When most us think about those affected by acne, we think about middle school, high school, or even college-aged kids. Speaking from personal experience, when I learned about acne, it was in the context of puberty, and therefore, it was implied that once puberty was over, breakouts would cease to exist. This isn’t wholly inaccurate, as 85% of Americans between the ages of 12 and 24 struggle with acne. But it's also not the full truth. Acne does not necessarily stop when you reach a certain age.
The Rise in Adult Acne
Dermatologists have seen a growing number of patients in their 30s and 40s with acne, which leads them to believe that acne can occur at any stage of life. (So yes, I’m sorry to say that it is possible to be dealing with acne and wrinkles at the same time!) According to the American Academy of Dermatology, up to 15% of U.S. adult women struggle with acne, and that percentage has been increasing over the years. Other sources say 40-55% of adults have persistent acne.
George Washington University School of Medicine dermatology chair Dr. Adam Friedman shared that he treats more adult acne patients than teens, and they are “mostly women in the 30 to 50 age range.”
“Acne is not just for teens – there are extraordinary numbers of adults with acne, and the numbers seem to be going up,” said Dr. Friedman.
So why the sudden surge in acne?
Dermatologists and lab scientists have very few confirmed causations to point to when it comes to acne, especially adult acne. Research has proven that acne arises when pores become clogged, typically with oil (known as sebum) or dead skin. But the deeper-rooted causes behind clogged pores are difficult to pin down. Scientists have found connections between acne and hormonal fluctuations, which is presumably why adult women struggle with acne more often than adult men. Additionally, certain makeup and skincare products are known to clog pores due to their comedogenic components, like lanolin, benzaldehyde, beeswax, and more.
Some dermatologists theorize that acne products such as face washes, serums, creams, face masks, etc. can be partially blamed for this upward acne trend. Treatments like salicylic acid, benzoyl peroxide, and antibiotic creams are relatively new to the skincare scene, and their usage has grown alongside the rise in acne. It’s possible that these products cause imbalances in the skin’s microbiome. Doctors have discovered that certain bacterial strains are beneficial to the skin barrier, so when using harsh antibiotics, the skin can become vulnerable and susceptible to germs. Additionally, over-washing has been known to dry out the skin and cause acne.
Dermatologists used to believe that curing acne was just about eliminating oil, but it’s really about balancing the bacteria, oil, and vitamins on your face.
Dermatologists used to believe that curing acne was just about eliminating oil from the skin barrier, but it’s really about balance – balancing the bacteria, oil levels, and vitamins on your face. “What we put on our skin can improve or disrupt the survival of these microorganisms. This is something we didn’t know before, but we’re paying attention to now,” said Dr. Freidman.
Other possible culprits for the rise in acne could be the Western diet, stress, and air pollution. However, research has not confirmed whether these factors are direct causes because acne is such a complex skin condition.
One study from the early 2000s compared the incidence of acne between rural and urban areas. Its findings showed that almost none of the rural-residing participants had acne, while the city-dwellers suffered much higher percentages. Scientists believe that this high discrepancy “cannot be solely attributed to genetic differences among populations but likely from differing environmental factors,” such as air pollution.
Strong correlations have been found between acne and diet and stress, but it’s too soon to assume causation. What this means is that diet and stress cannot be reasons alone for your breakouts, but these factors could be worsening your acne.
While it may seem like “stress” is a contributing factor to nearly every health condition these days, it is connected to your skin in a meaningful way. According to the American Psychological Association, our country is as stressed as it has ever been, with nearly half of Americans reporting that their stress has increased in the last five years. When you experience anxiety, your brain sends a signal to the rest of your body that cortisol is high. This in turn causes the skin’s sebaceous glands to produce more oil, which can lead to clogged pores and blemishes like whiteheads and blackheads.
Diet is also related in some capacity to skin, though dermatologists are still uncovering exactly how. Research shows that a diet filled with sugary and processed foods causes blood sugar spikes, increases inflammation, and produces increased oil in the skin. Since acne is largely an inflammatory skin condition, an inflammatory diet could be casually related in some capacity.
Other possible causes for acne include medication side effects, family history, and face and hair products. Be sure to check labels on all products you put on your body to ensure they are non-comedogenic (non-pore-clogging) and read side effect labels in their entirety.
Misconceptions and Stigma Around Adult Acne
Our culture has been wrongly conditioned to associate breakouts with a lack of hygiene, a greasy diet, and out of control hormones. While some of these factors may have some truth to them, claiming that a pimple reared its ugly head on your cheek because you ate a burger is inaccurate and unproductive. And while acne has been widely considered a byproduct of hormonal fluctuations, doctors do not believe it’s indicative of abnormal hormone levels. In fact, acne is one of the most common and benign side effects of puberty, menstruation, and pregnancy. Another misconception about acne is that it will simply go away on its own. Acne may disappear at a certain age with little to no explanation for some, but for others, it can continue well into adulthood.
I’m conscious of washing my linens, avoiding touching my face, and drinking lots of water to maintain my skin barrier.
As someone who has struggled with acne for much of my adult life, the humiliation I felt by the pimples on my cheeks was made far worse by the stigma that I was in my mid-twenties. I was under the impression that since I had no pimples in my middle or high school years, when my hormones were changing the most, I had escaped the horrible experience of acne. When I got to college and my breakouts became unsightly and unmanageable, I was sorely disappointed. It felt isolating and embarrassing knowing that my peers were mostly over the acne hurdle and now had clear skin while I was 22 with vicious breakouts.
Knowing what I know now about acne has transformed my skincare routine, lifestyle choices, and self-esteem. I adopted a “less is more” routine that uses simple, all-natural, non-comedogenic products. I’ve learned to ditch my serums and face masks, and instead rely on a simple cleanser, retinol, SPF, and moisturizer. I’m also more conscious of washing my linens, trying to avoid touching my face, and drinking lots of water to hydrate and maintain my skin’s barrier. While at first, I was wildly disappointed to discover that acne could follow me throughout adulthood, my self-esteem eventually improved in learning that I’m not alone in this acne journey.
Research has shown that acne is an extremely complex condition whose direct cause is largely unknown. Scientists have pointed to some factors that correlate to worsening acne, but to prove causation would require more research. If you’re struggling with adult acne, reach out to a dermatologist to discuss treatment options. You can also learn more about adult acne at the American Academy of Dermatology Association.
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