There is a great deal of information out there regarding adult acne; so much so that it is often incorrect and confusing. In this guide, we shall provide a clear and factual understanding as to why the adult skin breaks out and how to treat it, because adult acne can feel embarrassing and is often a painful condition. Many adults who break out in their 30s and 40s have, incidentally, never had acne in their teen years. Some teenagers, however, continue to breakout way past into their twenties and adulthood. A common misconception regarding adult acne is that the sufferer ‘lacks basic understanding and sophistication’ regarding skin care. However, many adult acne sufferers are known to religiously use the cleanse-tone-moisturize routine (using only noncomedogenic products), drink 4-8 glasses of water and herbal teas while strictly avoiding caffeine, remove makeup before bed, exercise regularly and even have fancy facials now and then. Despite this: why does adult acne occur?
Causes of adult acne
The facts and demographics surrounding adult acne have changed considerably over the years. If recent research is to be believed, this condition is becoming quite common all over the world. Not just women, men are also known to suffer from adult acne. Even women in their post menopausal stage are known to breakout on their chins, cheeks and foreheads. According to American Academy of Dermatology, adult acne affects nearly 40 to 50 million people.
To understand the causes of adult breakouts; let us first study what acne is.
Acne is also called zits, lesions, blemishes or pimples. In medical terminology, acne is referred to as comedones, pustules or nodules. Whatever fancy term you may use; acne begins at the pores. Pores are tiny openings on the skin. Tiny hair follicles that are lined by special cells called keratinocytes are present on all these pores. After their life cycle is over; the keratinocytes are shed off. The replacement and renewal of these cells occurs throughout our lives.
In case of acne prone skin; the pores become clogged with oil, dirt and sebum. As a result, the keratinocytes have no place to come out of and get logged in the mess. In some cases, the keratinocyte cells get exposed to oxygen and turn into blackheads (or non inflammatory acne). In case of adult acne, bacteria called Propionibacterium Acnes also get logged in the clogged pores and thrive and feed on the sebum produced by the skin’s oil glands. Overtime, the body’s immune system overreacts to this bacterium creating a fibrous scar tissue around the infection leading to red and angry looking nodules which dermatologists refer to as inflammatory acne.
Thus, the cause of acne is the same whether you are a teenager or an adult. The misbehaving keratinocytes are the sole culprit of this skin condition. In case of adults, the keratinocytes become even stickier owing to adult hormones. Adult hormonal imbalance, in turn, is a result of hereditary factors, stress and poor diet.
Hormones and adult acne
A group of hormones called androgens are mainly responsible for adult acne. These include:
All these effectively male hormones are the key players that lead to the worsening of adult acne. In case of children in the pre-puberty stage, these hormones are not produced in the testes or ovaries. (Hence, kids do not get acne). Once puberty sets in, the androgen production begins, the keratinocytes start becoming thicker and stickier (in some people) and adult acne develops as explained above. In short: adult acne is the body’s (or the pore lining cells’) abnormal response to minimally abnormal (or even) normal hormonal levels.
In some adults, the androgen levels shoot up abnormally. These patients, in particular women, also display symptoms other than adult acne including:
- Hair loss
- Scanty, irregular or heavy periods
- Excess facial hair
- Breast tenderness and discharge
- Deepening of voice
Stress as cause of adult acne
The direct link between stress and adult acne has been established by several studies (the main one having been published in 2003 by the Archives of Dermatology-Chiu and Kimball).
Stress can be considered as the body’s natural response to changes in one’s environment that lead to disruption in psychological or physiological well being of an individual. Physical stress can be caused when one is too hot, too cold, or overly exhausted. Relationship difficulties, job issues, loss of a friend or loved one, etc are the typical reasons behind emotional stress. Whatever the reason behind one’s stress, the body reacts by stimulating the ovaries, testes and adrenal glands to release androgens throughout the body. This, in turn, causes hormonal imbalances that affect the individual down to the hair follicle levels causing inflammation and adult acne.
If stress is the main cause of adult acne, it is vital to learn stress management techniques in order to control it.
Summary of Causes of adult acne
- Adult acne occurs due to the same reason as adolescence acne – the hair follicle lining cells respond abnormally to hormones called androgens leading to inflammation.
- The highly resilient and adaptive bacterium called P.Acnes thrives in the clogged hair follicles in an oxygen depleted environment. The body’s natural immune system reacts to this by creating a wall of fibrous scar tissue surrounding the inflamed hair follicle.
- Adult acne is more common in women owing to the hormonal changes triggered by pregnancy, delivery, menopause etc. Decreased estrogen production and subsequent rise in testosterone hormones nearing menopause leads to stickier keratinocytes. Women undergoing treatment for infertility may also suffer from acne, but this type generally resolves on its own when the treatment is stopped.
- Menopausal acne occurs when estrogen and testosterone production both go down. This adult acne type responds well to conventional treatment.
- Lesser known types of adult acne include acne fulminans and acne rosacea. In severe cases, prompt medical attention and treatment may be required for their resolution. Exact causes of both these kinds of adult acne need extensive investigation but are mostly believed to be byproducts of an over reactive immune system.
As is clear, adult acne has various causes and it is important to evaluate and diagnose it accurately in order to treat it.