All about adult acne

PHOTO: All about adult acne

Just when you think you've left your pimply teen years behind you, an angry outbreak erupts on your skin. You are shocked - aren't pimples supposed to happen only to teens and those with bad facial hygiene?

The truth is that acne can happen to people in their 20s and 30s, and even beyond - even to those who take excellent care in washing and caring for their skin.

One common statistic is that about one in four men and one in two women will be affected by adult acne in their lifetime.

What causes adult acne?

Acne develops when hair follicles in the skin become clogged with dead skin cells and oil. This is more likely to happen when one's skin produces excessive oil and sheds more dead skin cells. Bacteria can breed in these clogged hair follicles, resulting in infection and inflammation.

While the exact cause of acne is not fully understood, scientists and doctors know that there are several factors that are linked to adult acne. Hormonal fluctuations, particularly in women, can result in acne breakouts, while certain make-up formulations can clog the skin and cause congestion on skin's surface.

Less common is medication-induced acne, which can occur in people who are taking anti-epileptic medication, steroids, birth control pills or the mood-stabiliser lithium. In such cases, the acne will usually clear up once the patient stops medication. However, given the severity of most conditions which require such treatment in the first place, patients must consult their doctors before attempting to discontinue their medication.

Heredity also plays a part - if your family members have acne, you are more likely to develop adult acne as well.

TCM perspective

The TCM perspective on acne

From a TCM perspective, however, acne can also signal other underlying health problems. "TCM believes that acne can be caused by both internal and external factors," said Dr Tang Yue from Eu Yan Sang in an e-mail interview with AsiaOne Health.

Dr Tang, who holds a Ph.D. in Integrated Medicine from Nanjing University of TCM, explained that one of these internal factors is 'heat'.

"The area where acne occurs may suggest that there is considerable 'heat' in some part or organ of the body, though this is not always the case," she said.

"For example, if acne appears on the chest, it may suggest that there is 'heat' in the lungs. If acne occurs on the back, where the bladder channels are, then it might suggest excess 'heat' in the kidneys, since the kidneys and the bladder work in tandem with one another."

What about acne on the face?

"Some areas of the face are significant," said Dr Tang. "The mid-frontal area is linked to excessive gastric 'heat', while acne in the areas of the cheeks near the ears often mean 'heat' in the liver and gall bladder." She added that such a diagnosis is based on the distribution of the meridians in the body.

However, before you think that your acne is caused by some disturbance in your internal organs, check that you are cleansing your face properly.

Dr Tang says that in TCM, acne can be caused by external factors as well. This includes improper skin hygiene or unsuitable cosmetic products. She added that most causes of acne "are the combined result of both external and internal factors."

Acne treatments

The conventional ways of treating adult acne include:

Topical creams containing benzoyl peroxide

Perhaps one of the cheapest and most effective treatments for adults who suffer mild to moderate acne, benzoyl peroxide creams effectively kill the p.acnes bacteria in the skin. It is also one of the most effective ingredients proven to work on cystic acne – a particularly painful and inflamed type of acne.

Always opt for creams that contain 2.5 per cent benzoyl peroxide, as higher concentrations can cause severe dryness of the skin without being any more effective than a 2.5 per cent formulation. A tube of 2.5 per cent strength benzoyl peroxide gel retails for about $14 at most pharmacies.

Salicylic acid

This beta-hydroxy acid (BHA) has anti-inflammatory properties and helps to deeply exfoliate the skin, thus keeping the pores clear. Look for products that contain 1 to 2 per cent of the ingredient, or opt for a dedicated salicylic acid lotion or liquid preparation that can be applied on the face as a toner. It is best used as part of one's daily routine as a preventive measure to keep acne at bay.

Antibiotics – topical and oral

If the acne is severe, antibiotics might be useful. However, there can be side effects - oral antibiotics are known to cause gastric discomfort, dizziness and nausea, while topical antibiotics can cause dryness and flaking of skin. Antibiotic treatments must be prescribed by a doctor.


Retinoids, such as Retin-A and Differin, help to increase the turnover of skin cells and prevents pores from clogging up. Retinoids also have the added advantage of being able to stimulate collagen in skin cells, thus reducing wrinkles and helping the skin to look younger. Retinoids are available by a doctor's prescription only. And no – those cosmetic products that claim to have retinoid-like ingredients will not work as well as the real thing.

Birth control pills

Originally designed to prevent conception, the birth control pills of today carry a wide range of health benefits and can treat conditions such as PMS, cramping, and hormone problems. This makes it extremely suitable for women whose acne is clearly linked to hormonal fluctuations. In Singapore, birth control pills can only be obtained from a doctor. Typically, a month's worth of pills can cost about $30.

PPx Laser

PPx laser treatments, such as those used in the DRX Clinic, are effective treatments for acne.
Hand-held devices such as LMS Spotlights use light therapy to reduce inflamation and treat pimples.

Introduced a few years ago, the PPX laser is used to treat mild to moderate acne. The virtually painless treatment works by using a specific light frequency to kill the bacteria in the skin, while 'vacuuming' impurities from within the pores. It is the only laser treatment which has been approved by the US Food and Drug Administration (FDA) for the treatment of comedonal acne, which is characterised by blackheads and whiteheads.

The treatment is offered by several doctors and beauty salons in Singapore and can cost $200 or more per session.

Hand-held light devices

A recent innovation, such devices use light to kill bacteria in the skin. Numerous models abound, with some being more effective for mild cases of acne, while others claim to be able to tackle serious, painful nodules. The science behind using light therapy is proven, but the efficiency of these devices is very much dependent on the manufacturer. Anecdotal comments from readers suggest that these devices are effective for certain skin types, but not for others.

Devices can cost between $100 to over $300, depending on the model.