Reasons why adults do not seek acne treatment

What is Adult Acne?

Adult acne is common. Although acne during the adolescent period is more common in males, the reverse pattern is observed in adults. Recent studies have shown that the prevalence of acne in adults, especially in women, is increasing.

Surveys have shown that the prevalance of acne in women aged 20-29 years is about 50%, women aged 30-39 years is about 35%, women aged 40-49 years is about 25%, and women aged more than 50 years is about 15%.

What does Adult Acne look like?

Post-adolescent acne or adult acne can be classified as either persistent acne or late-onset acne. The majority of adult acne sufferers have persistent acne starting from their teenage years. 

Adult adult is characterized by increased oil production, formation of comedomes and  inflammatory lesions. The severity of acne can range from mild to severe subtypes. Typically, the lower face or 'U-shaped' pattern is observed, with involvement of the cheeks, jawline and neck areas. Cystic acne forms are not uncommon either, and many individuals report acne affecting the chest and back regions.

The sequelae of persistent acne contributes to the presence of post-inflammatory hyperpigmented (PIH) lesions, atrophic acne scarring, keloid scarring and facial redness.

What causes Adult Acne?

The underlying causes of adult acne is complex, multifactorial and not fully understood. 

Acne is characterised by an increased sebum production, abnormal keratinization within the hair follicle, inflammation and the colonization by C.acnes bacterium.

The interplay between genetics, chronic stress, hormones, drugs, cosmetic use and underlying medical problems (e.g. polycystic ovarian syndrome) may be precipitating as well as perpetuating factors. An interesting study has shown that smoking is a risk factor for more severe adult acne forms.

So why do adults not seek acne treatments?

Adult acne can profoundly impact of your quality of life. Adult acne is associated with stress, anxiety and depression. Individuals who suffer from adult acne longer than 5 years and who are of older age have been observed to have more impairment of their quality of life.

So why do adult acne patients not seek treatment despite it being a common condition?

A recent survey showed that top reasons for not seeking medical treatment includes:

• Cannot be bothered to seek treatment (53.7%)
• Believing that acne will resolve by itself (45.1%)
• Concerned about costs of treatment (35.2%)
• Satisfied with over the counter treatments (33.5%)

These treatment barriers should be acknowledged together with an understanding that effective medical treatments are available to treat adult acne. The early treatment of adult acne improves your quality of life, helps achieve healthier skin and reduces the potential for acne scarring.

References:

1. Goulden V, Clark SM, Cunliffe WJ. Post-adolescent acne: a review of clinical features. British journal of dermatology. 1997 Jan;136(1):66-70. 
2. Collier CN, Harper JC, Cantrell WC, Wang W, Foster KW, Elewski BE. The prevalence of acne in adults 20 years and older. Journal of the American Academy of Dermatology. 2008 Jan 1;58(1):56-9.
3. Skroza N, Tolino E, Mambrin A, Zuber S, Balduzzi V, Marchesiello A, Bernardini N, Proietti I, Potenza C. Adult acne versus adolescent acne: a retrospective study of 1,167 patients. The Journal of clinical and aesthetic dermatology. 2018 Jan;11(1):21.
4. Baird E, Click I, Kotsonis R, Bibb L. Reasons why adults do not seek treatment for acne: a survey of university students and staff. J Dermatolog Treat. 2022 Aug 29:1-3.