Although more commonly talked about these days, adult acne still seems to have a stigma attached to it. In many of the consultations I have with clients, although some form of acne is definitely the underlying issue, they do not want to call it acne or say that they struggle with acne. Likely, this is due to the subconscious beliefs we have about acne. For example these beliefs could consist of, “you obviously are dirty and don’t take care of yourself”. While these statements are generally untrue for someone who is making an effort to find solutions to clear their skin, it is the perception we believe that the world sees and also affects how we see ourselves as adult women. After all, what woman wants to deal with breakouts and wrinkles at the same time?
The truth of the matter is that adult acne is much more common than you might think and is actually increasing. Clinical studies show that between 40-55% of the adult population are diagnosed with various grades of persistent acne. So, while you may feel like you are the only one, the increasing numbers will soon be the majority of adult women vs. a small minority. Believe it or not, I also have adult acne prone skin and at 41 years old, I wish I had known when I was in my 20’s what I know now about adult acne!
So, what causes Adult Acne?
While the root cause of acne is the same as teenage acne; pores that are genetically predisposed to malfunctioning (read more in What Actually Causes Acne), our hormones are the catalyst for the onset of active acne breakouts.
Adult acne is much more common in women than men since our hormones not only fluctuate throughout the month but can also dramatically change throughout our lives due to puberty and menopause but also birth control usage, pregnancy, stress and other factors that affect our delicate hormonal balance. This is why women see hormonal breakouts during that “time of the month” or how the skin seems to become clearer or worsen during different phases of life.
So, what are the reasons adult acne is on the rise?
While hormones and genetics are ultimately responsible for adult acne, there are other factors that are contributing to the increase and severity of adult acne.
Stress: Our fast-paced world is ever changing, and while innovation and technology has improved our lives greatly, it also has increased our stress levels, pressure to perform and multi-task like it is our crowning glory. If you think back to your childhood and what your mother’s life was like, it was likely much simpler than your daily hectic schedule.
I do believe as a society we have done an amazing job adapting to the ever-present stress in our lives to the point where most women tell me they are not very stressed (as again, there is also a weakness stigma attached to being stressed out). Therefore, we work very hard to suppress the feelings of being stressed, even though our body does sense it and reacts accordingly, often leading to increased headaches/migraines, restless or sleepless nights, suppressed immune system, digestive issues and as you may have guessed; hormonal fluctuations or even imbalances.
While it can be hard to quantify, stress absolutely contributes to adult acne since it greatly affects our hormones and their effect on the skin. In response to stress, our endocrine system secretes increased levels of cortisol and androgens which escalate our production of sebum (the oil our skin produces). Because our skin’s natural oil is the food which acne bacteria needs to grow and proliferate, stress literally adds fuel to the fire when it comes to acne breakouts.
I have also had numerous cases of adult women who suddenly have a massive eruption of severe and painful inflamed acne which seems to appear overnight. 9 times out of 10 this is due to a recent traumatic event or acute stress period of time which is jolting and sometimes altering to the body’s hormonal balance.
Reducing stress is essential to effectively managing adult acne which is why I advocate for stress reducing actions with all my clients. This can be unique to you and what helps you to relax and destress, but tried and true actions would be: regular exercise that you enjoy, fueling your body with nourishing food, time away from electronics/social media, quality time with friends and family, finding a hobby that inspires you or volunteering your time to a cause you are passionate about (which also increases self-esteem and happiness.)
Diet: As our world is becoming faster paced, so is the increase in the amount of convenience foods, fast foods and stimulants average Americans reach for to quickly (and usually mindlessly) fill our tummies and give us instant energy. While many do strive to eat a healthy diet, these quick fixes are commonly a vice that we tend to fall back on.
And if you think about it, there has been a significant increase of convenience foods over the years to the point that most of the shelves in the grocery store are filled with shelf-stable, processed foods. While moderation is key, processed foods are a major contributor to adult acne.
Processed foods have a high dietary iodine content which is how they are able to be shelf stable. While iodine is a mineral that is essential for healthy hormone production by the thyroid, an overabundance of it is problematic for those with acne prone skin. This is because the excess iodides are excreted through the sweat glands which are irritating/inflaming to the pore and create an acnegenic* response on the skin.
*Acnegenic = irritation/inflammation to the pore which is the ideal environment for acne to form. Comedogenic = ingredients that block/clog the pore and increase comedone formation.
Aside from processed foods, these foods are also high in dietary iodine and are significantly triggering to acne:
- Dairy (milk, cheese, yogurt/greek yogurt, butter/ghee, ice cream, etc.), whey and casein protein powders/bars, seafood (especially kelp, seaweed), vitamins containing iodine, “super green” supplements (vitamins/powders containing spirulina, chlorella, algae, kelp).
There are also foods that have a high androgen activity, the hormone that signals to the oil glands to produce more oil, which for those with acne prone skin, can trigger new breakouts. These are some of the most common foods that have a high androgen activity:
Sugar and foods with a high glycemic index are significant acne triggers and also a culprit to premature aging. When we consume sugar, the body produces the hormone, insulin, which leads to increased inflammation in the body, including the skin; leading acne to thrive in an inflamed environment. Also, when insulin spikes, it signals the oil glands to produce more oil which feeds the bacteria. Reducing your sugar intake and choosing complex carbs (like oats, whole grains, sweet potatoes, lentils and beans) will not only help with clearing the skin but also prevent premature aging as well.
Popular beauty supplements are a very common acne trigger among adult women. Biotin, which is marketed as a supplement for hair and nail growth, is a major acne trigger which leads to inflamed, cystic acne. While it used to be found in beauty supplements targeted for healthy hair, nails and skin, unfortunately, it is found in most multivitamins, prenatal vitamins, B-complex vitamins and even some protein powders and collagen supplements. Chances are, if you have a multivitamin at home, it most likely contains biotin...and if it does not, please email me as they are increasingly hard to find!
Hormones: As mentioned above, hormones are the catalyst for acne, but sometimes, there are other factors that can exacerbate the issue.
First, while birth control is commonly prescribed with the intention to clear acne, in many cases, it will do quite the opposite and increase inflamed acne for those who are acne prone. Birth control is typically either estrogen or progestin dominant with varying degrees of androgenic effects. Unfortunately, the low dose, low estrogen or progesterone-only types of birth control that are frequently marketed to clear the skin will actually be a major acne trigger (the low-dose, low estrogen versions of birth control where the ingredient Ethinyl Estradiol is lower than .035mg or progesterone only versions of birth control, such as IUD's or shots, "mini-pill" or implants.)
Disclaimer: Only you and your doctor can determine what form of birth control is right for you and your health. The above is simply information that you can use to initiate a conversation between you and your physician.
Another common treatment for adult acne is the androgen inhibiting medication called Spironolactone or Aldactone. While it makes sense for an adult acne sufferer to take a medication to target the androgen hormone, Spironolactone is essentially trading one hormonal imbalance for another. It works by blocking the effect of the androgen hormones on the sebaceous gland (oil gland) that is what produces the food source for acne bacteria to grow. But acne triggered by hormones is always caused by more than one hormonal imbalance in the body. So, by blocking the androgen hormones, it causes other hormonal imbalances (estrogen dominance) to become worse. Estrogen dominance is when estrogen is high relative to progesterone and will also contribute to the root cause of acne. So, while you many might experience some results from Spironolactone, it is fueling a different fire beneath the skin. When Spironolactone is discontinued, the acne will come back and ultimately make the breakouts worse.
Disclaimer: There are some serious side effects to be aware of. If you are taking spironolactone, be sure to have a conversation with your doctor about having your potassium levels checked regularly and your best options to prevent pregnancy as it can lead to birth defects.
In some cases, adult acne could be a symptom of an underlying health condition such as PCOS (polycystic ovarian syndrome) which is a condition that affects hormone balance. Women with PCOS produce higher than normal amounts of androgens which can lead to cystic acne, excessive hair growth on the face, weight gain and painful, heavy and irregular periods. If you feel that you have these symptoms, be sure to see your doctor for a proper diagnosis.
To combat hormonal breakouts, I am frequently asked about over-the-counter hormone balancing supplements, such as Diindolylmethane (or DIM for short). While this seems like a reasonable and easy solution, I have found that many of my clients have various hormonal imbalances that are contributing to their breakouts, as discussed above. So, before experimenting with over the counter, “one size fits all” supplements, if you believe you have a hormone imbalance, I highly suggest having your hormones tested by a specialist. This is important to first see if there is an imbalance, and if so, what the imbalance is and what is the correct way to rebalance the hormones.
Skin Care, Makeup and Hair Care: Certain ingredients in skin care products, makeup and hair care are notorious for triggering breakouts. And even though many skin care and makeup companies market their products as “oil-free”, “non-comedogenic” or “won’t clog pores”, unfortunately there are no regulations which need to be met in order to make these marketing claims, which means any product can use these terms as a selling point even if it’s not accurate.
While many prescription acne medications and clinical skin care products have hidden pore clogging ingredients (generally as emulsifiers), the rise of natural or “clean” beauty products has greatly contributed to the increase of adult acne as these trendy products are formulated with some of the worst pore clogging offenders such as coconut oil, argan oil, cocoa butter and many others.
In addition, while some ingredients do not clog pores, acnegenic ingredients trigger acne in a different way. Unlike comedogenic ingredients (which are ingredients that clog pores), acnegenic ingredients increase the risk of acne formation due to irritation to the pore/follicle. This would include common ingredients such as: sodium lauryl sulfate, sodium chloride, various forms of algae, some fragrances and most essential oils.
For my full list of pore clogging ingredients to avoid, please start with my online skincare consultation to troubleshoot your skin and uncover all the triggers that are contributing to your adult acne breakouts.
Skin Treatments and Tools: Most women with adult acne are constantly searching for and scheduling facial treatments to clear the skin, as well as purchasing DIY tools for home use. As if navigating comedogenic and acnegenic ingredients in skin care and makeup isn’t overwhelming enough, there are some popular skin treatments marketed for acne sufferers that will perpetuate new and ongoing breakouts.
Microneedling, Deep Chemical Peels and Ablative Laser Treatments: Although these treatments marketed as a treatment to fade acne scarring, as well reverse the signs of aging, unfortunately for those who are acne prone, it can create more problems than it solves. There are several reasons why:
- The treatment itself is very traumatic to the pores which can create an acneic response leading to new breakouts.
- Because of the trauma, you will have to discontinue any products with active ingredients, those that help to fight acne, until the skin clears. Since managing acne prone skin requires consistency with products that address the root cause of acne and control acne bacteria, this would be the equivalent of skipping your skin routine and new acne would begin forming again.
Dermaplaning or Face Shaving Tools: while this treatment to exfoliate the skin and remove vellus hair (peach-fuzz) from the face is permissible when the skin if fully and consistently clear, dermaplaning on active acne will spread acne bacteria around which significantly increases the risk of new acne formation. Also, many of the face shaving tools on the market, electric and single blade, will only lead to more inflammation on the skin due to the irritating friction it creates which triggers an acnegenic response. I suggest to all my clients to forgo dermaplaning or face shaving until the skin is fully clear for several weeks to minimize the acne triggering risk.
Gua Sha or Jade/Quartz Rollers: Although very trendy right now, Jade/Quartz Rollers or Gua Sha are not ideal for those who are acne prone since the pressure can potentially trigger new acne, especially deep, cystic acne. The reason is that there could be underlying breakouts forming and the pressure from rolling and massaging the skin can burst the follicle wall, infecting all the surrounding pores which leads to deep, cystic breakouts.
Skin Brushes: While skin brushes are marketed to "deep pore clean" the skin, not only does it underdeliver on that promise, but it also does more harm than good. Because of the sonic technology, it creates micro tears in the skin which spread acne bacteria around and creates a lot of inflammation in the skin. Overtime, this chronic inflammation can also age the skin more rapidly. The key to a thorough cleanse is to make sure you massage your cleanser on your skin for about 60 seconds using your fingertips and lukewarm water.
Although adult acne may be on the rise, and the contributing factors seem overwhelming, there are solutions to not only clear the skin but address anti-aging concerns as well. With our thorough online Skin Consultations, we are able to uncover all the factors that trigger acne as well as provide a customized skin care regimen to clear adult acne and scaring, brighten the skin and prevent premature aging.