Adult acne: everything you need to know
Adult acne is a skin condition closely linked with emotional distress, and statistics suggest it’s on the rise. With stress, hormonal and environmental factors all playing a role in its development, it’s hardly surprising to hear that we’re experiencing a nationwide spike right now.
If you’re going through a bout of adult acne, know you are not alone – in fact, 15 per cent of adult women are estimated to have experienced the condition.
Here, the experts explain everything you need to know about adult acne, from the triggers that could be causing your breakouts to the best lines of attack – and the treatments that really work.
What is acne?
Simply put, acne is the result of a hair follicle that has become clogged. Dr Murad, board certified dermatologist and founder of Murad skincare breaks it down further:"Acne is an inflammatory response effecting the pilosebaceous apparatus, which is a hair follicle that goes into the skin. Surrounding the follicle is the sebaceous gland – this secretes sebum (an oily matter) to lubricate skin and hair. You can develop acne in places where these follicles are present – which explains why you don't get spots on your hands or fingers."
What are the main causes of acne in adults?
According to GP and holistic aesthetics specialist Dr Rabia Malik, acne in adults is often caused by hormonal changes, which lead to an increase in the production of sebum. “This can occur around various stages of the menstrual cycle, during pregnancy or as a result of certain conditions such as poly cystic ovarian syndrome,” she says.
Dr. Terry Loong, skin specialist at GetHarley and author of The Hormonal Acne Solution also believes hormonal fluctuations to be the root cause of most acne flare-ups, adding that “hormonal imbalance may cause the sebum to be stickier and thick, impeding the movement out of the pore lining, causing clogs.”
Acne can also be sparked by gut inflammation. “This is another common cause of acne in adults and can be due to a number of factors, including certain dietary triggers (such as gluten or dairy in those who might be intolerant),” says Dr Malik. “Although there is no conclusive evidence about the link between diet and acne, some studies have suggested that a high glycemic index diet may make acne worse, due to the impact of insulin spikes on other hormones.”
Of course, acne can be impacted by external factors as well, such as the products you apply topically. “Using certain skin products or cosmetics can also be a cause of acne in adults. For example, heavy creams or foundation that is not removed thoroughly can lead to blocked follicles,” says Dr Malik.
Are certain skin types more predisposed to adult acne?
“Oilier skin types are more predisposed to adult acne, because overactive sebaceous glands lead to a higher chance of follicles becoming clogged.
“Women are also more likely to have adult acne than men, primarily because of hormone changes related to the menstrual cycle and throughout life (particularly during pregnancy)” says Dr Malik.
Unfortunately, adult acne also runs in families. In 2018, a comprehensive study revealed previously unknown links between genetics and acne, suggesting that differences in hair follicle shape can influence the development of the condition.
Understanding the different types of acne lesion
Not all acne is equal, and there are in fact several different key categories of lesion. By identifying the one(s) you’re dealing with, you can better target your treatment.
“Acne occurs when the sebaceous glands (which are attached to hair follicles) produce too much sebum, causing the hair follicle to become blocked. If the blocked follicle is close to the skin’s surface, a whitehead forms and bulges outwards,” says Dr Malik.
Contrary to popular opinion, ‘blackheads’ are not caused by dirt becoming trapped within the pores. “Blackheads form when the plugged follicles open onto the skin, leading to oxidisation of melanin that results in a black appearance,” explains Dr Malik.
“Hair follicles can also become inflamed or infected by an overgrowth of normal skin bacteria, leading to papules, pustules, nodules or cysts,” she adds. Pauples are “raised areas of skin that are different in tone or texture,” while pustules are “bulging areas of skin containing a yellowish fluid.” Nodules appear as lumps growing beneath the skin, while cysts are “fluid-filled lumps just underneath the skin surface.”
The rise of maskne
When the pandemic took hold and mask-wearing became mandatory, a new beauty buzzword entered our lexicon. ‘Maskne’ refers to the development of breakouts around the mouth area and across the cheeks, and has affected many women who previously enjoyed largely clear skin. According to Dr Malik, this ‘maskne’ occurs “due to the combination of sweat, heat and pressure or friction on the skin, particularly for those who are wearing masks for prolonged periods of time.” She recommends avoiding foundation underneath a mask and cleansing skin as soon as possible after removing it for the day.
It’s also worth considering investing in a silk or natural-fibre mask, as they can be washed after every use and are largely more breathable than synthetic alternatives.
Tackling adult acne: the first steps
Rethink exfoliation
According to Dr. Malik, there’s one skincare trend in particular that is fuelling a spike in adult acne cases. “Recently, I’ve seen a lot more skin irritation due to over-exfoliation,” she says. “Skincare routines that lead to a disruption of the skin barrier can definitely trigger acne and breakouts. Using too many products, or using products with a very high percentage of active ingredients can lead to skin irritation.”
If you’re experiencing acne, ditch the alpha-hydroxy-acid exfoliating products in favour of something containing a poly-hydroxy-acid: with a larger molecular structure, these acids penetrate less effectively and therefore are easier for the skin to tolerate.
Similarly, Dr Loong also cites over-use of ‘active’ products as the cause of many self-inflicted acne cases. There is a tendency that I see with over-exfoliation, and using too many active ingredients too frequently, for the skin to become inflamed,” she says. The result of this is often a damaged skin barrier, which means an increase in sensitivity and inflammation: it’s a vicious cycle.
Address your diet
Dr Malik recommends aiming for a “low glycemic-index diet and eating more pre and probiotic foods to improve your gut health.” A probiotic supplement is also a good move: she recommends Symprove and Optibac. “Keeping a food diary can also help you determine if there are dietary triggers for your acne such as diary, gluten and sugar.” she adds.
Keep calm
Dr Loong also believes a spike in stress levels is contributing to the prevalence of adult acne cases today. “Stress affects our cortisol levels which, when consistently high, can increase inflammation, affect gut health and hormonal balance. What’s more, stress can disrupt sleep, prompt skin picking and increase food intolerances,” she says, adding that “stress tends to increase alcohol or caffeine intake, both of which can be dehydrating to the skin, so the skin compensates by producing more oil.”
Adult acne treatments – the in-clinic options
For acute acne flare-ups, you might want to consider enlisting the help of a professional. “I always recommend seeing a skin expert to help you devise the ideal home-care routine for your skin, and this can definitely be supported by in-clinic treatments,” says Dr Malik.
“Skin peels are some of my favourite treatments for adult acne because they are effective at unclogging hair follicles by dissolving dead skin cells and excess sebum on the surface of the skin,” she says. “Mandelic acid is effective for inflamed acne and salicylic-acid based treatments are particularly good for blackheads and whiteheads.”
While a face-to-face appointment may not be possible right now, many experts are currently offering virtual consultations, where personalised advice and topical prescriptions can be administered following a comprehensive video chat. Dr Loong offers 30-minute consultations via aesthetics platform GetHarley, while time with Dr Malik can be booked via her website.
Adult acne treatments – the at-home routine
According to Dr Loong, effectively managing adult acne requires a three-step programme. First, you must reduce the inflammation within the skin, which will “improve redness and restore the oil balance.” With inflammation managed, you can work to restore the stratum corneum (or skin barrier), and eventually encourage healthy skin regeneration, addressing scars left behind by previous breakouts.
“Finding the right cleanser is probably the most important first step, as it’s crucial to cleanse pores and prevent a build-up of sebum in the hair follicles,” says Dr Malik. While many teenage-focused acne lines eliminate excess oil with harsh astringents, adult skin is generally drier, so consider a gentle cream or milk that won’t over-strip the skin.
There are several stand-out ingredients to use on acne-prone skin, but it’s crucial to start slowly, especially with a product that is new to you. Dr Malik highlights salicylic acid to dissolve excess sebum from within the pores, as well as a night-time retinol to stimulate cell turnover. Dr Loong also rates niacinamide and zinc for their anti-inflammatory, barrier-building properties.
Of course, there are also ingredients it’s important to avoid. Olive oil, coconut oil and cocoa butter could potentially block the pores, making matters worse.
Ultimately, everyone’s skin is different, and getting to the root of your acne may be a lengthy process. While there’s no single route that leads everyone straight to clear, healthy skin, the principles of reducing inflammation and treating your skin barrier with kindness are universal first steps that everyone should employ.
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