One of the best things about being a grown-up is waving goodbye to those awkward years of adolescence. But there’s one thing we may not leave behind once we hit twenty one – acne.
Acne – blackheads, whiteheads and pimples – hits many grown-ups at some point in their lives, plaguing about 40% of women and 25% of men.
“Acne is triggered when the ducts connecting the sebaceous glands in the skin that dispenses oil to keep skin soft and healthy are abnormally overactive,” says Dr. Steven Chow, a consultant dermatologist.
“Excess of oil (sebum) and cells build up in the duct to clog pores with a firm, oil-soaked plug, creating an environment where bacteria and yeasts can thrive. The body’s immune system responds, inflaming the area.”
According to Dr Chow, there are many factors that can aggravate adult acne such as stress, inappropriate cosmetic items, medications and genetics, though it is widely accepted by most experts that hormones play a major role.
“Contrary to popular belief, acne is not caused by eating too many fast food hamburgers with French fries, consuming soft drinks, gorging on chocolate, thinking about sex or not washing your face.
“In adult acne, it is linked to hormonal imbalance, which is why grown men are less likely to suffer from it compared to women. In females, hormones go through peaks and troughs more frequently, brought on by changes in their cyclical physiology.
“The key to unlock how adult acne affects you is to understand the role of androgenic hormones, a class of masculine steroid hormones, and how it affects the skin.”
A male hormone, a woman’s dilemma
There are various androgenic hormones such as testosterone – developed in the testes in men and ovaries in women as well as the adrenal glands of both sexes – that prompt the production of the oily substance linked to acne.
“Flare-ups” can take place whenever the ratio of male-to-female hormones (androgens vs oestrogen) in the body changes, where there is an androgenic overdrive, ie more androgens than oestrogens.
This often ensues during adolescence, ovulation, menstruation, and childbirth, which also explains why acne is also common in women experiencing menopause.
During a menstrual cycle, the hormonal balanced is tipped off balance when the ovaries release the egg, causing the oestrogen levels to drop, or just before a menstrual flow, where progesterone, which has qualities of androgens, rises.
Progesterone is made in the adrenal glands and is essential for preparing as well as maintaining the uterine lining for a successful pregnancy, which leads to breakouts for many pregnant women during their first trimester.
Besides testosterone and progesterone, Dr Chow says that physical strain such as chronic severe sleep deprivation; binge dieting or gorging on junk food can activate stress related hormones that may also instigate acne.
“Stress exacerbates any disease and acne is no different.
“There is supporting evidence that indicates physical ‘tension’ can stimulate the production of corticotrophin, which sends the sebaceous glands that produce the sebum into a frenzy.”
This is in line with research published in 2002 and highlighted on CNN, which points to stress messing with hormones.
Stress stimulates the production of extra progesterone to help cope with the strain, where its androgen component can trigger acne.
“Men are not immune to stress and do experience ‘flare ups’.
“However, their bodies create high levels of testosterone throughout their lives, keeping their sebaceous glands at maximum stimulation,” commented Dr Chow.
This is why extra surges of hormone production in adult males have less affect on their acne when compared to women, Dr Chow explains.
“However, the good news is that adult acne is easily controllable via a healthy skin regime which can prevent it from becoming severe and disfiguring,” says Dr Chow.
Be gentle to your skin
The first most important thing for an acne-prone skin is hygiene.
It should include no harsh scrubbing or over-washing, because this can cause possible skin irritation or over-production of oil to replace what has been washed off, clogging pores in the process.
Products with gentle exfoliation ingredient should be used so as not to irritate the skin.
Also skip products containing alcohol where possible as these can take off the top layer of the skin and cause the glands to produce more oil, further causing blocking of pores.
“If you do spot acne-troubled areas, do not pick at them.
“This can aggravate the risk of skin infection and acne scars. In terms of make-up, use a light skin moisturiser and oil-free makeup,” advises Dr Chow.
“Should acne suddenly start breaking out after having clear skin for years and over-the-counter acne fighters don’t do the job, seek help from your family doctor or a dermatologist.”
This is because a dermatologist can help tease out the possible cause, and more importantly, find the treatment, or combination of treatments, that works best for your skin type.
The first line of defence
There are a range of treatment solutions for mild to moderate acne, ranging from antibiotics, physical treatments and even birth control medications that a dermatologist may recommend.
Most commonly used and usually form the first line of defence to tackle adult acne are retinoids, which are related chemically to vitamin A and are used in medicine to increase skin cell turnover.
Touted to be the most effective type of medications for unblocking the pores of oil glands, they are generally ideal for non-inflammatory acne – whiteheads and blackheads – before they transform into red angry pimples.
“Established topical retinoids such as adapalene gel form the latest arsenal of prescription acne fighters to help skin cells shed normally and squeeze out plugged material in the follicle, rather than allowing them to accumulate in pores,” says Dr Chow.
“Depending on the patient, the newer range of retinoids can be used in combination with antibiotics and have shown considerably less side effects such as dryness, irritation as well as redness which plagued the older generation of vitamin A creams.”
In more serious cases
Severe acne is characterised by deep cysts, inflammation, extensive damage to the skin and scarring, where systemic treatment by a dermatologist is a necessity.
“If not treated properly, acne can leave angry and ugly scars in its wake, which will mark a person for life.
“Here, patients can turn to acne surgery, oral isotretinoin and hormone-modulating agents like contraceptives,” Dr Chow recommends.
Acne surgery serves to drain and extract large cysts that do not respond to medication. It should be done by medical professionals so as not to cause infection and scarring.
Isotretinoin is a potent drug containing vitamin A derivative that has shown to be effective on cystic acne and is consumed orally.
“Clear skin is possible for even the most acne prone adult. All it takes is getting the right advice, manage your skin prudently and in time it will heal,” said Dr Chow.
