Expert Spotlight

Dr Greg Goodman
Associate Professor

Acne in adulthood and acne scarring
Consultant dermatologist with the Dermatology Institute of Victoria, and the Skin & Cancer Foundation of Victoria

Most of us have had acne during our teenage years. However, despite having had an acne-free youth, some women may find themselves affected by acne well into their adulthood.

“Acne tarda is a type of persistent acne, which peaks at age 28, and affects mainly women,” explained Dr Goodman. “Unlike the usual acne pattern, acne tarda tends to affect the jawline, upper neck and chin, and is often cyclic. It’s responsive to antibiotic treatment and hormonal therapy.”

Treatment for acne in older women

Hormonal therapy

Hormonal therapy includes low-dose contraceptive pills and anti-androgen pills. The anti-androgen pills block the male hormone androgen, thereby blocking excessive oil production by the oil glands.

Antibiotic therapy

Antibiotics can be used directly on the skin for acne. They may be used topically as solutions, creams or gels, or taken by mouth. Topical antibiotics are applied all over the affected area, not just as spot treatments.

Photodynamic therapy

In photodynamic therapy, a chemical called ALA is applied to the skin and then light or laser light is shone on the skin. This sets off a process that ends in killing the bacteria or the sebaceous gland that causes acne.

Acne scarring

Dr Goodman describes acne that causes scarring as almost “a dermatological emergency”. If acne is causing scarring, it has to be treated aggressively to bring it under control before the scarring is addressed. Many procedures are available to address scarring and the procedure selected for a particular patient depends on a number of things, including the type of scarring, where it has occurred and whether the patient is male or female.

Indented scars

If there are one or two indented scars, fillers may be used to raise the scar. Scars on the chin and the forehead – areas where muscles draw in the skin – can also be treated.

Fractionated resurfacing is another technique that can be used to deal with more extensive scarring. As Dr Goodman explained, it involves “driving tiny holes into skin, removing a cylinder of tissue where the scarring is, and leaving gaps between those holes.” Hence, the treated area heals as multiple pinpricks rather than as a large wound.

Repeated over several times, the gaps between the holes are filled in, and the end result is a deep resurfacing. In terms of downtime, the fractionated resurfacing procedure involves about two days of redness whereas there is generally no downtime associated with dermal filler treatment. There are many other treatments that depend on the type and severity of the scarring.

Thickened scars

Some acne scars, especially those on the jawline, neck, chest, back or shoulders, are thickened or raised rather than indented. These may be treated with blood vessel lasers or sometimes with injections of some types of steroids.  

Seeking treatment

An initial consultation for acne scars typically involves assessing the patient’s scar and other factors that impact on treatment such as the patient’s preferences, location and affordability issues. The treatment plan should also be worked out in the consultation, Dr Goodman said.