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When Does Acne Stop

Acne may last well into adulthood but with the right treatment you can "cure" it.
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Acne is a common skin disease that usually starts in the teenage years. For some, it resolves without treatment while others need aggressive treatments to prevent acne from staying right on into adulthood.

Mild and moderate acne usually produce lesions such as comedones (whiteheads and blackheads), papules or pinheads, pustules or pimples and seborrhea or red, scaly skin. In severe cases, these lesions may be joined by inflamed bodies such as nodules or large papules, cysts and acne scars.

Acne is mostly present on the skin in the parts of the body with the highest population of sebaceous follicles. These sites include the face, the back and the upper chest.

Acne cysts and nodules are usually found in the crevices of the body where sweat collects in hair follicles and sweat ducts. These can be observed as boil-like bumps in the areas around the buttocks, groins and armpits.

Types of Acne

Whiteheads: These develop from the total blockage of the pores by sebum, bacteria and dead skin cells. These plugs of greasy mixture are seen as tiny white spots on the surface of the skin. Whiteheads do not last as long as blackheads.

Blackheads: These develop from the partial blockage of pores by sebum, bacteria and dead skin cells. This mixture pushes out to the surface of the skin but the black specks are actually formed by the oxidation of melanin, the pigment responsible for skin color, in the air. Blackheads are stable and can be difficult to clear off.

Papules: These are seen as red, inflamed and tender bumps on the skin. They look ripe enough to pop but papules should be left alone since aggravating them will only make them break out in larger numbers and cause extensive scarring.

Pustules: These are inflamed red circles with white or yellow centers. Pustules are just pimples, and they can be carefully squeezed to pop.

Nodules: These are not a type of lesions like the above. They are swollen acne spots appearing as large, hard and painful bumps under the skin. They should never be squeezed since they can easily cause acne scars. Nodules can flare up repeatedly when aggravated.

Cysts: These are similar in appearance to nodules. However, cysts are filled with pus. They are also large, swollen, painful bumps. They should not be squeezed and they can cause acne scars.

Acne Scars: These are produces as the wounds caused by aggravating any of the above lesions and nodulocystic presentations of acne tries to heal. Acne scars can be simple indentations on the skin, have a wave-like appearance or form keloid structures.

Causes of Acne

In most people, the first signs of acne appear at adolescence. This coincides with the developmental changes happening during puberty especially the increased production of androgens such as testosterone in boys and girls.

Acne often has a genetic component. This means that it occurs regularly in succeeding generations of some families. In fact, the severity of acne can be hereditary too.

Apart from genetics, acne can also be caused by stress and sometimes diet. Currently, an association between foods with high hypoglycemic load and acne has been established. Milk is also believed to worsen acne symptoms.

Furthermore, there is a positive correlation between stress levels and the severity of acne. However, it is not clear which comes first; whether increased stress is a cause of acne flare up or acne causes a psychological response that is registered by the body as stress.

There are 2 major root causes of acne. These are discussed below.

Hormone Imbalance

The increased production of male sex hormones especially androgens such as testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS) are linked to acne formation. The production of these hormones can be also stimulated by certain drugs, diseases or lifestyle.

Hormonal activities during puberty and menstrual cycles provide the perfect condition necessary for increased sebum production and hyperkeratinization.  In fact, some drugs especially those used for birth control may cause acne in some women due to the hormonal imbalance they cause.

Other acne cases caused by hormonal imbalances include pregnancy-induced acne and menopause-induced acne. In the latter case, the reduced production of estradiol during menopause is responsible for the development of acne.

Estradiol is a known anti-acne hormone since it counterbalances the effects of the androgens.

Acne can also be caused by the hormonal imbalance produced by diseases such as Cushing’s syndrome and polycystic ovarian syndrome.

Lastly, a hormone called insulin-like growth factor 1 (IGF-1) is also believed to cause acne.

Bacterial Infection

Two bacteria have been identified to cause or contribute to the development of acne. These are Propionibacterium acnes and Staphylococcus epidermis.

Propionibacterium acnes is an anaerobic bacterium which colonizes skin surfaces with normal pores and acne-affected pores. There are different strains of this bacterium and some of them promote normal skin health while others are associated with chronic acne eruptions.

However, where Propionibacterium acnes and Staphylococcus epidermis are both present, acne always results.

These bacterial strains are able to change the nature of skin by increasing sebum production, promoting a cycle of inflammation and causing the clogging of the skin pores. Unfortunately, these bacteria are becoming increasingly resistance to the antibiotics used to treat acne.

Adult Acne

Although acne is associated with adolescents and youth in their early twenties, it can also affect adults. In fact, some people experience acne well into adulthood and even into menopause.

Adult acne can be a source of urgent concern. It is just as damaging to one’s self-image as it for teenagers. Adult acne can cause psychological distress and even suicidal tendencies in the people suffering from it.

Adult acne is more common in women. It is estimated that 25% of men are affected by adult acne while 50% of women experience it at least once in their adult lives. Acne can break out even in adults who never experienced it in their adolescence.

In adults, acne spots are usually found on the lower face. These spots are mostly found around the jawline, mouth and chin. They can be as mild as zits and as severe as nodules. These lesions can also be found on the upper chest and at the back.

Furthermore, adult acne is mostly hereditary. It occurs more in people who have a parent, sibling or child with acne breakouts. It can also be caused by stress since stress causes an increase in the production of androgens.

The causes of adult acne are similar to those of early onset acne. Adult acne is chiefly caused by hormonal changes, and this is why it is more common in women.

Another form of common acne in adults is acne cosmetica which is caused by oily irritants found in cosmetics.

Drugs can also cause adult acne. Acne can break out after some women stop birth control pills or if they take pills containing only progestin and not estrogen. This is because the sudden hormonal imbalance leads to a rebound production of high amounts of androgens.

How Long Does Acne Last?

How long it takes for acne to clear depends on a lot of factors. In some people, acne clears early after adolescence and with little treatment. However, most people are not so lucky.

Most people need one form of treatment or another to fully treat acne. It is worth knowing that acne has no cure but it can be cleared away with the right treatments. 

For most people, acne disappears or diminishes significantly at the age of 25. This is because at this age, hormone productions are well under control and the oily teenage skin will begin to transform into the dry adult skin.

Women, of course, generally have acne for longer than men. In fact, some women have acne breakouts once every month during their menstrual cycles and during pregnancy as well as during menopause.

Stress is also a bigger contributor to acne in women than in men.

Where long-term acne treatment is required, herbal remedies may be a better alternative to conventional drug in managing acne. This is because the herbs used for treating acne generally address multiple causes of skin condition and also have lesser side effects.

Generally, acne caused by hereditary is the most difficult to treat especially when the family members have histories of adult acne. However, treatment should continue since acne sometimes resolves suddenly due to changes in the body or the cumulative effects of the treatment itself.

Next Article: Herbal Medicine for Acne
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