I'm wondering if as adults, anyone else here has noticed major differences in *types* of acne they get as they aged. I thought I'd share my acne's "evolution" as time has progressed. I'm a female, so be forewarned that I might mention some woman issues here... Any males are free to share their experiences, though...
In my teens (12-20) my acne was mostly inflamed, filled with pus. Lucky me, I hit puberty early, and had acne about two years before most other people my age. I could sometimes get large, deep cysts. If I happened to have a "successful" extraction, the lesion would heal quickly and disappear.
My most common methods of treatment were antibiotics from the dermatologist, topical Azelex and Erygel. I was on amoxicillin, tetracycline, cephalexin, erythromycin-- if my dermatologist stopped an antibiotic, my acne would come back. I would get the worst acne around my nose, chin, forehead (T-zone) with breakouts on my back and chest as well. My skin was generally oily despite the weather, but it would heal relatively quickly. I rarely had allergic reactions, although I would occasionally get peeling from the topicals.
From ages 20-26, my skin was in a weird flux. I had lost a lot of weight around age 21 (too much) and my acne was better.. I had stopped having my period. Eventually I gained some weight back, and my period restarted. My skin went from the pus-filled, quickly healing acne to hard, numerous, deep tiny cysts that would not pop nor heal. They became more likely to grow on my neck, my jaw line. Antibiotics stopped working altogether. Topicals seemed to do nothing. Popping acne seemed to cause a vicious cycle, and the lesions would grow back after I thought I had "drained" them.
26-27, I had a brief vacation from acne while nursing my son. Note that I don't recommend getting pregnant to curb acne!
The bad skin came back shortly after I stopped nursing and resumed menstruating, and the tiny, hard, non-healing cysts returned. I did have the Mirena IUD put in, so I'm not sure if it aggravated my acne. My skin was drier and I had to be more careful about causing reactions with harsh cleansers. I had occasional scalp breakouts. My back became horrendous with numerous tiny pimples. My skin was oily during the summers, but still needed moisturizer at times.
Age 29, I had Accutane (with a different dermatologist, in a different state), and the acne disappeared until a month after I stopped. Still, the hard, numerous pimples. Fast forward two-three years. They were back in full force, deep, and one dermatologist described them as "tiny cysts". They became horrible around my jawline, my neck, and close to my ears. My current dermatologist (back in PA, where I live now) was puzzled after various other treatments and prescribed Accutane again. I had the Mirena taken out shortly after stopping the second round of Accutane.
Knock on wood, my acne hasn't been as bad as it was prior to my second round of Accutane, although it is far from perfect. As an adult, antibiotics seem to have no effect. The only useful treatments seem to be somehow linked to exfoliation (Tazorac, for example). It's as if my adult skin doesn't want to shed, my hair follicles constantly get plugged up, and this results in tiny hard lesions that never heal. I rarely (knocks on wood) get really huge painful cysts anymore-- just many small persistent, treatment-resistant ones.
I have to be judicious about what treatment I use when I break out. As a teen, I would repeat the same routine every day. As an adult, I can't be a robot when caring for my skin. Sometimes my skin requires milder cleansers like Mustela and Cetaphil-- other times I need more foamy cleansers to cut down on the oil. Sometimes I have to skip my topicals because my skin feels too raw or dry. Popping certain zits can be futile, since they inevitably grow back.
Any thoughts on acne differences as one gets older?