Medication Can Help Clear Up Adult Acne
Acne is often considered a teen-agers’ problem. But it’s no stranger to many adults in their 30s and 40s, who often encounter acne vulgaris and wrinkles simultaneously. What to do?
Robert Stern, associate professor of dermatology, Beth Israel Hospital and Harvard Medical School, Boston:
“First (a physician should) determine if this is new acne or worsening of the same old acne. If it’s worsening, look at habits that might exacerbate it, such as wearing more makeup. Look at hormonal changes, such as stopping or starting oral contraceptives or a change in the interval between menstrual periods.
“If a doctor has checked off all those and there are no triggers to look at, next determine how bad (it) is. Characterize it. Is it mainly blackheads and whiteheads or inflammatory acne?
“Depending on the answers to those questions, decide on treatment.
“For people who have mainly blackheads and whiteheads, I might try Retin-A. For small red pimples I might try a topical antibiotic like erythromycin or clindamycin. For moderate to severe acne, I might try an oral antibiotic and a topical treatment, either benzoyl peroxide or Retin-A.”
“In my opinion, there is no substantial data to prove adding zinc to erythromycin (recently suggested by researchers) works any better.”
Alexander Miller, Yorba Linda dermatologist; assistant clinical professor of dermatology, UC Irvine School of Medicine:
“Men in their 30s and 40s with acne usually have had it to some degree since their teens or 20s. Women with acne in their 30s and 40s may have had it all along, never had it or redevelop it.
“I classify it first. If it’s mostly whiteheads and blackheads, I use topical preparations like Retin-A or benzoyl peroxide, salicylic acid washes or prescription sulfur-containing preparations.
“Pimples can respond to Retin-A and benzoyl peroxide but usually require an antibiotic as well, either oral or topical. It takes four to 12 weeks to see a peak level of improvement. The goal is to phase out the oral antibiotics over several months and maintain the topical treatments.
“Erythromycin with zinc has worked on some of my patients, but it’s difficult to say how much better it is than erythromycin alone.
“Ordinarily 70% to 80% of people will get significant improvement with one of these approaches. If acne is severe, Accutane (taken orally) is a reasonable option under strict medical supervision. A 20-week course is typical, and 90% of people will clear their acne; 90% of those will maintain clearance of severe acne.”
