If you think that you have crossed your carefree teenage years that will set you free from those annoying acne zits, well, think again. Acne or pimples can continue to nag you even in your adult life. Adult acne, as it is medically termed, is acne persisting beyond the age of 25 or occurring for the first time after the age of 25.
What causes adult acne?
Adult acne, unlike its adolescent counterpart, has not yet been completely understood. Factors that have been implicated can often co-exist in the same person.
1. Women rule
Studies show that women suffer more from adult acne than men1. Hormonal imbalances, increased use of cosmetics and increased exposure to hot, humid environment during cooking can all contribute to the female preponderance.
2. Stress adds on
Stress has become the buzzword in today’s times. We are always on the go, chasing targets with chaos in our minds and wings beneath our feet. Prolonged stress has found to be a huge factor in causing adult acne, with 25-70 % of patients attributing stress as a cause for their acne across many studies2. Stress can be of varying types – personal or professional, but it will definitely show on your face as unwanted spots. Severe acne itself could add on to the stress thus compounding the problem.
3. Cosmetics and over the counter products
Both men and women are bombarded with cosmetic products of every type. From a simple face wash to an advanced anti-ageing cream, you are spoilt for choice. Choosing a product that does not suit your face can trigger or worsen adult acne. The same holds good for facials and spa therapies. Cream based products that could clog your pores and vigorous facial massage will worsen acne.
Skin lightening products that are a rage, especially in India and are easily available over the counter are implicated in a large number of adult acne cases. These products, overtly misused by both youngsters and adults, often contain a combination of a potent topical steroid like mometasone furoate along with lightening agents like hydroquinone and tretinoin. Long term use of this combination can lead to steroid induced adverse effects including severe acne.
4. Wrong diet
Going hand in hand with the current lifestyle is bad dietary habits. Lack of time to prepare fresh and healthy home-cooked meals is leading us to adopt unhealthy food habits. A diet with a high glycemic index can worsen adult acne. This includes rice, sweets, cakes, pastries, ice creams, chocolate and the like. A diet high in sugars will cause a sudden rise in insulin levels that leads to a cascade of events worsening acne. Milk and milk-based products are also shown to aggravate adult acne.
5. Hormonal imbalances
Polycystic ovarian syndrome (PCOS), a disorder mainly related to a sedentary lifestyle, is a major factor contributing to adult acne in women. This condition is associated with multiple follicles in the ovaries that leads to increased levels of the male hormone, testosterone and its byproducts, in the blood. This can not only lead to acne, but also cause hair loss, skin darkening and hirsutism. Adult acne can also be a sign of underlying androgen excess due to other medical conditions like late onset congenital adrenal hyperplasia. Your dermatologist may suggest blood investigations like serum free testosterone, dehydroepiandrosterone, follicular stimulating hormone, luteinizing hormone and prolactin to look for an underlying hormonal problem. A pelvic ultrasound may also be required.
Does adult acne look different?
Adult acne is more inflammatory and persistent in nature. If adolescent acne has more of whiteheads and blackheads, adult acne, on the other hand, has more inflammatory lesions called papules and nodules. These can often be painful. They can leave behind unsightly scars that can range from dark/ red spots to deep pitted scars.
Treatment of adult acne
Adult acne is more resistant to conventional treatment and has a higher chance of recurrence. If you are a woman of child-bearing age and are planning to conceive or if you are breast feeding, you will have to discuss treatment options accordingly.
1. Avoid triggers
Factors that could be triggering your acne like cosmetics, drugs and skin lightening creams should be strictly avoided. Avoid sun exposure if you feel that sunlight is worsening your zits.
2. Dietary modification
Have a healthy diet loaded with vegetables, fruits and fibre rich cereals. Avoid junk food and foods with a high glycemic index. Restrict coffee and tea to two cups a day.
Exercise helps in improving the overall health, elevates your mood and relieves stress. It also helps in hormonal regulation in PCOS and improves insulin resistance associated with this condition. 30-45 minutes of brisk walk or any form of aerobic activity is good enough to reduce adult acne.
4. Medical treatment
Antibiotics like doxycycline, lymecycline and azithromycin may be prescribed by your dermatologist to control inflammatory acne lesions.
Isotretinoin is a commonly prescribed medicine in moderate to severe cases of adult acne. However, the drug is teratogenic and is contraindicated if you are pregnant or planning pregnancy in the coming year. Women with adult acne should always make it a point to inform the dermatologist about their plans to conceive or if they are lactating.
Oral contraceptives are commonly prescribed if adult acne is associated with PCOS and patient shows other features of excess androgen levels. This, of course will not be ideal if pregnancy is being planned.
5. Chemical peels
Chemical peel is a clinic- based procedure in which an alpha/beta hydroxy acid is used to exfoliate the upper layers of the skin. It is especially promising in adult acne which is quite stubborn to treatment. Salicylic acid based peels are preferred as they can penetrate deep into the oil glands and cleanse them off the excess debris and bacteria. They are generally repeated once every 2 weeks for a total of 8-12 weeks.
Yoga and meditation are also advised in adults with chronic stress. In fact, any activity that alleviates stress and calms your mind can definitely help in reducing further outbreaks of acne.
With changing lifestyles, fast paced careers and sedentary jobs, more and more adults continue to struggle with acne even up to their 4 th decade. Adopting our grandparent’s lifestyles with plenty of fresh air, active and simple life and healthy, home cooked meals will help to keep this problem at bay.
1. Khunger N, Kumar C. A. A clinic-epidemiological study of adult acne: Is it different from adolescent acne?. Indian J Dermatol Venereol Leprol 2012;78:335-41
2. Goulden V, Clark S, Cunliffe W. Post-adolescent acne: A review of clinical features. Br J Dermatol 1997;136:66-70.