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Your Skin Cares Series

Keeping Adult Acne Under Control: Answers to 5 Questions You Need to Know

If you’re dealing with acne well into your 20’s or 30’s or even 40’s, you’re not alone. And I’m sure you also have a laundry list of questions… probably starting with why me? I know it’s easier said than done but don’t worry. The clear skin you want is absolutely achievable, but it starts with being informed and working with your dermatologists to get the best regimen together for you. So, we’ve got answers to some of those questions that I’m sure are floating in your head.

WHY AM I DEALING WITH ACNE AS AN ADULT? 

We often think of acne as a teenage or puberty problem, and there’s a valid reason for it. ” During our teen years, our bodies have an upsurge of androgens, also known as “the male hormones, like as testosterone.” [FYI:  Don’t worry ladies, we all have a certain level of these hormones in our bodies….it’s perfectly normal. However, there are instances where some people have higher than normal levels, which warrants a full assessment from your physician)– but that’s beyond this conversation].
 
Essentially, these hormones crank up the skin’s sebum (or oil) production. For some, acne does clear in the early twenties, but for many people, the acne drama persists past the teenage years. We asked Dr. Tanasha Simela, a cosmetic and medical dermatologist and she shared that “adults can develop acne well into their 30s, 40s, and even 50s.”
 
According to the Journal of the American Academy of Dermatology, 54% of women above the age of 25 have some form of acne. To add to that, more and more people are getting acne for the first time as adults– this is what dermatologists call “adult-onset acne.” The way adult acne shows up is quite different compared to teenage acne. The breakouts happen more along the lower chin, jawline and neck areas (but of course, your dermatologist would be the best at defining this). 
 
Now, let’s couple the fact that adult acne can sometimes be challenging to treat with the unpleasant realities of dark spots from post-inflammatory hyperpigmentation that many women of color face. You get overbooked dermatologists and a lot of money spent skin care products at your Sephora’s and Walgreens. Why? PIH is one of the main reasons why most women of color with acne-prone skin seek out a dermatologist.

SO WHY DO WE GET IT?

Source: modified from drbimages / Getty
 
Well, we don’t fully understand why adult women develop acne, what we do know is that “adult-onset” acne is multifactorial” say Simela. She cited fluctuating hormone levels, stress, family history, medication side effects, and high glycemic index diets as common causes contributing to acne. Dr. Simela also shared over-cleansing can cause breakouts, which is typically overlooked as a causal factor. Sometimes counterintuitive, there are certain beauty, hair, and skincare products we use that can also cause or worsen breakouts. For example, using heavy, oil-based makeup and foundations on already oily or acne-prone skin types creates the perfect storm for breakouts. Certain hair care products are known to cause what’s called “pomade acne,” or breakouts around the forehead and temple areas.  
 
So as you can see, there’s no ONE way to treating adult acne. It requires a holistic approach and is very individualized— you have to look at everything, from diet to genetics to hormone levels and even your beauty and personal care habits. 

IS ACNE MORE PREVALENT IN SKIN OF COLOR? 

“I don’t think acne is more prevalent in women of color, but PIH is a common problem in skin of culture as a whole” Simela shared. In both men and women of color, the development of inflammatory acne lesions can often lead to PIH, scarring, and keloids, all of which adds another layer of complexity for treating acne in skin of color. 

HOW DO I GET RID OF IT?

Before listing skincare products, ingredients or even prescription options, let’s quickly review how the following four factors or changes in the skin contribute to breakouts. 
 
  1. Hyperkerinatization
    Usually, the skin cells that line the hair follicle shed and are brought to the skin’s surface by the sebum. When these dead skin cells don’t shed at the proper rate, they tend to stick together with the help of excess keratin, a natural protein found in the skin. This causes the follicle to be plugged/blogged or clogs the oil duct, leading to acne.
  2. Increased sebum production
    Our bodies naturally produce sebum or oils to lubricate our hair and skin. It made up of a combination of fats, lipid, wax, and squalene. Oil production is very normal, but people with acne-prone skin tend to produce more sebum, which happens to be an ideal breeding ground for overgrowth of the bacteria known to cause acne, P. acnes
  3. Excess P. acnes
    For the record, P. acnes found on the surface of our skin and in most cases causes no problem. In fact, certain strains of this bacteria help to protect our skin from being colonized by other bugs that can cause infections, etc. However, in an environment of increased sebum, clogged pores (which means limited access to oxygen), P. acnes flourishes (and not in a right way). 
  4. Inflammatory response
    The overgrowth of P. acnes causes the body to release white blood cells to fight the bacteria, which cause the inflammation associated with acne. This is what is called an inflammatory response. Dr. Simela adds that research shows that this elevated inflammatory response may be a significant reason why African Americans with mild to moderate acne still develop hyperpigmentation. 
Ok, now that you have a general understanding of what happens to the skin that leads to breakouts, let’s highlight some treatment considerations. (we’ll go into detail about treatment options in few other posts as part of the series). A well-round regimen is important and should target the different skin factors mentioned above as well as include products with anti-inflammatory properties. “Since there are many factors that can contribute to adult acne, it is imperative to visit a dermatologist so that together, an effective regimen can be created that fits your lifestyle,” Simela adds.  Dermatologists tend to use a combination of products, whether OTC or prescription, as well as topical and oral treatments. Additionally, products to reduce PIH are also important when creating a regimen for patients with skin of color. 

WHAT ELSE CAN I DO TO PREVENT OR KEEP MY BREAKOUTS UNDER CONTROL?

 
SAY NO TO STRESS AND GET YOUR BEAUTY SLEEP.
Well, we did mention stress contributes to acne– this is because when are stressed out, our bodies ramps up the level of the hormone, cortisol in our blood. This hormone, like testosterone, can increase oil production as well as inflammation. Additionally, cortisol levels tend to be higher in those who don’t get enough sleep. So reducing stress, chilling out and getting your beauty sleep can go a long way regarding minimizing breakouts.
 

CHECK YOUR DIET. PASS ON THE SIMPLE SUGARS AND DAIRY.
While the debate around the actual relationship between diet and acne is still ongoing, what we do know is milk consumption and foods with a high glycemic index are associated with acne. Studies have shown that high glycemic index foods cause excess insulin levels, which leads to changes in the circulating hormones that contribute to acne. Additionally, consumption of dairy and milk proteins (i.e., whey) are known to increase insulin levels and other growth-stimulating hormones, all of which play a role in the effects of androgens and sebum production, and ultimately acne. So, if you’re looking for ways to keep breakouts under control, skip the dairy, pass on the simple sugars and sweets (which can be very hard to do), and opt for diets low in saturated fat and high in whole grains, fruit, and vegetables. 

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