Here, we dive into what adult acne is, what makes it different, how you can tend to it naturally—and why it’s very closely related to your hormones. What causes acne? Now that’s a hard question to answer, most derms note. See, there is a genetic link with acne2—meaning, you are more likely to have it if someone in your family did or does—but what actually triggers an individual to develop the condition remain somewhat a mystery: Some people are affected more by diet, others respond to external aggressors like an irritating face product; some breakout from stress, others lifestyle habits are to blame. Given the root causes are varied and not totally clear, there is no correct way to treat acne as a whole, given that each case is highly individualized and likely includes multiple confounding causes. Read: Your most effective acne-tending remedy might be different from another person’s. That’s OK. So onto the twenty-something-plus kind: Adult acne is simply a colloquial term used to describe acne when it happens to, well, adults. It is often referred to in the general population to as “hormonal acne,” but all acne is hormone-mediated to some degree. Adult acne does tends to have different triggers and appearance than acne that happens when you are a teen (more on that in a second). And, yes, it is totally possible3 to not have acne as a teen and then develop the condition later in life, although it is less frequent. All-in-all, the condition is completely normal and common: Reports show that half of all women in their 20s have acne4. And by the time women reach their 30s, a third report still having acne. (Even women over 50 still report having acne at a rate of about 15%.) And while men can have adult acne, it is far more prevalent in women than men. The prevalence of adult acne in women over men likely has to do with one of the triggers of acne: fluctuating hormones. Women’s hormones fluctuate more frequently, and given that hormones affect every aspect of your body, they also affect the skin. Here’s a summary from the American Academy of Dermatology of how hormones affect the skin as it relates to acne: Hormones can increase sebum production; they can affect how “sticky” skin cells are, making shedding the cells more difficult and leading to clogged pores; and they can cause increased overall inflammation. Board-certified dermatologist Jaimie Glick, M.D. agrees that together these form a one-two punch: Overactive sebum production means excess oil traps dead skin cells in our pores. This becomes an ideal environment for the rapid multiplication of the common bacteria that live on our skin. The result is pores that are very inflamed and can quickly become painful pimples. And to top it all off, your body may be less able to deal with existing acne and scarring when you’re really stressed. “[One study on stress and wound healing12] has shown that stress can slow down healing, which may worsen acne and acne scarring,” says Glick. Foods with a high glycemic index, notably, have a good amount of research to back them. Overconsumption of foods with a high glycemic load is also a main characteristic of a Western diet and is a key factor in acne development or severity15," says Molly Knudsen, M.S., RDN. “Blood glucose and insulin could affect the skin14 in a couple of different ways: First, this spike in blood sugar causes the release of insulin and insulin-like growth factor-1 (IGF-1). Insulin then stimulates the production of androgens (male hormones) that can then lead to higher sebum production in the skin, and then lead to acne. Secondly, high amounts of insulin in the blood before or after a meal may make the skin create more skin cells, making acne that’s already present worse.” Menopausal acne has more to do with the changes in the microbiome, since acne is highly influenced by changes in the makeup of your skin flora. “As our hormones diminish in menopause, the functions they perform to maintain the health and vitality of the skin diminish as well, characterized by a change in sweat, sebum, and the immune functions resulting in significant alterations in the skin surface including pH, lipid composition, and sebum secretion,” board-certified dermatologist Keira Barr, M.D., previously told us about menopause and skin. “These changes also provide potential alterations in the skin that may affect the skin microbiome.” After a pimple has come and gone, retinol can help decrease post-breakout scarring as well. In addition to exfoliating dead skin cells, retinoid blocks the activity of enzymes18 behind melanin synthesis, resulting in a more even skin tone. Salicylic acids are oil-soluble and can help break down and control oil production. AHAs, like lactic and glycolic, are chemical exfoliators that can help unclog pores, but tend to be less drying for sensitive skin folk. And there are plenty of botanical ingredients that help temper inflammation, namely antioxidants. “On Day 14 there is a surge in luteinizing hormone (LH), which not only harkens a rise in progesterone, but testosterone peaks at Day 14, and these two hormones both contribute to increased sebaceous gland activity and oilier skin including an oily scalp and greasy hair,” says Barr. “As estrogen levels are declining, there may be more inflammation, irritation, and disruption of the skin barrier and microbiome, which can also contribute to breakouts.” “If you’re breaking out, you may not be able to tolerate the treatments you used as a teenager because the skin is thinner and drier and the treatments may be too harsh,” says Barr. Instead, focus on supporting your skin barrier function (through things like peptides and ceramides), reducing inflammation in the skin, and keeping sebum production balanced.
