore, people with this skin type are prone to acne.
Types of acne inflammation
Acne is accompanied by different types of elements on the skin. They are usually divided into non-inflammatory and inflammatory. The former include open and closed comedones: colorless bumps on the skin or blackheads. The second are red pimples: papules, pustules and nodes.
Closed comedones appear as discolored bumps on the skin. They may not be visible to the eye, but they will be felt to the touch. These comedones are formed when the mouth of a pore is blocked by skin cells.
Open comedones are those whose mouth is visible on the surface. Their top is oxidized by air and contains the skin pigment melanin, which is why such comedones are also called blackheads.
Papules are small, red inflammations with no visible pus. When there are many of them, the skin looks uneven, like a grater with small holes.
A pustule is a red inflammation with a visible white or yellow head on the skin.
Nodules and cysts are inflammations that occur in the deep layers of the skin. They mature slowly and painfully pass, and then scars may remain.
Usually, the type of an element indicates the stage of its development. First, a microcomedone is formed – a small comedone that is not noticeable on the skin. It then grows into a closed or open comedone, which develops into a papule, pustule, or nodule. However, this is not always the case. Some papules, pustules and nodes are formed immediately from the invisible microcomedone.
In adolescents, acne usually manifests itself as comedones in the T-zone: on the forehead, wings of the nose and chin. In adults, acne is more often located on the cheekbones and chin. In this case, inflammatory elements predominate, but there is also a comedonal form of acne, like in adolescents. Adolescent acne is more common in men, while age-related acne is more common in women.
Inflammation can also occur with other skin conditions, such as rosacea. Only a doctor can distinguish one from the other and make the correct diagnosis. Usually, an examination is sufficient for this, but if the specialist suspects other accompanying problems, he or she may send you for tests. Or you may be advised to contact other specialists – an endocrinologist or a gynecologist.
Rashes that are not acne
Milia are small cysts that lie under the skin and are made of keratin. Milia most often form in the area around the eyes. They are similar to closed comedones.
Sebaceous filaments are the channels through which the secretion of the skin passes. We don’t normally see them, but when the skin begins to produce more secretion than usual, the pores can become wider and the sebaceous threads darker. Because of this, they become like black dots. The main difference between sebaceous threads is that they do not form a cork; they are also smaller and lighter than black dots.
What causes acne?
The appearance of acne depends simultaneously on different reasons.
Endogenous causes. One of the main ones is changes in the work of hormones or receptors in the skin to which they attach. When the level of male sex hormones in the skin rises or the sebaceous glands become more sensitive to them, the sebaceous glands begin to produce more secretion, which increases the risk of acne. At the same time, the levels of sex hormones in the blood in most cases remain within the normal range and dermatologists rarely recommend that patients with acne have them checked.
The functioning of skin cells and tissues also depends on genetics. If a parent or sibling has had acne, the risk is higher.
Exogenous causes. Stress, diet, smoking, inappropriate skin care are factors that can worsen the course of the disease.
There is a widespread myth that acne appears only due to problems with the stomach, intestines or other organ and the reason is always inside. This misconception has arisen due to the fact that systemic antibiotics are often prescribed to treat diseases of the internal organs, which also lead to skin improvement in people with acne.
Studies show that problems with the gastrointestinal tract are indeed more common in people with dysfunction of the sebaceous glands, but a causal relationship between them has not yet been established. Now the so-called acne maps are widespread on the Internet, which indicates the connection between the location of the rashes and the problems of specific organs. However, the presence of inflammation in certain areas on the face has nothing to do with the work of internal organs. There is no reliable evidence that the intestines are responsible for the forehead, and the pelvic organs are responsible for the chin.
Acne stages
There is no single system for determining the stage of acne, so the disease is conditionally divided into three: mild, moderate and severe. In the mild stage, there are papules and pustules, but large and painful nodules are absent. With a moderate degree, the patient has many papules and pustules and several nodes. Signs of severe degree are many papules and pustules, as well as a large number of nodes.
What happens if acne is not treated?
Acne can both worsen and remain at one stage for a long time, but the likelihood of progression is still high. The disease affects a person’s mood and psychological comfort. People with acne have a higher risk of clinical depression, suicidal thoughts, and anxiety. The longer the acne is left untreated, the more likely it is for emotional stress and self-esteem problems.
Delaying acne treatment increases the risk of scarring at the site of the nodes over time. Scars form when inflammation penetrates into the deep layers of the skin and damages them. When the inflammation subsides, the skin cells try to rebuild the tissue with collagen protein. If too much or too little collagen is produced, a scar will be visible at the site of the pimple.
Pigmentation in the case of acne is red or brown spots that remain at the site of the pustule or nodule after they pass. According to surveys of acne patients, pigmentation can even bother a person more than acne itself, as it is noticeable on the skin and takes a long time. Acne spots can last for a year or several years.
The amount and visibility of pigmentation and scarring depends on how the person deals with acne. If you try to squeeze out the pus with your hands, then the spots take longer, and the risk of scar formation increases. Leaving the skin alone and leaving the inflammation untouched will result in less pigmentation and a lower risk of scarring.
For several years I had only a comedonal form, which did not cause severe inconvenience. Over time, comedones began to become inflamed, papules, pustules and nodules appeared on the skin more and more often. During my visit to the doctor, I was diagnosed with moderate acne.
How I realized that I needed to see a doctor
My acne developed slowly. Two years ago, closed comedones began to appear on the cheeks. Sometimes they became inflamed, but this did not bring much discomfort. Gradually, comedones and inflammations increased.
I have tried various beauty products in the hope of managing acne on my own. When I realized that nothing was helping, and the skin looked worse and worse, I decided to consult a specialist.
Acne diagnostics
During the consultation, the doctor washed off my makeup and examined my clean skin, asked questions about medications and dietary supplements that I was taking, and asked to see the products I use. Before going to the doctor, I advise you to take pictures of the jars with your cosmetics and their composition, so as not to carry everything with you.
My answers to questions and an examination by the doctor were enough to diagnose age-related acne. I didn’t have to take anything extra, because nothing bothered me at that moment, apart from skin problems. The doctor commented on the care: she advised what it is better to refuse, and what, on the contrary, should be added.
The dermatologist also asked if I had problems with reproductive health. At the time of the consultation, everything was fine, but then for two months in a row I had a strong delay in menstruation, and my face turned into a minefield. I knew that hormone problems could be the cause of acne. Just in case, I made an appointment with a gynecologist. An appointment with my doctor costs $200.
The gynecologist performed an ultrasound scan, made sure that there was no polycystic ovary syndrome, which could be the cause of acne, and said that hormone tests were not needed in my case. After that, I had no delays, the periods returned to normal. Perhaps there was just a lot of stress due to the pandemic. Inflammation on the face also diminished slightly but did not stop completely. In addition, many red spots remained.
How much does acne treatment cost: personal experience
Acne is a chronic condition. Even after effective treatment, the flare-up may return. Therefore, in remission, you need to continue to care for your skin and follow your lifestyle. At the last appointment, the doctor noted a positive trend. I was offered to do one more cleaning and complete the treatment if everything goes according to plan.
I spent about $3,000 on acne treatment. The amount is impressive. I even had to take payday loans online in Georgia 3 times to undergo the recommended procedures at a clinic. I will mention them below. Payday loans can really be the only way out when you need money for treatment urgently. I always repay such loans in a few weeks as payday loans are short-term ad small-dollar (amounts usually do not exceed $1,000). I recommend that you apply online as this saves time and effort significantly. Lenders typically transfer funds to the borrower’s bank account as soon as the same day.
How to treat acne at home
During the consultation, the doctor recommended adding products with acids, benzoyl peroxide and retinoids to the treatment to exfoliate the skin, destroy bacteria that lead to inflammation, and accelerate the maturation of closed comedones. All this is needed in order to quickly get rid of those comedones that are already there, and prevent the appearance of new ones.
I was also advised to get a facial cleaning, but I decided that I would try to deal with home care first. Here’s what I used.
Moisturizing toner. I didn’t pay for the consultation, but I bought CLINIQUE’s Acne Solution Clarifying Lotion in the salon. It cost $30. I was lucky: The lotion moisturizes, soothes the skin and gives a subtle glow. I used it after every wash. It lasted for about four months. Then I bought another toner – Kiehl’s Ultra Facial Oil-Free Toner for $50. It is a little less pleasant to use and does not give the skin shine, but moisturizes well.
Benzoyl peroxide 2.5%. It kills bacteria that are involved in the formation of inflammation. It is sold in pharmacies in the form of a cream. It cost about $20. I applied the cream pointwise to the inflammation in the morning after the lotion.
Topical retinoids. The dermatologist advised me to apply Differin Gel on the skin 2-3 times a week, which is sold in a pharmacy and costs about $45. It contains adapalene – one of the types of retinoids that are recommended for the treatment of acne. Retinoids reduce the production of skin secretions and accelerate the maturation and resolution of closed comedones. After 2-4 weeks of use, inflammation on the face may increase. So it was with me. I have no photographs of that period because I did not want to take them at all. As well as looking in the mirror.
Retinol palmitate. At the second consultation, the dermatologist also recommended usng an oil solution of retinol palmitate orally for 3 months. Studies have shown that 300,000 IU daily is the best result for acne. I was prescribed a dose of 200,000 IU. This is quite a lot, especially if a person has any medical conditions, so taking such drugs should be discussed with a doctor. I buy retinol palmitate in 10 ml vials for $5 per unit. One vial is enough for me for about 5 days. During the entire treatment period, I bought about 10 bottles and spent $50.
Salicylic acid. The doctor also recommended adding salicylic acid products to the treatment to exfoliate the skin. I purchased was Bioclear Face Lotion – a lotion with salicylic, mandelic and azelaic acids. I loved that it exfoliates skin well, brightens blemishes and gives skin a glow. I apply it on days when I do not use retinol, in the morning or in the evening after washing my face. It costs $40 for 200 ml.
Foam for washing. At the second appointment, I asked the doctor to choose a cleanser that can speed up the recovery. Before that, I had a neutral gel with no active ingredients. I was advised to use a foam with acids Clean & Clear Advantage 3-in-1 Foaming Acne Wash with Salicylic Acid for better skin cleansing. It cost $55. I left the gel for the morning wash and the foam for the evening.
Sun protection. I also used sunscreen before the consultation, but this is especially important when treating acne. Retinoids make the skin more sensitive to sunlight, so a protective cream should be applied 10-15 minutes before going outside. It costs about $40.
Moisturizing cream. I have a regular Don’t Touch My Moisturizer cream. A 50 ml package costs $25. For acne-prone skin, it is better to choose creams that are designed for combination or oily skin. They are less likely to provoke comedones. However, there can be an individual reaction to the cream, therefore, in the first days of use, you need to watch how the skin reacts.
In total, acne home care cost me about $300.
What my home skin care looks like
| Daily in the morning | In the evening on days when I use retinoids, 2-3 times a week | In the evening on days when I use salicylic acid lotion | In the evening on days when no active ingredients are used |
| Soft gel for cleansing the skin | Micellar water for makeup remover | Micellar water for makeup remover | Micellar water for makeup remover |
| Salicylic Acid Lotion (on retinoid-free days) | Cleansing Foam | Cleansing Foam | Cleansing Foam |
| Tonic (as soon as the lotion is absorbed) | Lotion | Salicylic Acid Lotion | Lotion |
| Duac Topical Gel for spot inflammation | Retinoid serum | Tonic | Moisturizer |
| After 30 minutes – regular cream or sunscreen, depending on whether I go outside | Moisturizer |
What procedures did I undergo to treat acne?
Cleaning and peeling. The doctor advised doing a professional cleaning to remove closed comedones. During cleaning, the beautician squeezes them out and pierces the inflammatory elements so that they heal faster. If you do it yourself or with an incompetent doctor, you may have scars on the skin. Before piercing, a good beautician shows the client that the package with the needle is new and then opens it.
I only went to cleanse in the summer when I had a lot of inflammation due to topical retinoids. In addition to cleansing, I had an acid peel to remove dead cells from my skin. They are one of the reasons for the formation of comedones because peeling skin scales clog the pores.
Light therapy. The bonus to cleaning was LED light therapy. You lie in a dark room for about 15-20 minutes with a lamp above your face. Blue light kills bacteria that lead to inflammation. In total, I paid about $500 for cleaning, peeling and light therapy.
Phototherapy. The dermatologist suggested that I come for phototherapy on a Broad Band Light device. During this procedure, the beautician tightly brings a device to the skin, which acts on it with the help of light. Feelings are not pleasant, but you can be patient. Feels like a hot impulse penetrates the skin. This type of therapy has shown good results in studies: when it was done every three weeks, inflammation was reduced by 70%.
The doctor invited me to be a model since the clinic was just opening, and made a good discount. I paid $300 although the total cost was $600. I liked that the result is visible immediately after the procedure. Three weeks later, I went for a second procedure.
In total, the hardware treatment cost me $1,800.
How I changed my lifestyle to treat acne
The link between diet and acne is controversial. There are studies that suggest that milk and a diet rich in foods with a high glycemic index can trigger breakouts. These products include all sweets, rice, pasta, white bread, potatoes.
I refused milk a year ago for other reasons. I buy oatmeal instead. It is more expensive, but if there is a discount, it costs like regular milk, and then I buy more.
In the office, my colleagues and I often bought sweets and fast food. When the period of self-isolation began, I continued to do this, ordering food home, but I got tired after a couple of months. I saw that my skin was getting worse and decided to try changing my diet. Instead of sweets, I chose fruits, added a lot of cereals and vegetables.
It’s hard to say how much this affected the skin because I did a lot of other things. But I noticed one thing for sure: after a couple of months of the new diet, the nails stopped breaking, and the hair became denser. I realized that nutrition is important for the condition of the skin, when I lived with friends for a week and we ate a lot of sweets. Against this background, I have more new inflammations. I do not find any other reason for them.
Before, I could take a clean body towel and wipe my face with it. I don’t do that now. For my face, I have separate soft towels with which I blot the skin, but do not rub it. A new day – a new towel.
How else is acne treated?
Topical drugs. The main treatments for acne are retinoids and benzoyl peroxide. In addition, the doctor can prescribe topical antibiotics.
Using antibiotics alone to treat acne is not recommended as the bacteria get used to them. If a person does not tolerate retinoids, then agents with salicylic, glycolic or azelaic acid may be suitable for treatment.
Azelaic acid is often recommended for the treatment of pigmentation that forms at the site of inflammatory elements.
Systemic drugs. For severe acne, your doctor will likely prescribe systemic retinoids. They dry the skin a lot and often lead to flaking, so the doctor will advise you to additionally moisturize it with topical agents.
Before starting and during the course of treatment with systemic retinoids, the patient is advised to monitor the health of the liver, since high doses of vitamin A negatively affect this organ. They are usually prescribed to take a functional liver test, as well as determine the level of cholesterol and triglycerides.
Retinoids negatively affect the formation of the fetus, therefore, they are prohibited from taking during pregnancy, and patients are advised to use reliable methods of contraception during the course of treatment.
If there is no improvement with topical therapy, your doctor may prescribe systemic antibiotics along with topical retinoids and benzoyl peroxide to reduce the likelihood of bacteria becoming habituated. The usual time to take systemic antibiotics for acne is three months.
Antiandrogens. Acne in women is associated with a malfunction of the male sex hormones androgens, so antiandrogens are sometimes used to treat the disease. These are drugs that suppress the work of male sex hormones. These include combined oral contraceptives, spironolactone, cyproterone acetate.
A doctor may prescribe antiandrogens if the acne is resistant to topical therapy and the person has other symptoms that show hormone imbalance. In men, these drugs are not used because they cause unwanted side effects.
How long does it take to treat acne?
In the first weeks of treatment, acne gets worse as comedones begin to mature and more papules, pustules and nodules form. Worsening indicates that the prescribed therapy is working. As a rule, improvement from the prescribed therapy can be noticed after 4-6 weeks. To completely get rid of inflammation, you have to be patient: treatment can take 2-3 months or more.
If no improvement occurs for more than a month, most likely the chosen treatment strategy is not suitable. In this case, the doctor may change the course of treatment and prescribe systemic retinoids or antibiotics. You should bear in mind that the improvement from the use of oral contraceptives will be noticeable only after 2-3 months.
After treatment of the disease and going into remission, a person may have post-acne, which is characterized by pigmentation and scars.
Things to remember
- Acne is easily confused with other skin conditions. It is important to find a competent doctor who will prescribe the necessary treatment and will not aggravate the problem;
- Facial products that help to cope with acne: topical retinoids, products with salicylic and azelaic acids, benzoyl peroxide, antibiotics;
- If you decide to use retinoids, don’t forget about sunscreen;
- It is better to approach the treatment in a comprehensive manner – change skin care and pay attention to the lifestyle in general.