QUESTION: I am a 39-year-old mother of two children aged 10 and eight years old. In the last two months, I had a sudden resurgence of acne on my face, especially on my forehead and chin, something which I have not suffered from since my teenage years.
It is quite alarming to me as I am not on any medication, am always careful with my diet and have not changed any skincare products.
I have tried drinking more water and applied over-the-counter acne ointment. None of it seems to help.
ANSWER: What you are experiencing is known as adult-onset acne.
While acne is typically associated with teenagers, what dermatologists are finding is that it is becoming increasingly common in women in their 20s, 30s, 40s and even 50s.
This is also shown in studies both in Asia and Europe.
It has been estimated that up to 50 per cent of women may be affected by acne at some point in their adult lives.
Adult acne tends to be very persistent, and it is typically associated with premenstrual flares.
Inflammatory lesions (red bumps and pustules) are common on the face and jawline, but may also affect the chest and back.
Comedones - whiteheads and blackheads - are also found.
There are several possible reasons for adult acne, including stress and fluctuating hormone levels. Women often experience these hormonal changes around their periods and after stopping birth control pills.
Excessive levels of androgen, which is a male hormone found in both men and women, can make acne worse because it stimulates oil glands and enhances the blockage of pores.
The majority of women have normal androgen levels, but your doctor may order blood tests if you have acne which is associated with excessive facial or body hair, or very irregular menstrual periods.
Genetic predisposition may also play a role.
Occasionally, acne is a side effect of some medications, but this is not relevant in your case.
Good skincare products should not cause acne to worsen, so look out for labels that state that they are non-comedogenic, non-acnegenic or oil-free.
As far as food is concerned, it has been found that a diet high in refined carbohydrates (sugars) is linked to an increased prevalence of acne.
Adult acne can be effectively treated, so you should see your doctor. Treatment includes topical medications, including retinoids and certain fixed-combination products, and oral medications for more severe cases, which include antibiotics and occasionally anti-androgens such as oral contraceptive pills.
Oral isotretinoin, a vitamin A-derivative, is effective for acne as well.
However, the patient should be carefully assessed and have a thorough discussion with her doctor before deciding on what medication to take.
Factors such as plans for pregnancy while on treatment, possible side effects and the existence of other medical conditions must be taken into consideration.
Do take note that treatment for acne often takes several months, and some form of maintenance therapy with topical medication is often recommended even after the active phase is over.
DR TAN HIOK HEE
Senior consultant dermatologist at Thomson Specialist Skin Centre
A version of this story was originally published in The Straits Times on April 5, 2016. For more stories like this, head to www.straitstimes.com/lifestyle.