Marmur Medical Blog

A poll of my friends (both guys and girls) has revealed they worry most about acne. The kicker . . . we’re all in our twenties!

A poll of my friends (both guys and girls) has revealed they worry most about acne. The kicker . . . we’re all in our twenties!

I thought being in my twenties meant that I would never ever have to deal with another pimple ever again. I thought the days of crazy hormone levels and excess oil production were all behind me, and not just behind me, but also behind all of my friends. Turns out, I was dead wrong. Not only do we twenty-something-year-olds get pimples occasionally (some more than others), it’s the single skin condition we worry about most! In case you were worrying that my test sample was not large enough, the American Academy of Dermatology has reported that the occurrence of late-onset acne (acne occurring in your 20s and 30s) is increasing in the dermatological world.

Since leaving the throes of puberty, I find that most break-outs I experience have been brought about by stress. Medical school is never short on the stress. To cope, I’ve learned a few tricks and have a few cosmetic pinch-hitters up my sleeve for the occasions when the stress gets a little too much, and that pimple shows up in some embarrassingly obvious place, like the tip of my nose. Before I get into the technical details of eradicating pimples, what exactly is acne and what are the common causes, especially at our age?

Acne itself is associated with many symptoms including inflamed areas of skin, blackheads, pimples, and if severe enough, eventual scarring. In your twenties, the acne vulgaris of your teenage years has most likely subsided to just a few pimples every once in a while. Most bouts of acne are brought upon by hormonal imbalances, specifically an imbalance of hormones belonging to the androgen class (such as testosterone, dihydroestosterone and dehydroepiandrosterone sulfate), as well as growth factors (such as insulin-like growth factor 1). Acne arising during puberty is usually caused by a testosterone increase, which stimulates the sebaceous glands (secrete sebum, an oily substance that lubricates and protects skin) and hair follicles, together known as the pilosebaceous unit. During your twenties, there are many other factors scientifically proven to cause acne including: normal hormonal cycles associated with menstruation; genetic predisposition (due to mutations in acne-related genes); infection (Propionibacterium acnes with or without Staphylococcus epidermidis); stress; and a diet loaded with dairy products and carbohydrates, especially sugars (there goes milk and cookies).

There are entire sections of drugstores devoted to the annihilation of your blackheads and pimples, not to mention all the fancy products you can find at your local Sephora or high-end department stores. In my cosmetic arsenal there are many beauty products for which I will not sacrifice luxury, spending the extra dollars to get an upscale brand. However, my pimple-fighting squad is not one of these items. For fighting the occasional breakout, I turn to drug-store brand acne fighters and opt for one containing salicylic acid, a product naturally found in willow bark. Like it’s cousin, acetylsalicylic acid (otherwise known as aspirin), salicylic acid has some anti-inflammatory properties therefore reducing the redness and swelling associated with a pimple. In addition, this compound slows the shedding of dead skin skins and release of extra sebum that will clog pores. If you’re not sure which acne fighter is best, try Dr. Marmur’s recommendation of glo.therapeutics’ Clear Acne Cleanser (contains 2% salicylic acid, scrubbing beads and apple enzyme), sold at Marmur Medical.

If salicylic acid is not for you there are many other ingredients you can look for including benzoyl peroxidase, alpha-hydroxy acids, or sulfur. Benzoyl peroxidase is an organic compound known to stop the clogging of pores by removing the excess oil and dead skin cells. Though it is effective, at first use it may cause excessive dryness and irritation. It also happens to be in the same family of products as bleach, so don’t get it on your clothes or hair. Alpha-hydroxy acids are found in fruits; these compounds remove dead skin cells, reduce inflammation and stimulate the growth of new skin for a healthy, smooth, glowing complexion. Sulfur, though not a commonly found ingredient anymore, was once considered the gold standard for removing dead skin cells and oil. However, just like any other sulfur-containing product, sulfur treatments are accompanied by a nasty smell akin to rotting eggs (as if having a pimple wasn’t bad enough in the first place).

The newest comer on the acne scene is retinoid, a derivative of vitamin A (the active ingredient being retinoic acid). Adapalene is the most commonly used form of retinoid for acne treatment. Retinoid will unclog pores by preventing dead skin cell accumulation. In addition, retinoid can reduce wrinkles by increasing the production of collagen and promoting the sprouting of new blood vessels. The compound will not only fade age spots, but the increased amount of new blood supply to the skin will give a rosy glow and healthy complexion. The added anti-aging effects make retinoid-containing treatments compatible with late-onset acne due to the “anti-aging” properties. However, these compounds are notorious for causing redness and peeling skin, in some instances making acne even worse before it gets better (you have been warned). Currently, most dermatologists will prescribe a retinoid-containing cream for those who are acne-prone, and if you are anti-skin-product-prescription, the over-the-counter version is retinol (this compound takes longer to be converted into retinoic acid, but you can expect the same results as the prescription creams in about 12 weeks). Just remember, retinoid-containing creams make your skin extremely sensitive to light, so whatever day moisturizer is used, it should have at least SPF 15.

(Just as an aside, tretonion, a retinoid commonly used, is classified as a class D medication that should not be used during pregnancy. Let your dermatologist know if you are pregnant or plan on becoming pregnant in the near future before using retinoid/retinol. Make sure the product you choose is safe for you!)

There are many causes of acne in your twenties: hormones, stress, bacteria, genetics and diet. Thankfully there are about as many treatments for acne as causes, including salicylic acid, benzoyl peroxidase, alpha-hydroxy acids, sulfur and retinoids. Just like the back of your hand, a person’s acne will be individualized, causing the need for a unique management course that’s “just right”. It is important to find a treatment that works well for you and doesn’t cause any unwanted side effects. So go forth, fight your acne, and remember, you’re not alone when it comes to battling the unwanted pimples of your twenties.

Written by:
Margit Lai Wun Juhasz
Mount Sinai Medical Student