Managing Adult Acne

Managing Adult Acne


Most individuals anticipate and accept that acne is part of growing up. As adults, though, they expect to be free of this ailment and often revel coming out of puberty relatively unscathed by it. While pubescent acne affects more males than females, adult acne is more prevalent in females.  Acne can hit adults in their 30s, 40s or even 50s, and as adults it is much more difficult to treat. Below are factors that may contribute to adult acne:


Hormonal Fluctuations


For many females, acne is due to changes or fluctuations in hormones and often occurs around the mouth area and on the chin.  Hormonal fluctuations in women leading to breakouts occur around monthly menstrual cycles, during pregnancy and when going through peri-menopause and menopause. It can also be related to starting or ceasing the use of birth control pills. In these situations, it becomes increasingly difficult to target both aging appearance concerns and acne concerns simultaneously.


Clogged Pores


In the skin, four basic changes contribute to acne, and they all involve the pilosebaceous unit or hair follicle.  There is increased sebum production from the sebaceous gland, hyperkeratinization or clogging of the duct, increased bacterial activity and inflammation.  Since acne presents as different types of lesions (blackheads, whiteheads and inflamed lesions), then one or more of the factors may be involved depending on the resulting change in the skin.  Approaches to treatments may also vary according to the type of acne lesions present.  Benzoyl peroxide has antibacterial activity, while salicylic acid has antikeratolytic properties, i.e. it helps to unclog pores.


Sensitivity to Skin Care Products


Some skin products may also contribute to acne, because some ingredients have a greater potential to clog pores. Identifying products that have been tested for comedogenecity and/or acnegenecity may be helpful. Sometimes individuals are simply more sensitive to certain ingredients. By being aware of products that cause sensitivity, individuals may be able to identify patterns or ingredients of personal concern.  In some very hot and humid conditions, the use of heavy moisturizers can also contribute to acne breakouts. Some acne treatments can be very drying to skin, and it is important for women to choose products carefully and manage their skin condition appropriately.




Research has identified that stress can instigate acne flare-ups1. Stress triggers the production of corticoid hormones, causing an androgen response in the body. Sebaceous or oil glands are stimulated by androgens, ultimately causing more production of oil or sebum. This provides an environment in the skin follicle that supports more bacterial activity, resulting in acne. Unfortunately, not looking our best can stress us out, and this ends up in a constant cycle. Taking time to relax may help mitigate this underlying cause.




Historically, the belief that what we eat influences acne has fluctuated, but recent research has shown a correlation may exist between acne and high glycemic diets2.  Thus, eating less sugar and more complex carbohydrates and fiber may help reduce acne breakouts.   


Other Factors


Another cause could be items coming in contact with our skin. For example, there is a theory circulating on the internet that cell phone use can contribute to acne breakouts. Cell phones, especially smart phones are constantly being touched and handled. This could lead to increased bacteria on the screen, which is then brought up to the face making contact with the cheek. While there is no current research on this exact phenomenon, studies are being conducted identifying “cellular phone dermatitis”. This research discusses dermatitis from cell phones stemming from nickel or chromate allergies4.


Acne can be treated with topical ointments. It is important to maintain regular cleansing habits, but topical ointments provide additional help. The ingredients benzoyl peroxide and salicylic acid have been identified by the U.S. FDA as over the counter (OTC) acne treatments. Benzoyl peroxide as an antimicrobial agent reduces surface bacteria and has bactericidal activity in the sebaceous follicles3, which eliminates the bacteria that causes acne.  Salicylic acid is betahydroxy acid that helps exfoliate the keratinocytes on the outermost layers of the skin, including inside pores and follicles. The lipid solubility of salicylate allows it to penetrate into pores and follicles even when filled with sebum5. Helping cell turnover and breaking up sebum plugs help to keep pores clear, eliminating the environment needed to produce acne. An additional benefit of salicylic acid for adult acne is it has anti-aging properties due to the improvements in cell turnover.


Unfortunately, adult acne can be tough to treat and OTC formulations may not work for some individuals. In this case, seeking the assistance of a dermatologist would be needed.



1.       A Chiu, SY Chon, AB Kimball. The Response of Skin Disease to Stress: Changes in the Severity of Acne Vulgaris as Affected by Examination Stress. Arch Dematol/Vol 139, July 2003; p 897-900.

2.       J Burris, W Rietkerk, K Woolf.  Acne: The Role of Medical Nutrition Therapy.   Journal of the Academy of Nutrition and Dietetics, Volume 113/Issue 3 (March 2013); p 416-430.

3.       DR Berk, SJ Bayliss. Cellular Phone and Cellular Phone Accessory Dermatitis Due to Nickel Allergy: Report of Five Cases. Pediatric Dermatology, Vol 28/Issue 3 (May/Jun 2011); p 327-331.

4.       Bojar RA, Cunliffe WJ, Holland KT. The short-term treatment of acne vulgaris with benzyl peroxide: effects on the surface and follicular cutaneous microflora. Br. J. Dermatol. 132, 204–208 (1995).


posted by Helen Knaggs