Sarah Villafranco, M.D., is a natural skin-care expert and practiced emergency medicine for 10 years.
What is adult acne, and how is it different?
Acne vulgaris is a complex skin condition that occurs from increased sebum production, chronic inflammation, and the normal skin bacteria Propionibacterium acnes. Although P. acnes is a normal skin organism, it causes trouble when it gets trapped under the skin’s surface by causing increased inflammation, both on the surface of the skin and in the deeper layers. There is a genetic link with acne—meaning, you are more likely to have it if someone in your family did or does—but other triggers remain somewhat a mystery. Also unclear: how, exactly to treat acne, given that each case is highly individualized and likely includes multiple confounding causes.
Adult acne is simply a colloquial term used to describe acne when it happens to, well, adults. It is often referred in the general population to as “hormonal acne,” but all acne is hormone-mediated to some degree. Adult acne tends to have different triggers and appearance than acne that happens when you are a teen (more on that in a second). And, yes, it is totally possible to not have acne as a teen and then develop the condition later in life, although it is less frequent. All-in-all, the condition is completely normal and common: Reports show that half of all women in their 20s have acne. And by the time women reach their 30s, a third report still having acne. (Even women over 50 still report having acne at a rate of about 15%.) And while men can have adult acne, it is far more prevalent in women than men.
The prevalence of adult acne in women over men likely has to do with one of the triggers of acne: fluctuating hormones. Women's hormones fluctuate more, and given that hormones affect every aspect of your body, they also affect the skin. Here's a summary from the American Academy of Dermatology of how hormones affect the skin as it relates to acne: Hormones can increase sebum production; they can affect how "sticky" skin cells are, making shedding the cells more difficult and leading to clogged pores; and they can cause increased overall inflammation.
How can you tell you have hormonal acne?
There are a few ways to tell if your breakouts might be triggered by hormones:
1. Appearance and area can give clues.
Adult acne tends to look and appear different from breakouts you might get because you worked out in your makeup or because it's humid out. First thing to consider: the location. Hormonal acne appears around the chin area, jawline, and neck (and sure, this is suggested by face mapping, but research even suggests this). And while all acne is triggered by inflammation on some level, hormonal acne tends to show signs of that inflammation more aggressively: meaning it's red, tender, and puffy.
2. If it's timed around your period...
Do you tend to break out around your period? This is an incredibly common, and research-backed, phenomenon: According to this study, almost two-thirds of acne-prone women report having flares before or on their menses (more specifically in the "late luteal phase of the menstrual cycle," or after ovulation and right before you start bleeding). And while the exact mechanism of this is not confirmed, the most general understanding tends to be the increased presence of the hormone androgens, specifically DHEA-S, which stimulates the sebaceous glands to produce excess sebum.
3. If it comes from stress...
We know that hormones can be affected by internal and external factors: Research shows that stress changes the levels of the corticotropin-releasing hormone both in the blood and in the sebaceous gland itself, which doubly affects sebum production. In other words: Stress can cause more sebum production which can help create an ideal environment for bacteria to flourish on the skin). We also know from research that stress causes more inflammation in the body, including skin. The combination of these factors can cause hormone-related breakouts during times of stress.
4. If it's diet-related...
Adult acne can also be exacerbated by what you eat. For a few decades, dermatologists denied the connection between food and acne. Well, recent research has started turning the tide on this. Studies show that there's a connection between dairy—skim milk, primarily—and acne. Other studies show a strong connection between foods with a high glycemic index and acne symptoms. While the mechanisms for both of these food groups are different, the speculation is that the breakouts are caused by hormone responses.
How can you treat it?
First, consult with a professional about your acne treatments. (Although acne is non-life-threatening, the presence can affect a person's well-being. Studies show that those with acne experience anxiety and depression. And on a more superficial level, untreated acne and picking can lead to permanent scarring.) For more severe cases, they might recommend prescription topicals or oral medications.
At home, there are ingredients to try, based on your needs and tolerance. Retinoids (and their natural alternatives) increase cell turnover, making it more difficult for the cells to stick together and clog pores. Salicylic acids are oil-soluble and can help break down and control oil production. And there are plenty of botanical ingredients that help temper inflammation, namely antioxidants.
But, given everything we've learned about acne's hormonal triggers, you should also treat acne holistically. Consider whether food and stress are triggers. You can try putting yourself on a clear-skin eating plan, or at least limit dairy and foods with a high-glycemic-index rating. As for stress, we know that lowering levels of stress can be good for multiple factors—but we also know it's hard to do, so the best advice here is to try multiple modalities until you find one that is right for you. You can also visit a hormone specialist, if you think your acne warrants it.
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