Over the age of 18 and still struggling with acne? Read our ultimate guide to adult acne and how to tackle it
Words Dr. Anjali Mahto, Consultant Dermatologist at the Cadogan Clinic
What causes adult acne?
Adult acne seems to be more prevalent over the last decade in dermatology outpatient clinics. It’s more common in women and consists of two subtypes: persistent acne (acne that continues from teenage years and fails to clear) and late-onset acne (first beginning after the age of 25 years). There is clearly a hormonal drive in women, and studies suggest that local disturbance in androgen hormones around the sebaceous (oil) glands has a role to play. Additionally, many individuals with adult acne are likely to have a family history of the condition. There is also growing evidence that dietary factors such as refined sugars and to a lesser degree dairy (in particular low-fat products) may also drive acne in select individuals.
Why do you think more and more people in their twenties and thirties are developing acne as adults?
Unfortunately, we don’t have a full understanding of the difference in the cause of acne in teens versus adults at this stage. Anecdotally, there seems to be data that suggests that acne is starting earlier and continuing for longer than previously noted. We are not entirely certain why this is the case. However, women are much more likely to suffer with acne during adulthood than men, probably due to their complex hormonal cycles which fluctuate due to things like inflammation and stress. Of note, women that develop acne for the first time as an adult are more likely to relapse or fail to respond to conventional acne therapies.
Is there any way to prevent it?
Although acne can strike unexpectedly and from unavoidable things such as hormone balance and a family history of the condition, it is important to have a good skincare routine and use cosmetic products that are non-comedogenic. Squeezing spots is always a bad idea as it can result in driving inflammation deeper into the skin and leaving permanent scars. Follow a nutritional diet with plenty of whole grains, vegetables and pulses. Stress can anecdotally also play a part in aggravating inflammatory skin conditions such as acne. Learn to de-stress and make sure you get enough sleep and exercise. Participate in activities such as yoga and meditation if this works for you.
What are the options for treatment?
There are various treatments for adult acne, so it’s best to visit your dermatologist to be advised of the most appropriate and effective for your individual needs. We’re able to offer a wide range of treatments including creams, antibiotics, hormonal treatments (spironolactone, cyproterone), lasers, chemical peels, and isotretinoin. We can also do some additional tests including blood tests to measure hormone levels or an ultrasound scan to exclude an underlying disorder such as polycystic ovarian syndrome, which may be driving hormonal acne. Steroid injections are a useful method for treating large, stubborn, solitary acne cysts, or if a rapid response is required like before an important social event. Steroid can be injected directly into the acne lesion and this results in flattening of the cyst within 42-72 hours. This procedure should only be done under the guidance of a dermatologist, as there are potential risks with the procedure if carried out in the hands of a non-specialist.
Does diet have an effect on acne?
There is emerging scientific data that consumption of foods with a high glycaemic index (GI) and certain dairy products (in particular, low-fat milk) can aggravate acne. These foods are rapidly absorbed by the body result in raised blood sugar or glucose levels. Raised circulating blood glucose levels promote the release of the hormone insulin and IGF-1 (insulin growth factor 1). Both of these increase oil or sebum production and act on the body to produce more male hormones known as androgens (both men and women have androgens). All these factors together are thought to promote the development of acne. Therefore, in some individuals, it may help to limit these types of food.
What skincare ingredients should those with acne-prone skin look out for/avoid?
Comedogenic ingredients are commonly found in make-up, suntan lotions and cleansers and consist of things such as cetylated lanolin, algae extract, algin, benzoic acid, cajeput oil, cetyl acetate and more. If any of these are within the first seven ingredients on the ingredient list of a product you are choosing, you may want to reconsider. If, however, any of these ingredients are far down on the list, this means the manufacturer may have included it in a very small amount and the product may still be safe to use. Watch the ingredients in your sunscreen – sometimes there are ingredients, such as lanolin that don’t have ‘oil’ in the name, but can still clog pores and cause breakouts anyway. The better term to look for is not only oil-free, but non-comedogenic.
What are your top skincare buys for acne-prone skin?
It’s important to choose a cleanser specially formulated for acne, such as Avene Cleanance Cleansing Gel or La Roche-Posay Effaclar Foaming Gel Cleanser. After cleansing, use a light gel-based moisturiser that is “non-comedogenic” (i.e. prevents the formation of blackheads), such as Neutrogena Oil-Free Non Comedogenic Moisturiser. Even oily skin needs moisturising as oils do not equate to hydration!