"Hi Dr. Karol, I have more acne now in adulthood than I did when I was teenager. Why is this and what can I do about it?”
Acne can be puberty-related or it can occur later, in adulthood. In puberty, the acne is caused by changes in hormone levels including testosterone in both males and females and estrogen plus progesterone in females. In both cases, however, testosterone is the main culprit. Genetic predisposition is another strong contributing factor. What can also contribute to acne is lack of appropriate skincare. A lack of skin-hygiene can introduce more bacteria to the sites of acne pimples, increasing inflammation, redness and those tell-tale bumps. For puberty-related acne, there are many effective products on the market. Each teenager should also consult with their doctor about their acne, as moderate to severe breakouts can lead to permanent scaring on the face.
The story with adult acne is similar, but can be more complicated and also more serious. Hormones also happen to be the most common cause of adult acne. However, hormone levels do not change in adults as severely in teenagers and thus, such changes in adults should be investigated with more scrutiny.
Hormonal changes typically occur in women during menopause. Such changes can bring on acne, but this is unusual. This is due to the fact that the main hormonal changes during menopause are estrogen and progesterone, which have little impact on acne exacerbation. Nonetheless, acne during menopause should be investigated by a dermatologist.
Acne-causing hormonal changes can be brought on by other means as well. The most common examples are steroid use (illicit and prescription), medications such as lithium and most anti-seizure drugs, as well as steroid producing tumors. The most common prescription steroid used by patients is prednisone. Most prescription steroids are used for auto-immune diseases and in some cases chronic inflammatory conditions. A famous example is Crohn’s disease or Ulcerative Colitis. A very important take home message is that adult acne may be caused by steroid producing tumors. These can be located on the adrenal glands (located at the tips of kidneys), by ovaries (in women) or testes in men. Thus, it is very important to consult with your doctor when you have adult acne in order to undergo appropriate testing (usually a blood test and abdominal ultrasound to begin with) to either eliminate or confirm this diagnosis.
Finally, stress (mental or physical) can cause acne in adults, especially those with strong genetic predispositions (often those who have experienced significant acne during puberty). In all cases, we cannot be absolutely certain if the acne is caused by stress or something more sinister, so all cases of adult acne should be investigated by your doctor.
As a final note, remember that hygiene (especially facial hygiene) is important to heal and prevent further breakouts in people of all ages. Use natural products without harmful chemicals to regularly cleanse the face and moisturize afterwards. Contrary to what many believe, harsh chemicals aren’t necessary to combat acne, but rather high-quality products formula for oily and breakout-prone skin.