I’m an Adult. Why Am I Still Getting Acne?

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Acne image
Acne image

There’s always a reason things happen, Meanwhile, there’s a reason acne is synonymous with awkward teenage years.

Acne occurs when your hair follicles become plugged with oil and dead skin cells. It often causes whiteheads, blackheads or pimples, and usually appears on the face, forehead, chest, upper back and shoulders. Acne is most common among teenagers, though it affects people of all ages.

Roughly 95 per cent of pubescent teens and tweens deal with breakouts, But the idea that pimples vanish after puberty is a myth. “It’s amazing to me that patients still come in and tell me they’re surprised to hear that acne persists into adulthood,” says Adam Friedman, MD, professor and interim chair of dermatology at the George Washington University School of Medicine and Health Sciences. “For a lot of people, especially women, acne is a chronic disease.”

While it’s true that acne is less common among adults than it is among teens, more than half of twentysomething women (and 42 per cent of men) suffer from acne.

“Acne is an inflammatory disease in which the immune system gets turned on inappropriately.”

“Young men tend to get [acne] more severely than young women because they’re more oily and producing more testosterone,” says Diane Berson, MD, an associate clinical professor of dermatology at Weill Cornell Medical College. “But once men are clear, they tend to stay clear.” Women, on the other hand, can experience flare-ups throughout adulthood, she says. Why? “Any kind of hormonal change or fluctuation can trigger a breakout in someone who is predisposed to the condition,” Berson says. And that’s a lot of people.

Forget the stuff you learned as a kid about “dirt” clogging pores and causing pimples. While that can happen, Friedman says persistent acne has little to do with filthy skin. “First and foremost, acne is an inflammatory disease in which the immune system gets turned on inappropriately,” he says.

The oil-producing glands in your skin — the sebaceous glands — are “immune organs,” meaning they can regulate inflammation, Friedman says. An acne patient’s immune system seems to misidentify some types of harmless skin bacteria as threats. And this misidentification causes the sebaceous glands to overproduce both oil and inflammation-stoking signals, which contributes to the formation of swollen, puss-filled pimples, he explains. Hormone fluctuations seem to make these sebaceous glands even more sensitive — and therefore more prone to inflammation and subsequent breakouts, Friedman says.

All this helps explain why additional cleansing or moisturizing may not clear your complexion. “Overwashing and facials can irritate the skin, which makes the inflammation worse,” Friedman says.

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While endocrine disorders (or steroid use) can cause hormonal shifts and acne breakouts in men, a woman’s menstrual cycle can trigger recurring acne up to and through menopause, Berson says. Pregnancy, going off birth control, and any other change or condition that affects a person’s hormones can also instigate a breakout, she says. Friedman says those taking testosterone treatments during gender reassignment therapy are also at risk for “really horrific” breakouts.

When it comes to treating adult acne, expert advice varies a lot depending on the person and the severity of their pimples. “The first step is to create a skin regimen that’s simple and not overwhelming,” Friedman says. That usually means a gentle cleanser, used once or twice a day, followed by an oil-free moisturizer.

“Eating healthy won’t get rid of acne, but it can help.”

If you’re prone to acne, facials and abrasive scrubs can irritate the skin, Friedman says. Stress and some foods can also cause or contribute to inflammation. Anything high on the glycemic index — so soda, candy, white potatoes, white bread — those can be pro-inflammatory,” he says. “Eating healthy won’t get rid of acne, but it can help,” he adds.

Friedman adds that an ounce of prevention is worth a pound of cure. Topical retinoids and anti-inflammatory creams can help keep acne-causing inflammation under control, he says. “But smearing benzoyl peroxide on your face probably won’t do much for you,” he adds. “Once an acne lesion is present, the only thing that will get rid of it quickly — like within 24 hours — is a shot of a steroid.”

These shots knock out the redness and swelling that are hallmarks of inflammation and that tends to make acne blemishes look big and angry, Friedman explains. But they’re a temporary fix — the kind of thing that can be helpful the day before your wedding or some other event when you need to be clear. They do nothing to prevent future breakouts.

There’s no one-size-fits-all treatment for adult acne, Berson adds. “I say start with a visit to a dermatologist because there are so many things out there that may or may not provide improvement.” Along with ruling out or pinpointing hormone-related triggers, “we need to find which ingredient or formulation or treatment vehicle works best, and this is really an individualized approach,” she says.

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