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New Survey Highlights Emotional Toll of Adult Acne

August 2008

 

Adult patients now make up approximately half of all acne patients seen by dermatologists — and their numbers are growing, according to the results of the Skin Matters 2008 Survey, conducted by Harris Interactive and sponsored by OrthoNeutrogena.

The survey, which polled 514 acne patients aged 20 to 40 years, looked at the emotional toll of the disorder. According to the survey:
• 38% of the adults said that having acne was more stressful as an adult than as a teenager.
• 50% found having acne as an adult more unappealing than having either wrinkles (36%) or grey hair (29%).
• 41% found that having acne negatively impacts their self-confidence.
• 38% found that it negatively affected their mood.

Hilary Baldwin, M.D., President of The American Acne and Rosacea Society, and Vice-Chair and Associate Professor of Dermatology at the State University of New York at Brooklyn, was not surprised by the survey findings.

“If you ask people who had acne both as a teenager and an adult, they all agree that having it the second time around is much worse — the condition negatively affects their self-esteem and feeling of self-worth.”

“It has become increasingly common for adults to experience acne — one in five women who suffer from acne is between the ages of 25 and 40,” says Richard Fried, M.D., Ph.D., Clinical Director, Yardley Dermatology and Yardley Skin Enhancement and Wellness Center, and author of Healing Adult Acne. “Acne can be even more difficult for this age group,” he notes, “as it can be responsible for stress, depression, social withdrawal, job impairment and intimacy problems.”

Misconceptions Persist

One misconception that seems to persist is the notion that acne is an adolescent phenomenon. The survey found that 67% of adults with acne believed that they would no longer have it by the time they reached their twenties.

This is a common cause of frustration among many adult patients, notes Diane Berson, M.D., Assistant Clinical Professor of Dermatology, Weill Medical College of Cornell University, New York, NY. She explains that patients who have had acne as a teenager can often be frustrated because they feel that “enough is enough” and wonder when they’ll outgrow the acne.

Although the etiology of adult acne is the same as that for teenagers, there may be different triggers. “In adult women especially, hormonal fluctuations from their monthly cycle, going on or off birth control pills, pregnancy or perimenopause can often cause flare-ups,” says Dr. Berson.

Treatment Options in 2008

Many aspects of acne treatment are similar for both teens and adults. But the dermatologist must individualize therapy and take into consideration skin type, acne type and even lifestyle, when putting together a treatment regimen, say the experts.

“You can’t have a cookbook approach and give the same thing to a 50-year-old woman who is having hormonal acne or mild acne with dry skin, and a 17-year-old adolescent who is very oily,” states Dr. Berson.

The good news is that there have been a number of improvements in the treatment of acne over the years, notes Dr. Berson. “Years ago, acne treatments were only targeted for teenagers with oily skin,” she says. “Today there is a recognition that adults, especially adult women, do develop acne, and an effort has been made to make products more compatible with their skin.”

According to the experts, first-line therapy for patients with mild-to-moderate acne is always a topical retinoid plus/minus a topical antimicrobial. “Topical retinoids will not only treat the acne, but, more importantly, will prevent further breakouts and, as an added bonus for adults, help improve photodamaged skin,” says Dr. Berson.

Dr. Baldwin also begins with topical agents but is not afraid to “bypass the face” and go to oral medications, especially hormonal therapies. “If you can give a busy woman a pill that will work as well as several creams, so much the better” she notes. Dr. Berson adds “hormonal therapies — either birth control pills or spironolactone — are not stand-alone therapies. They don’t treat existing acne, but are effective for preventing acne flare-ups in the women with a clear hormonal influence.”

Dr. Baldwin also tends to prescribe oral isotretinoin sooner in adults than in teenagers, because the alternative for someone whose acne is bad enough to warrant isotretinoin is, by definition, full-strength antibiotics. She explains that most of these adult patients will not be able to discontinue their antibiotics without flaring, and will therefore need to continue them for a long period of time. Most teens will outgrow their acne by about age 18 to 20. On the other hand, an adult woman will likely have her acne until menopause. Since isotretinoin cures acne in 80% of patients, in adult women its use obviates the need for long-term antibiotics and their inherent consequences.

Counseling is Key

One big difference in dealing with adult patients, notes Dr. Baldwin, is the amount of counseling. Be empathetic, she recommends. “I actually say, ‘This must really make you mad. How are you dealing with it?’ Let patients know that you are there to help and that they are in the right place.”

Dr. Fried agrees. “The effect acne has on each individual varies. The dermatologist needs to state that you realize living with acne as an adult is especially difficult. Dealing with acne and wrinkles at the same time seems intuitively unfair,” he says.

In addition, Dr. Berson tells patients what side effects they might expect. “They may experience redness, peeling, dryness and their acne may not improve for a few weeks. It is important to give the patients a realistic time-line for improvement; otherwise they may get frustrated and wonder why their acne is not better after 1 week.”

Compliance is an Issue

The issue of compliance, or lack thereof, was another question asked by the Skin Matters Survey. While acne is very treatable, the survey found that 91% of dermatologists say patient compliance is a barrier to successful treatment. The survey also found that only 54% of adults with acne say they follow their skin treatment regimen exactly as prescribed.

“The survey demonstrates that adults have just as hard a time with treatment compliance as teens,” says Dr. Fried. “Help them to hang in there — and contrary to overnight internet wonders, our therapies will work well and long-term.”

To deal with the stress of acne, Dr. Fried also recommends non-pharmaceutical measures. “Progressive muscle relaxation, guided imagery, yoga and Tai Chi all can decrease stress and increase focus and control, leading to better compliance with treatment regimens.”

In Dr. Baldwin’s practice, adult patients are a bit more compliant than teens — but just a little. “Adults are more motivated, but they are also more frustrated,” she notes. “If you dry them out and make them flaky and red, you really lose them.”

To improve patient compliance, Dr. Berson recommends starting with the least complicated regimen. “I do believe the simpler you make the regimen, the better the compliance. And as the survey shows, “you need to spend a lot of time on the first visit explaining the nature of their condition and how to use the treatment correctly.”

 

 

Adult patients now make up approximately half of all acne patients seen by dermatologists — and their numbers are growing, according to the results of the Skin Matters 2008 Survey, conducted by Harris Interactive and sponsored by OrthoNeutrogena.

The survey, which polled 514 acne patients aged 20 to 40 years, looked at the emotional toll of the disorder. According to the survey:
• 38% of the adults said that having acne was more stressful as an adult than as a teenager.
• 50% found having acne as an adult more unappealing than having either wrinkles (36%) or grey hair (29%).
• 41% found that having acne negatively impacts their self-confidence.
• 38% found that it negatively affected their mood.

Hilary Baldwin, M.D., President of The American Acne and Rosacea Society, and Vice-Chair and Associate Professor of Dermatology at the State University of New York at Brooklyn, was not surprised by the survey findings.

“If you ask people who had acne both as a teenager and an adult, they all agree that having it the second time around is much worse — the condition negatively affects their self-esteem and feeling of self-worth.”

“It has become increasingly common for adults to experience acne — one in five women who suffer from acne is between the ages of 25 and 40,” says Richard Fried, M.D., Ph.D., Clinical Director, Yardley Dermatology and Yardley Skin Enhancement and Wellness Center, and author of Healing Adult Acne. “Acne can be even more difficult for this age group,” he notes, “as it can be responsible for stress, depression, social withdrawal, job impairment and intimacy problems.”

Misconceptions Persist

One misconception that seems to persist is the notion that acne is an adolescent phenomenon. The survey found that 67% of adults with acne believed that they would no longer have it by the time they reached their twenties.

This is a common cause of frustration among many adult patients, notes Diane Berson, M.D., Assistant Clinical Professor of Dermatology, Weill Medical College of Cornell University, New York, NY. She explains that patients who have had acne as a teenager can often be frustrated because they feel that “enough is enough” and wonder when they’ll outgrow the acne.

Although the etiology of adult acne is the same as that for teenagers, there may be different triggers. “In adult women especially, hormonal fluctuations from their monthly cycle, going on or off birth control pills, pregnancy or perimenopause can often cause flare-ups,” says Dr. Berson.

Treatment Options in 2008

Many aspects of acne treatment are similar for both teens and adults. But the dermatologist must individualize therapy and take into consideration skin type, acne type and even lifestyle, when putting together a treatment regimen, say the experts.

“You can’t have a cookbook approach and give the same thing to a 50-year-old woman who is having hormonal acne or mild acne with dry skin, and a 17-year-old adolescent who is very oily,” states Dr. Berson.

The good news is that there have been a number of improvements in the treatment of acne over the years, notes Dr. Berson. “Years ago, acne treatments were only targeted for teenagers with oily skin,” she says. “Today there is a recognition that adults, especially adult women, do develop acne, and an effort has been made to make products more compatible with their skin.”

According to the experts, first-line therapy for patients with mild-to-moderate acne is always a topical retinoid plus/minus a topical antimicrobial. “Topical retinoids will not only treat the acne, but, more importantly, will prevent further breakouts and, as an added bonus for adults, help improve photodamaged skin,” says Dr. Berson.

Dr. Baldwin also begins with topical agents but is not afraid to “bypass the face” and go to oral medications, especially hormonal therapies. “If you can give a busy woman a pill that will work as well as several creams, so much the better” she notes. Dr. Berson adds “hormonal therapies — either birth control pills or spironolactone — are not stand-alone therapies. They don’t treat existing acne, but are effective for preventing acne flare-ups in the women with a clear hormonal influence.”

Dr. Baldwin also tends to prescribe oral isotretinoin sooner in adults than in teenagers, because the alternative for someone whose acne is bad enough to warrant isotretinoin is, by definition, full-strength antibiotics. She explains that most of these adult patients will not be able to discontinue their antibiotics without flaring, and will therefore need to continue them for a long period of time. Most teens will outgrow their acne by about age 18 to 20. On the other hand, an adult woman will likely have her acne until menopause. Since isotretinoin cures acne in 80% of patients, in adult women its use obviates the need for long-term antibiotics and their inherent consequences.

Counseling is Key

One big difference in dealing with adult patients, notes Dr. Baldwin, is the amount of counseling. Be empathetic, she recommends. “I actually say, ‘This must really make you mad. How are you dealing with it?’ Let patients know that you are there to help and that they are in the right place.”

Dr. Fried agrees. “The effect acne has on each individual varies. The dermatologist needs to state that you realize living with acne as an adult is especially difficult. Dealing with acne and wrinkles at the same time seems intuitively unfair,” he says.

In addition, Dr. Berson tells patients what side effects they might expect. “They may experience redness, peeling, dryness and their acne may not improve for a few weeks. It is important to give the patients a realistic time-line for improvement; otherwise they may get frustrated and wonder why their acne is not better after 1 week.”

Compliance is an Issue

The issue of compliance, or lack thereof, was another question asked by the Skin Matters Survey. While acne is very treatable, the survey found that 91% of dermatologists say patient compliance is a barrier to successful treatment. The survey also found that only 54% of adults with acne say they follow their skin treatment regimen exactly as prescribed.

“The survey demonstrates that adults have just as hard a time with treatment compliance as teens,” says Dr. Fried. “Help them to hang in there — and contrary to overnight internet wonders, our therapies will work well and long-term.”

To deal with the stress of acne, Dr. Fried also recommends non-pharmaceutical measures. “Progressive muscle relaxation, guided imagery, yoga and Tai Chi all can decrease stress and increase focus and control, leading to better compliance with treatment regimens.”

In Dr. Baldwin’s practice, adult patients are a bit more compliant than teens — but just a little. “Adults are more motivated, but they are also more frustrated,” she notes. “If you dry them out and make them flaky and red, you really lose them.”

To improve patient compliance, Dr. Berson recommends starting with the least complicated regimen. “I do believe the simpler you make the regimen, the better the compliance. And as the survey shows, “you need to spend a lot of time on the first visit explaining the nature of their condition and how to use the treatment correctly.”

 

 

Adult patients now make up approximately half of all acne patients seen by dermatologists — and their numbers are growing, according to the results of the Skin Matters 2008 Survey, conducted by Harris Interactive and sponsored by OrthoNeutrogena.

The survey, which polled 514 acne patients aged 20 to 40 years, looked at the emotional toll of the disorder. According to the survey:
• 38% of the adults said that having acne was more stressful as an adult than as a teenager.
• 50% found having acne as an adult more unappealing than having either wrinkles (36%) or grey hair (29%).
• 41% found that having acne negatively impacts their self-confidence.
• 38% found that it negatively affected their mood.

Hilary Baldwin, M.D., President of The American Acne and Rosacea Society, and Vice-Chair and Associate Professor of Dermatology at the State University of New York at Brooklyn, was not surprised by the survey findings.

“If you ask people who had acne both as a teenager and an adult, they all agree that having it the second time around is much worse — the condition negatively affects their self-esteem and feeling of self-worth.”

“It has become increasingly common for adults to experience acne — one in five women who suffer from acne is between the ages of 25 and 40,” says Richard Fried, M.D., Ph.D., Clinical Director, Yardley Dermatology and Yardley Skin Enhancement and Wellness Center, and author of Healing Adult Acne. “Acne can be even more difficult for this age group,” he notes, “as it can be responsible for stress, depression, social withdrawal, job impairment and intimacy problems.”

Misconceptions Persist

One misconception that seems to persist is the notion that acne is an adolescent phenomenon. The survey found that 67% of adults with acne believed that they would no longer have it by the time they reached their twenties.

This is a common cause of frustration among many adult patients, notes Diane Berson, M.D., Assistant Clinical Professor of Dermatology, Weill Medical College of Cornell University, New York, NY. She explains that patients who have had acne as a teenager can often be frustrated because they feel that “enough is enough” and wonder when they’ll outgrow the acne.

Although the etiology of adult acne is the same as that for teenagers, there may be different triggers. “In adult women especially, hormonal fluctuations from their monthly cycle, going on or off birth control pills, pregnancy or perimenopause can often cause flare-ups,” says Dr. Berson.

Treatment Options in 2008

Many aspects of acne treatment are similar for both teens and adults. But the dermatologist must individualize therapy and take into consideration skin type, acne type and even lifestyle, when putting together a treatment regimen, say the experts.

“You can’t have a cookbook approach and give the same thing to a 50-year-old woman who is having hormonal acne or mild acne with dry skin, and a 17-year-old adolescent who is very oily,” states Dr. Berson.

The good news is that there have been a number of improvements in the treatment of acne over the years, notes Dr. Berson. “Years ago, acne treatments were only targeted for teenagers with oily skin,” she says. “Today there is a recognition that adults, especially adult women, do develop acne, and an effort has been made to make products more compatible with their skin.”

According to the experts, first-line therapy for patients with mild-to-moderate acne is always a topical retinoid plus/minus a topical antimicrobial. “Topical retinoids will not only treat the acne, but, more importantly, will prevent further breakouts and, as an added bonus for adults, help improve photodamaged skin,” says Dr. Berson.

Dr. Baldwin also begins with topical agents but is not afraid to “bypass the face” and go to oral medications, especially hormonal therapies. “If you can give a busy woman a pill that will work as well as several creams, so much the better” she notes. Dr. Berson adds “hormonal therapies — either birth control pills or spironolactone — are not stand-alone therapies. They don’t treat existing acne, but are effective for preventing acne flare-ups in the women with a clear hormonal influence.”

Dr. Baldwin also tends to prescribe oral isotretinoin sooner in adults than in teenagers, because the alternative for someone whose acne is bad enough to warrant isotretinoin is, by definition, full-strength antibiotics. She explains that most of these adult patients will not be able to discontinue their antibiotics without flaring, and will therefore need to continue them for a long period of time. Most teens will outgrow their acne by about age 18 to 20. On the other hand, an adult woman will likely have her acne until menopause. Since isotretinoin cures acne in 80% of patients, in adult women its use obviates the need for long-term antibiotics and their inherent consequences.

Counseling is Key

One big difference in dealing with adult patients, notes Dr. Baldwin, is the amount of counseling. Be empathetic, she recommends. “I actually say, ‘This must really make you mad. How are you dealing with it?’ Let patients know that you are there to help and that they are in the right place.”

Dr. Fried agrees. “The effect acne has on each individual varies. The dermatologist needs to state that you realize living with acne as an adult is especially difficult. Dealing with acne and wrinkles at the same time seems intuitively unfair,” he says.

In addition, Dr. Berson tells patients what side effects they might expect. “They may experience redness, peeling, dryness and their acne may not improve for a few weeks. It is important to give the patients a realistic time-line for improvement; otherwise they may get frustrated and wonder why their acne is not better after 1 week.”

Compliance is an Issue

The issue of compliance, or lack thereof, was another question asked by the Skin Matters Survey. While acne is very treatable, the survey found that 91% of dermatologists say patient compliance is a barrier to successful treatment. The survey also found that only 54% of adults with acne say they follow their skin treatment regimen exactly as prescribed.

“The survey demonstrates that adults have just as hard a time with treatment compliance as teens,” says Dr. Fried. “Help them to hang in there — and contrary to overnight internet wonders, our therapies will work well and long-term.”

To deal with the stress of acne, Dr. Fried also recommends non-pharmaceutical measures. “Progressive muscle relaxation, guided imagery, yoga and Tai Chi all can decrease stress and increase focus and control, leading to better compliance with treatment regimens.”

In Dr. Baldwin’s practice, adult patients are a bit more compliant than teens — but just a little. “Adults are more motivated, but they are also more frustrated,” she notes. “If you dry them out and make them flaky and red, you really lose them.”

To improve patient compliance, Dr. Berson recommends starting with the least complicated regimen. “I do believe the simpler you make the regimen, the better the compliance. And as the survey shows, “you need to spend a lot of time on the first visit explaining the nature of their condition and how to use the treatment correctly.”

 

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