Adult acne: Understanding underlying causes and banishing breakouts

"I'm not a teenager anymore, why do I still have acne?!" This is a question we hear from patients on a daily basis. The truth is, it is quite common to see acne persist into adulthood. Although acne is commonly thought of as a problem of adolescence, it can occur in people of all ages.

Adult acne has many similarities to adolescent acne with regard to both causes and treatments. But there are some unique qualities to adult acne as well.

What causes adult acne?

Adult acne, or post-adolescent acne, is acne that occurs after age 25. For the most part, the same factors that cause acne in adolescents are at play in adult acne. The four factors that directly contribute to acne are: excess oil production, pores becoming clogged by "sticky" skin cells, bacteria, and inflammation.

There are also some indirect factors that influence the aforementioned direct factors, including

• hormones, stress, and the menstrual cycle in women, all of which can influence oil production
• hair products, skin care products, and makeup, which can clog pores
• diet, which can influence inflammation throughout the body.

Some medications, including corticosteroids, anabolic steroids, and lithium, can also cause acne.

Many skin disorders, including acne, can be a window into a systemic condition. For example, hair loss, excess hair growth, irregular menstrual cycles, or rapid weight gain or loss in addition to acne, or rapid onset of acne with no prior history of acne, can all be red flags of an underlying disease, such as polycystic ovarian syndrome, or other endocrine disorders. Tell your doctor if you are experiencing additional symptoms; he or she may recommend further evaluation.

How can I prevent breakouts?

Like most things in life, acne is not always completely in one's control. There are, however, some key tips we offer to help prevent breakouts:

• Never go to bed with makeup on.
• Check labels: when purchasing cosmetic and skincare products, always look for the terms "non-comedogenic," "oil-free," or "won't clog pores."
• Avoid facial oils and hair products that contain oil.
• Some acne spots are not actually acne but are post-inflammatory pigment changes from previous acne lesions or from picking at acne or pimples. Wear sunscreen with SPF 30+ daily, rain or shine, to prevent darkening of these spots.

There is some evidence that specific dietary changes may help reduce the risk of acne. For example, one meta-analysis of 14 observational studies that included nearly 80,000 children, adolescents, and young adults showed a link between dairy products and increased risk of acne. And some studies have linked high-glycemic-index foods (those that cause blood sugar levels to rise more quickly) and acne.

With that said, it's important to be wary of misinformation about nutrition and skin. As physicians, we seek scientifically sound and data-driven information; the evidence on the relationship between diet and acne is just starting to bloom. In the future, the effect of diet on acne may be better understood.

What are the most effective treatment options?

The arsenal of treatment options for acne treatment is robust and depends on the type and severity of acne. Topical tretinoin, which works by turning over skin cells faster to prevent clogged pores, is a mainstay in any acne treatment regimen, and has the added bonus of treating fine wrinkles and evening and brightening skin tone. Isotretinoin (Accutane, other brands), taken by mouth, is the closest thing to a "cure" for acne that exists and is used to treat severe acne. Women who can become pregnant need to take special precautions when taking isotretinoin, as it can cause significant harm to the fetus.

For women with hormonally driven acne that flares with the menstrual cycle, a medication called spironolactone, which keeps testosterone in check, can be prescribed. Oral birth control pills can also help regulate hormones that contribute to acne.

In-office light-based treatments, such as photodynamic therapy, can sometimes help. Chemical peels, also done in-office, may help to treat acne and fade post-inflammatory pigment changes.

Simple, non-irritating skin care products are important for anyone with acne. Choose products that are gentle and safe for skin with acne, and eliminate products that are harsh and can make matters worse. It's also important not to squeeze or pick at acne lesions, as that can worsen discoloration and scarring.

With proper evaluation by a board-certified dermatologist and commitment to a treatment regimen, almost all cases of acne can be successfully treated. After all, adulthood is stressful enough without breakouts!