There some distinct differences between adolescent acne and adult acne. For adult acne, more women are susceptible to it while for adolescent acne, males are affected more frequently. Adult acne usually occurs as inflammatory lesions, especially papules, pustules, and nodules, and they usually appear around the chin, jawline, and neck. There might be comedones, although it is rare, in the form of closed comedones, retentional lesions, or microcysts around the lower face. Cystic acne has been found in up to 12% of adults, even though adult acne is usually mild-to-moderate in severity.

1. Hormonal considerationsWomen who have acne frequently have effects of hyperandrogenism like hirsutism, premenstrual flare, and alopecia. However, in tests, very few of them have any indication of hyperandrogenism.

• Menstrual cycle

For females with adult acne, there is proof that the acne flares premenstrually because of the hormonal changes. However, it varies with the individual and only 44% of women have breakouts before their periods. Furthermore, older women have a higher tendency of have the flares than those who are 33 years or younger. Another study finds that 83% of women with persistent acne have premenstrual flares.

• Androgens

There might be a relation between target tissue androgens in the skin and adult acne. Androgens are produced in the sebaceous glands and keratinocytes, which produces keratin. Serum androgens may also grow the tissue-driven androgens in women with acne.

2. Endocrinopathies and genetic factors

• Late-onset congenital adrenal hyperplasia

It is found that adult acne and late-onset congenital adrenal hyperplasia (CAH) are related. A study shows that 11.8% of the patients with acne past adolescence have less of the enzyme 2-hydroxylase.

• Polycystic ovarian syndrome

The symptoms of the polycystic ovary syndrome (PCOS) was found in 52-82% of patients who have adult acne. However, the hormonal states were not the same as it would be in classical PCOS.

• Genetics

Studies on how family genetics affect the probability of having adult acne show that genetics do play a part in the presence of adult acne. A study on identical twins show that if one has acne, there is a 97.9% chance that the other would have acne as well. Not only the presence of acne is affected, the development, persistence and response to treatment is affected as well.

3. External factors

• Drug-induced acne – Some medicine, like prednisolone, lithium, anabolic steroids, and phenytoin can possibly cause acne
• Exposure to ultraviolet light – Ultraviolet radiation can cause inflammation and generate a substance called squalene peroxide significantly causes acne to appear. This is also why there is a persistence of acne in tropical countries, adding on to the uncontrollable perspiring and increased humidity.
• Climate – Cooler climates improve acne while hot tropical climates aggravates acne
• Obesity and food intake – It is likely that increased low-density lipoprotein (LDL) cholesterol is related to acne. This might be because metabolic syndromes with higher serum levels of insulin-like growth factor (IGF) are also related to acne lesions.
• Smoking – Smoking might contribute to how severe acne may be, the more cigarettes you take, the more acne will show up on your face. It typically appears scattered around the whole face, avoiding the lower part of the face and jawline.
• Cosmetics – Makeup has shown to aggravate acne for some women. However, some have seen no clear link between the two. A possible explanation is using oil or greasy products that can clog up the skin.
• Stress – Chronic stress has been related to adult acne. It is thought that it is because of the increased androgen secretion in females. Studies have found that acne and stress is linked in up to 71% of patients.
• Pregnancy – Different pregnant women have different outcomes for acne. 18% of them found a flare during pregnancy, 43% found an improvement, and 39% of them felt no effect.

There will be acne scarring, and the longer the duration of acne, the more scars will appear, and psychological diseases will emerge as well. With both acne and scarring, there is a higher chance that you will have psychological problems relating to your acne and scars. With therapy, if you start early with adult acne, can improve acne in the majority of patients and can prevent very bad scarring.

Although the methods for treating adult acne are very similar to treating adolescent acne, there are a few differences that need to be noted. Treatments need to be specific to each individual patient to suit their personal needs and lifestyle.

1. Oral Medication for Adult Acne

Oral medication kills bacteria that cause acne, reduces inflammation and prevents breakouts from occuring. Retinoids decreases inflammation and regulate the generation and loss of skin cells. Discuss with our doctor on which oral acne medications would treat effectively. Here is the list of oral medication available:

• Erythromycin kills bacteria that causes acne to prevent new breakouts. It increases sun sensitivity, so I suggest to avoid sunlight exposure or to put on protective clothing if you would be exposed to the sun for a while. A few side effects are diarrhea, vomiting, reduce in appetite, and stomach upset.
• Tetracycline treats acne by decreasing inflammation and killing acne-causing bacteria. More common side effects includes nausea, diarrhea, vomiting, and stomach pain.
• Doxycycline (a derivative of tetracycline) slows down growth of acne-causing bacteria. It also increases sensitivity to sunlight, hence, do avoid sun and artificial ultraviolet rays exposure during your course of medication. This medication might reduce the effectiveness of birth control pills, so use an alternative birth control during your treatment.
• Minocycline reduces inflammation/swelling, tenderness and redness of pimple, aw well as removes bacteria. Studies have shown that this antibiotic removes bacteria more effectively than other acne medication.
• Clindamycin curbs the production of bacterial proteins, leading to fewer acne-causing bacteria.If you have a history of ulcerative colitis or gastroenteritis, I advise you to avoid using clindamycin orally. Some common side effects of clindamycin are rash, peeling skin, itching, vomiting, constipation, abdominal pain, nausea, diarrhea and inflammation of the esophagus.
• Bactrim (containing trimethoprim and sulfamethoxazole) treats different types of bacterial infections. Please avoid this pill if you are allergic to these contents. Bactrim will cause side effects such as swollen tongue, joint pain, dizziness, insomnia and ringing in the ears.
• Ortho Tri-Cyclen helps to balance the hormones, preventing the sebaceous glands from generating too much oil that leads to breakouts. Oil clogs the pores and heightens the risk of acne. Females over the age of 35 should avoid taking this drug as there might be the risk of blood clots.
• Ortho-Cyclen (containing ethinyl estradiol and norgestimate) are prescribed to treat severe acne. You are not encouraged to take this if you have abnormal vaginal bleeding, history of circulation problems, breast or uterine cancer, liver disease, liver cancer,  severe migraines, or a history of blood clots.
• Isotretinoin are prescribed to treat nodular acne that leads to serious disfigurement. Females who take this must use a reliable contraceptive method during treatment.Isotretinoin causes birth defects in humans. This medication helps  sebaceous glands to mature, reducing the amount of oil produced.
• Tretinoin keeps the pores clean to avoid the inflammation that encourages acne growth. This drug replaces older skin with new skin. Tretinoin might cause negative effects such as mood changes, hair loss, headache, belching, indigestion, itching, bloating, anxiety, nausea, weakness, vomiting, blurred vision, and difficulty sleeping.

2. Topical Treatment for Adult Acne

Topical Anti-bacterials are commonly prescribed by doctors for to treat mild to moderate acne. A few effective anti-bacterials are benzyl peroxide, clindamycin and erythromycin. Besides anti-bacterials, Retinoids (derived from Vitamin A) are also effective for acne treatment. Topical anti-bacterials and retinoids acne treatments usually last for six weeks’, depending on the progress of individual.

Advantages of Topical Treatment for Adult Acne:

• Antiseptics to decrease the bacteria on the skin to reduce acne.
• Remove excess oil from the skin to prevent clogging of pores.
• Anti-inflammatory effect that helps to clear whiteheads and blackhead.
• Topical retinoids removes dead skin cells and prevent them from growing in your hair follicles.
• Retinoids have anti-wrinkle contents that trigger collagen production to provide a smoother skin for chronic acne sufferers.

Disdvantages of Topical Treatment for Adult Acne:

• It’s does not work instantly as anti-bacterials and Retinoids they take around 20 minutes to get absorbed into the skin.
• Anti-bacterials and retinoids increases skin sensitivity to UV rays.
• Might cause dryness, peeling and irritation (stinging sensation) of the skin.
• Topical retinoids are recommended during pregnancy as they might lead to birth defects and deformities.

3. Light and Laser Treatment for Adult Acne

Laser and light treatments is rather promise in treating acne. Some patients with serious acne cysts have seen to clear up for years with this treatment. However, there is no single laser or light treatment can treat all kinds of pimples, acne cysts, blackheads, whiteheads and acne nodules. Different types of lasers and light therapies instead:

• Blue, red, and blue + red light devices: This method is useful to treat pimples but not effective to remove blackheads, whiteheads, acne cysts, or nodules.
• Infrared light: Infrared light can treat pimples, including those that forms on the back. However, it cannot treat blackheads, whiteheads, cysts, or nodules.
• Photodynamic therapy (PDT): During PDT, a solution would be applied between 15 minutes and 3 hours before the doctor uses a laser or light device to treat the skin. However, this solution increases the skin sensitivity to light. PDT therapy shows great results in treating severe acne such as acne cysts.
• Photopneumatic therapy: Photopneumatic therapy is a combination of an intense pulsed light (IPL) laser with a gentle vacuum. It removes excess oil and dead skin cells, preventing it from clogging pores. It can treat blackheads, whiteheads, and some pimples, but not acne nodules or cysts.