April 3, 2009

Adult Acne

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Adult acne (also called rosacea) is a common inflammatory skin disorder that tends to arise between 30 and 50 years of age. It is a disease of uncertain etiology and is more likely to affect faired skinned persons.

The basic adult acne lesion, called the comedo, is a sebaceous follicle plugged with sebum, tiny hairs, dead cells and sometimes bacteria. Closed comedones with some pathological changes in pilosebaceous duct (hypercornification of the duct) are called whiteheads. Open comedones that present when whiteheads reach the skins surface and touch air are called blackheads. Their black color is not dirt, but the melanin (skin pigment) that accumulates in the opening of the oil gland. Other troublesome acne lesions can develop such as papules, pustules, nodules, and cysts. Papules and pustules are blockages of oil glands that are inflamed. Papules are red lesions (pimples). Pustules are pimples topped by pus-filled lesions that are usually red at the base. Nodules are large, painful, solid lesions that are deep-seated within the skin. They may develop additional infection and have the potential to produce long-term scarring. Cystic acne is considered the severe acne form. They are tender, sensitive, deeper, painful, pus-filled lesions that cause scarring.

The goals of adult acne treatment should include clearance of acne, prevention of scarring and, morbidity minimization. Patient education is the first and at times the most crucial step for effective acne treatment. It is essential to dispel myths that consumption of greasy food, potato chips, sugar and chocolates are responsible for the development of acne. The patient must be advised to cleanse the skin gently and use a non-comedogenic moisturizer. The patient should also avoid picking and rubbing the skin and using scented or harsh skin products. Other important preventive measures should include use of proper shaving technique and being consistent with the skin care regimen. Drinking more water can also help skin stay healthy. Evidence states that modification of the testosterone dose; dosing schedule or delivery method helps improve acne symptoms.

Patients with mild to severe adult acne form can be treated with topical or oral medicines. Although systemic therapy is mainly used for treatment of severe form of adult acne, it is sometimes needed for moderate cases. A variety of systemic agents used to clear adult acne include interlesional corticosteroid injection, isotretinoin, oral antibiotics (tetracycline and erythromycin) and oral contraceptives.

Azelaic acid, benzoyl peroxide, clindamycin, erythromycin, and sodium sulfacetamide are the prescription topical antimicrobials used to treat adult acne in the United States. Several types of prescription topical retinoids used to treat adult acne include adapalene, tazarotene, and tretinoin.