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Adult Female Acne AKA Hormonal Acne

One of my favourite cartoonists Lainey Molnar, recently put up a comic capturing what acne can be like for many of us.

We may laugh and it is funny. Equally, it is one of the commonest presentations to doctors for women past the age of 25.







Adolescence is meant to be a time of some acne; it is almost a given, due to hormonal changes that puberty brings with it. Upto 85% of adolescents, male and female, will have some form of acne between the ages of 16-18 years of age.

As with all acne, it is classified into mild, moderate and severe and treatment modalities are based around classification due to increased risk of persistence and knock on effects such as pigmentation and scarring which can be very distressing for people.

Acne tends to improve by age 25, but can persist, especially in females when it is then classified as Adult Female Acne or AFA.

How does AFA differ from adolescent acne?

  • Can be very persistent
  • can last into one’s 30s, 40s and even menopause
  • in some women, it may show up for the first time in adulthood, or around menopause. Premenstrual flares are common.
  • the cause is believed to be due to hormonal fluctuation due to menses, pregnancy as well as menopause itself.
  • it tends to be mild to moderate in severity, unlike adolescent acne.
  • Unlike adolescent acne, it tends to be largely around teh lower face and neck but may be anywhere on the face, chest and back

How do we treat adult acne?

Treatment is similar to that in adolescence. However, due to persistence, more aggressive treatments and a combination of treatments may be needed to get it under control even for relatively mild symptoms.

By the time I see patients with persistent acne, they have usually tried various over the counter products, they may have been to salons for facials and other treatments, some of which may paradoxically have the effect of making the acne worse, and may contribute to scarring and pigmentation rarely.

Acne is a medical disease and treatment options need to be medical, with adjunctive therapies as appropriate added in where needed and beneficial.

I’d suggest saving time and beginning with a skin consultation with a trusted doctor who is comfortable with skin diseases and obtaining personalised advice including prescription medication if it appropriate. Treatment is time consuming and depending on what is involved, may be costly, but the alternative means that acne continues to persist and cause unwanted side effects such as scarring and pigmentation that will also need to be addressed at some point, with added time and cost.

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