Adult Acne: The Ultimate Guide

Adult acne is very prevalent. Researchers collier et al. found that about 50% of women in their 20’s suffer from acne and about 35% of women in their 30’s. In contrast to 42% for men in their 20’s and 20% of men in their 30’s [1].

However, you do not have to read scientific literature to find out adult acne is a real problem. You might be suffering from adult acne right now. If so this guide will be very useful to you.

This guide will help you alleviate or completely remove the causes and symptoms of acne.

Let’s dive right in.

What is adult acne

You can categorize acne in many different ways. For example, you have acne vulgaris, acne rosacea, acne conglobata, fungal acne, and many more. These are words to describe the type of acne.

However, when we’re talking about adult acne, we’re not necessarily talking about types of acne, but more about the age of the person that experiences the acne. A very simple definition of adult acne is:

Adult acne refers to people over the age of 21 who still suffer from acne breakouts.

The most common form of adult acne is acne vulgaris and it refers the whiteheads, blackheads, pustules, papules and nodules. When we’re talking about acne conglobata we’re talking about inflammatory and painful cysts. Since 99% of the people reading this article are going to be suffering from either vulgaris or conglobata, the rest of this guide is going to be focused on these forms.

What causes adult acne

We know that teen acne is heavily associated with hormones, since adolescence is a time wherein hormones go haywire. But adult acne on the other hand can be caused by a number of different factors.

This is the main reason that people often have a hard time dealing with adult acne. Addressing a single factor (such as hormones) might help a little bit, but won’t get you clear completely.

However, when you take a holistic approach, you stand a very good chance of getting clear completely. So before we get to the step by step approach on how to get rid of adult acne, let’s look at how pimples actually form on the skin.

For microcomedos (whiteheads & blackheads) to form 1 thing need to happen:

  • There must be a clogged hair follicle, due to abnormal skin cell functioning or hyperkeratinization.

When a hair follicle gets clogged partially due to abnormal skin cell production and shedding, the sebum is trapped in the hair follicle which results in those lovely blackheads. When the hair follicle is blocked entirely we’re talking about a whitehead. Now, these two types of comedones can be a pain but this is not the end of the story.

When a hair follicle is blocked entirely the hair follicle fills up with sebum, and this allows the bacteria P. acnes to thrive. That’s because the environment that is created in a clogged, sebum-filled hair follicle is oxygen-free and lipid-rich. So what happens next is that the bacteria P. acnes interact with the lipids (which are fats) in the sebum and this eventually (through lipid peroxidation) causes inflammation. When this whole process is done, you can call yourself the proud owner of an inflamed pimple (pustule, papule, nodule, or even cysts).

Now if you were paying attention, you noticed a whole host of problems started with 2 simple steps: clogging of the hair follicle and overproduction of sebum.

So naturally we need to know what causes this clogging and overproduction of sebum, to get rid of adult acne entirely.

Like we stated before a number of different factors can be the root cause, including oxidative stress, hormones, mental stress, diet, skin & hair products, and medicine.

The effects of oxidative stress on the epidermis

Oxidative stress is one of the most important factors when it comes to adult acne. The concept was first introduced by Allan Lorincz in 1965. He suggested that acne formation is likely caused by free radical damage to the lipids (fats) in sebum. Now to keep everything simple and clear I’m going to use an analogy.

Your hair follicle has sebaceous glands that produce sebum. You can think of sebum as the lubrication for your skin which keeps your skin healthy and supple. Now through things such as UV radiation and harmful chemicals this lubrication can become “toxic”. This toxic state creates free radicals that can be compared to a bunch of violent thieves in your skin. These thieves steal vital nutrients from your skin and cause (oxidative) damage. These thieves cause such a ruckus that the skin cells stop working properly and a comedone starts forming.

To combat the violent thieves your body has a trick up its sleeve. The body produces inflammation to protect itself from the free radicals. While this inflammation can be considered a good thing and protects your body from harmful stimuli, it’s basically fighting fire with fire. That’s because the immune system also produces “reactive oxygen species” or free radicals at the site of inflammation which causes oxidative damage. [1]

So to summarize, the free radicals are the bad guys because they cause oxidative stress and tissue injury. That’s why it’s so important to have antioxidants in the body. These antioxidants basically keep the thieving free radicals happy by donating their own electrons, which neutralizes the free radicals and stops them from hurting other cells.

Unfortunately people who have acne have lower levels of antioxidants. For example one study showed:

  • Acne sufferers have 65% Less Beta-carotene,
  • Acne sufferers have 45% less Vitamin E,
  • Acne sufferers have 40% less vitamin C,
  • Acne sufferers have 33% less vitamin A,

Chemicals such as benzoyl peroxide are known to strip the skin of important antioxidants such as vitamin E. A single use of benzoyl peroxide can deplete vitamin E in the skin by 93.2% [2].

So inflammation and oxidative stress can clog pores and are one part of the adult acne equation, but it doesn’t stop there.

The effect of hormones on the skin

Androgens (which are male sex hormones) are very important in the acne formation process. The androgens testosterone and dihydrotestosterone (DHT) are the main culprits when it comes to pimples. They directly impact the size of sebaceous glands and the amount of sebum that is produced [3].

Now, this overproduction of sebum is negative in many different ways but especially because:

  • Sebum is sensitive to oxidative stress which results in blockages and inflammation,
  • Sebum has the lipids that the bacteria P. acnes needs to thrive.

And like you already know by know both these things can lead to acne or to a worsening of existing acne.

So it seems everyone should do a blood test to check if hormone levels are in balance right? Well not exactly…

It turns out your skin has so-called “precursor hormones” like DHEA and DHEAS. These precursor hormones get converted into testosterone and DHT by enzymes in the skin. So your blood hormone levels may be perfectly fine, but the problem lies in the pre-cursor hormones in the skin.

One study found that 7 out of 9 women that supplemented with DHEA started developing acne. Which subsided once the supplementation stopped [4].

Now here’s the interesting part. It turns out the hormone insulin (and insulin-like growth factor 1 “IGF-1”) has a huge impact on the way DHEA gets converted into testosterone and DHT. This directly links hormonal acne to diet, since diet can spike insulin levels. This brings us to the next part of the adult acne equation.

The effect of diet on bumps

Diet is the single most important factor when it comes to acne. Up to a few years ago, most dermatologists claimed there was no direct connection between diet and acne. However, more and more research now suggests the complete opposite [5].

We know that hormones in the skin influence sebum production. We also know that the hormone insulin (and IGF-1) directly influences at what rate precursor hormones get converted into testosterone and DHT.

Since highly refined carbs, and sugary foods & drinks spike insulin levels, we can see how junk food causes acne. The whole process can be summarized as follows:

Highly glycemic foods -> Spike insulin -> Release of IGF-1 -> More DHEA produced by the liver -> DHEA gets converted into Testosterone and DHT in the skin -> Overproduction of sebum -> Pimples.

Now if this whole hormonal aspect to diet wasn’t enough, there’s also the fact that your diet heavily influences your gut health.

The effect of the gut on acne

In western societies, we are often confronted with highly processed and sugary foods. These foods give us a few minutes of “mouth pleasure”, but afterward continue their journey into our stomach and gut to wreak havoc.

Sugary foods are bad in the sense that they feed bad bacteria in the gut while starving good bacteria. There are several interesting studies such as the one done by Parodi et al. that show small intestinal bacterial overgrowth (SIBO) directly contributes to acne (acne rosacea in this instance) [6].

Moreover, the “leaky-gut” theory is gathering progressively more support. It states that certain foods can damage the “gut lining” which keeps toxins and food particles out of the bloodstream. When this barrier is compromised, toxins, bacteria, and undigested food particles enter the bloodstream and activate the immune system’s inflammatory response.

When inflammation becomes systemic, it can influence the body’s ability to respond to insulin properly. And as you know by know insulin is one of the most important factors in the creation of acne.

So diet heavily influences gut health, and the gut in turn influences acne through several different pathways, including bacterial overgrowth and inflammation.

Similar to diet, there’s another factor that can influence gut and skin health.

The effect of stress on pimples

There are several different studies that look at how the skin functions under stress. For example, a 2001 paper by Garg et al. shows damaged skin recovers significantly slower when someone is stressed [7]. So we already know this can be very problematic when we try to heal from acne.

But stress is not only something that prevents the skin from healing, it also plays a big role in acne formation itself. Several studies show stress has negative side effects such as inflammation [8,9], gut problems [10], and hormonal problems [11]. As we talked about before, all three of these factors can cause acne and pimples.

So addressing each of these factors on their own won’t help as long as the underlying stress hasn’t been dealt with.

Lastly we’ll briefly touch upon an “often left out” subject.

The effects of medicine on acne

You might be doing everything right. You’re completely zen, you don’t have hormonal issues, you don’t have gut problems and your eating an anti-inflammatory diet, but still you have acne. The most common reason for this to happen is because of the effects of certain medicine.

Medications such as hormonal creams, orticosteroids, anticonvulsants, lithium barbiturates, steroids, DHEA, and bromides or iodides can all cause acne.

So taking all this into account, what can we do?

How to get rid of adult acne

Getting rid of adult acne is relatively simple once you know where to look.

We’ve looked at the 5 most important factors when it comes to acne

  • Hormones
  • Inflammation
  • Gut health
  • Stress
  • Medicine

So getting rid of adult acne is as simple as addressing each of these factors in a holistic manner.

We know certain actions cause a domino effect leading to acne. For example, stress and bad diets lead to inflammation, gut problems, and hormonal issues.

So you should take a 2 step approach

  1. First you reduce stress and improve your diet to prevent the cascading negative effects.
  2. Second you support your body with supplements and skin products to balance your hormone levels, heal your gut and reduce inflammation.

A ton of papers show that meditation drastically reduces stress (personally I like to use the “sadhguru app”) [12]. So once you’ve managed stress levels you can continue to improve your diet by avoiding all refined grains, heavily processed food and added sugars. Lastly you can continue healing your body by using proven acne products.

That’s how you get rid of adult acne!

Now I want to hear from you, what do you think of this method? Let me know in the comments section below.

References

[1] Collier, Christin N., et al. “The prevalence of acne in adults 20 years and older.” Journal of the American Academy of Dermatology 58.1 (2008): 56-59.

[1] Chatterjee, Shampa. “Oxidative stress, inflammation, and disease.” Oxidative stress and biomaterials. Academic Press, 2016. 35-58.

[2] Weber, Stefan U., et al. “Topical α-tocotrienol supplementation inhibits lipid peroxidation but fails to mitigate increased transepidermal water loss after benzoyl peroxide treatment of human skin.” Free Radical Biology and Medicine 34.2 (2003): 170-176.

[3] Arora, Megha Kataria, Amita Yadav, and Vandana Saini. “Role of hormones in acne vulgaris.” Clinical biochemistry 44.13 (2011): 1035-1040.

[4] Gebre‐Medhin, Gennet, et al. “Oral dehydroepiandrosterone (DHEA) replacement therapy in women with Addison’s disease.” Clinical endocrinology 52.6 (2000): 775-780.

[5] Smith, Robyn N., et al. “The effect of a high-protein, low glycemic–load diet versus a conventional, high glycemic–load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial.” Journal of the American Academy of Dermatology 57.2 (2007): 247-256.

[6] Parodi, Andrea, et al. “Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication.” Clinical Gastroenterology and Hepatology 6.7 (2008): 759-764.

[7] Garg, Amit, et al. “Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders.” Archives of dermatology 137.1 (2001): 53-59.

[8] Pilger, Alexander, et al. “Affective and inflammatory responses among orchestra musicians in performance situation.” Brain, behavior, and immunity 37 (2014): 23-29.

[9] Rohleder, Nicolas. “Stress and inflammation–The need to address the gap in the transition between acute and chronic stress effects.” Psychoneuroendocrinology 105 (2019): 164-171.

[10] Konturek, Peter C., T. Brzozowski, and S. J. Konturek. “Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options.” J Physiol Pharmacol 62.6 (2011): 591-599.

[11] Ranabir, Salam, and K. Reetu. “Stress and hormones.” Indian journal of endocrinology and metabolism 15.1 (2011): 18.

[12] Mohan, Amit, Ratna Sharma, and Ramesh L. Bijlani. “Effect of meditation on stress-induced changes in cognitive functions.” The Journal of Alternative and Complementary Medicine 17.3 (2011): 207-212.

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