You’d think after making it past those awkward teenage years you’d never have to deal with acne again, right? Wrong.

Adult female acne occurs when a women suffers from acne past the age of 25. It is a common condition that affects many women. In most cases this is a persistent form of acne that continues from puberty into adulthood, however some women will experience acne for the first time in adulthood.

At any age, acne can have a significant impact on a women’s quality of life, but this often becomes worse as acne continues to persist into adulthood. It’s associated with high levels of embarrassment, frustration and low self-esteem.

Acne is a condition mediated by the immune system and often hormonally driven. When it persists into adulthood, it is most commonly due to genetic and/or hormonal factors. Many lifestyle factors can also contribute to acne such as medications, cosmetics, diet, stress, and tobacco use. Even more so in adult acne, regardless of the cause, there is an inflammatory reaction on the skin.

Genetics will play a role in the number and strength of the sebaceous glands. These are glands on the skin that produce sebum. When sebum mixes with skin cells, it creates a plug leading to acne formation. This can further be perpetuated by bacteria on the skin leading to inflammation, and often more serious acne. Genetics can also determine our bodies immune responses, and influence our hormonal control, both of which could predispose someone to develop acne. When someone has abnormal proliferation of skin cells, or higher amounts of bacteria on their skin, this will also propagate the production of more acne.

Hormones are big influencers of acne development, both in puberty and into adulthood. The major players are the androgens, which includes dehydroepiandrosterone sulfate (DHEAS), Testosterone and Dihydrotestosterone (DHT) – a more potent testosterone. These act to increase sebum production at the level of the skin. Insulin, another important hormone involved in blood sugar regulation can increase androgen production on the skin when in excess. The most common hormonal condition leading to acne is Polycystic Ovarian Syndrome (PCOS), where women have higher levels of insulin and androgens, both which drives acne formation.

Stress can play a major role as well and aggravates acne in up to 70% of women with adult acne. Hormones released when we are stressed will increase inflammation on the skin, and increases the production of androgens as well, both of which increases development of acne. Anything that can increase stress hormones has the potential to impact acne. This can be eating a poor diet, not getting enough sleep, blood sugar imbalances on top of the emotional stressors of day-to-day life.

Diet is also be an important driver of acne. Various foods, such as those with a high glycemic index/load and those containing dairy have been linked with a higher likelihood of developing acne and worsening of existing acne. These foods stimulate higher levels of insulin, which increases androgens levels on the skin, and promotes inflammation resulting in increased acne.

One of the major issues with adult acne is that it tends to be more refractory to treatment than teenage acne. Due to it being more inflammatory in nature, and skin not being as resilient with age there is higher likelihood of scarring. This is why it is important to get a proper assessment of the underlying factors, so that treatment includes a holistic approach, and extends beyond just topical treatments. This is more likely to lead to longer-term resolution of the problem.

Need help navigating your adult acne? We’re here to help!

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