Ask A Dermatologist: Is Adult Acne on the Rise?

Acne is one of the most prevalent dermatological conditions worldwide, affecting millions of people across various age groups. Traditionally, acne is seen as a rite of passage through adolescence; a skin condition that tends to clear up as one transitions into adulthood. However, an increasing number of adults are grappling with this persistent issue well into their 20s, 30s, and beyond. This blog post will focus on adult acne, discussing its prevalence, root causes, and treatment options.

How Common Is Adult Acne?

Adult acne is more common than one might think. According to the American Academy of Dermatology (AAD), acne affects approximately 50 million Americans every year, and a significant portion are adults. Studies have shown that acne persists into adulthood for many people, with around 15% of adult women and 5% of adult men experiencing acne well into their later years.

Notably, adult acne is more prevalent among females than males. A study published in the Journal of the American Academy of Dermatology found that 45% of women aged 21-30, 26% of women aged 31-40, and 12% of women aged 41-50 had clinical acne. This trend can be attributed to various factors, including hormonal fluctuations, particularly those related to menstrual cycles, pregnancy, and polycystic ovary syndrome (PCOS).

What Causes Adult Acne?

There are multiple factors that can contribute to the development of adult acne. These factors range from psychological stress to the use of specific cosmetic products, dietary habits, and underlying health conditions.

Stress

The impact of psychological stress on acne is significant. Stress triggers the production of androgens and cortisol — hormones that stimulate the sebaceous glands to produce more oil — leading to clogged pores and breakouts. The COVID-19 pandemic, with its associated anxieties and disruptions to daily life, has exacerbated stress levels for many adults, potentially contributing to an increase in adult acne cases. A survey conducted by the American Psychological Association found that 78% of adults reported experiencing increased stress during the pandemic, which could have a direct impact on skin health.

Cosmetic Products

Certain cosmetic products can also be culprits in the development of adult acne. Products that are comedogenic, meaning they have the potential to clog pores, can exacerbate acne. Examples include heavy makeup, oil-based foundations, and certain hair products. It’s crucial for individuals prone to acne to select non-comedogenic and fragrance-free products to minimize the risk of breakouts.

Diet

Diet plays a notable role in acne development. Foods high in sugars and refined grains, such as white bread, pasta, and pastries, can spike insulin levels and contribute to inflammation and acne. Other dietary culprits include:

• Fast food: Often high in unhealthy fats and sugars.
• Chocolate: Although the evidence is mixed, some studies suggest that chocolate can trigger acne in certain individuals.
• Dairy products: Milk and other dairy products may influence hormone levels and potentially lead to acne.
• Refined sugars: Found in sodas, sweets, and other processed foods.

Underlying Health Conditions

More serious underlying health conditions can also cause adult acne. Endocrine disorders, such as PCOS, are known to cause hormonal imbalances that lead to acne. Additionally, conditions like Cushing’s syndrome and other hormonal disorders can manifest as persistent acne. It’s crucial for individuals with severe or resistant acne to consult with healthcare providers to rule out any underlying health issues.

How Is Adult Acne Treated?

Treating adult acne requires a comprehensive approach tailored to the individual’s skin type, severity of acne, and underlying causes. Here’s a detailed look at the various treatment options available:

Topical Treatments

Retinoids

• Derived from vitamin A, retinoids help to unclog pores, reduce inflammation, and increase cell turnover.
• Typically applied in the evening, starting with a lower concentration to minimize irritation.

Benzoyl Peroxide

• Benzoyl Peroxide kills acne-causing bacteria and helps to clear clogged pores.
• Available in various strengths, often combined with other acne treatments like clindamycin.
• Applied once or twice daily, can cause dryness and irritation, so it’s advisable to start with a lower concentration.

Salicylic Acid

• A beta hydroxy acid that exfoliates the skin and keeps pores clear.
• Found in over-the-counter cleansers, toners, and spot treatments.
• Can be used daily, but may cause dryness and peeling for sensitive skin.

Topical Antibiotics

• Reduce bacteria and inflammation.
• Often combined with benzoyl peroxide to prevent antibiotic resistance.

Oral Medications

Antibiotics

• Reduce bacteria and inflammation from within.
• Typically prescribed for moderate to severe acne, used for a limited period to avoid resistance.

Hormonal Treatments

• Particularly effective for women with acne linked to hormonal fluctuations.
• Birth control pills and spironolactone.
• Helps regulate hormones and reduce androgen production.

Isotretinoin (Accutane)

• Accutane is powerful oral retinoid that treats severe acne by shrinking oil glands and reducing oil production.
• Prescribed for severe acne that doesn’t respond to other treatments, usually taken for 15-20 weeks.
• Requires close monitoring due to potential severe side effects, including birth defects.

Procedures

Chemical Peels

• Use of chemical solutions to exfoliate and improve the skin’s texture.
• Performed by a dermatologist, can reduce mild acne and improve the appearance of scars.

Laser and Light Therapy

• Laser treatments and light therapy target acne-causing bacteria and reduces inflammation.
• Performed in a series of sessions, with minimal downtime.

Microneedling

• Involves tiny needles that puncture the skin to promote collagen production.
• Can improve the appearance of acne scars and overall skin texture.

Lifestyle Changes

Skincare Routine Adjustments

• Use skincare and cosmetic products labeled as non-comedogenic to avoid clogged pores.
• Cleanse the face twice daily with a mild, non-irritating cleanser.

Dietary Modifications

• Reducing intake of high-glycemic foods, dairy, and sugar can help manage acne.
• Drinking plenty of water aids in maintaining healthy skin.

Stress Management

• Incorporating stress-reducing activities such as exercise, meditation, and adequate sleep.

When to Consult a Dermatologist

Severe adult acne that does not respond to over-the-counter treatments or home remedies calls for a visit to a dermatologist. Signs that indicate the need for professional care include:

• Deep, painful cysts or nodules.
• Significant inflammation and widespread breakouts.
• Acne that causes emotional distress or affects daily activities.
• Persistent acne that does not improve with initial treatments.

How Are Acne Scars Treated?

Acne scars can be a lasting reminder of past breakouts and can significantly impact self-esteem. Treating acne scars often requires professional dermatological intervention. Some common techniques include:

• Dermal fillers: Used to raise depressed scars to the level of the surrounding skin.
• Laser resurfacing: Helps to smooth the skin and reduce the appearance of scars.
• Microneedling: Promotes collagen production to improve skin texture.
• Chemical peels: Remove the top layer of skin to reduce the appearance of scars.
• Subcision: A minor surgical procedure to release the fibrous bands causing the scars.

While acne is often thought of as a teenage affliction, it is clear that adult acne is a significant and growing concern. Understanding the prevalence, causes, and treatment options is crucial for managing this condition effectively. By addressing factors such as stress, cosmetic product use, diet, and underlying health conditions, individuals can take proactive steps toward achieving clearer, healthier skin.

Madeleine Gantz, MD, FAAD is a board-certified dermatologist. She has a diverse educational background, having received a Bachelor’s degree in mathematics from Lafayette College as well as a Master’s in nutrition from Columbia University prior to enrolling in medical school at Drexel University. Dr. Gantz is certified by the American Board of Dermatology and is a Fellow of the American Academy of Dermatology. She is committed to helping her patients look and feel their very best!