Clearing Up Adult Acne Myths

Zits and pimples are generally thought to be a problem for teenagers with raging hormones and fast-food diets. However, adult acne is common and can have numerous causes.

“If you’re an adult struggling with acne, it’s really important to know you’re not alone,” says Dr. Bridget McIlwee, a board-certified dermatologist and dermatopathologist and a fellowship-trained Mohs surgeon. “Many people think acne is a disease of teenagers, which simply isn’t true.”

A 2008 study showed that more than 40% of people over the age of 20 reported suffering from acne, with women more likely to experience it than men. Though the prevalence of acne declined with age, large numbers of both men (12%) and women (26%) continue to experience acne over the age of 40.

Dr. McIlwee adds that acne is more than a cosmetic issue. If not treated appropriately, acne can cause permanent scarring and, in severe cases, deformity. Acne patients have higher rates of depression and suicidal ideation than the general public. As an osteopathic dermatologist, Dr. McIlwee is acutely aware of the complex interaction between appearance and psyche, and prides herself on helping dermatologic patients address these issues.

Greasy foods are not the problem

One common and stigmatizing misconception is that greasy foods cause acne. Diet is related to acne, but not in the way that most people might assume.

“Sometimes there is a perception that people with acne don’t clean their faces well enough or maybe eat too many greasy foods, but that isn’t the case,” Dr. McIlwee says.

She explains the only evidence-based connections between diet and acne appear to be diets with high glycemic indices and those including lots of skim dairy. Foods with the highest glycemic indices contain large amounts of carbohydrates or sugars without sufficient amounts of proteins or fats to counteract these effects on blood sugar. Diets rich in such high glycemic index foods can lead to abdominal obesity, diabetes and acne, amongst other issues.

Dr. McIlwee advises that individuals concerned about acne should consume full-fat or 2% dairy, since non-skim dairy products contain enough fat and protein to counteract the natural sugars (lactose) occurring in milk.

Types of acne

Broadly speaking, acne is an inflammatory condition that can be exacerbated by numerous factors. The development of acne is a complex interplay between a patient’s genetics, hormones, naturally produced sebum (oil), the presence of a type of skin bacteria called Propionibacterium acnes, and the body’s inflammatory response.

Dr. McIlwee says there is likely a genetic component to acne, as acne patients often have a family history of other relatives with the condition. However, specific genetic mutations for common acne – sometimes called acne vulgaris – have not yet been identified.

In adults with acne, the most common causes are hormones, medication use, or, less likely, occupational exposure, Dr. McIlwee says. In women, acne may worsen before or during the menstrual cycle. Acne may also be caused by hormonal imbalances stemming from another condition, such as polycystic ovarian syndrome (PCOS), or from use of a substance that alters hormones, such as anabolic steroids.

Dr. McIlwee notes that the majority of adults with acne do not have any clinically significant hormonal imbalances. Despite this, medications aimed at hormonal factors can still be effective in treating these patients’ acne.

Treatment options

When it comes to treatment of adult acne, the first step is to see a board-certified dermatologist, according to Dr. McIlwee. There are many treatment options available, depending on the type, severity, and cause of the acne. Early treatment is key to prevent scarring.

The use of gentle skin care products is an important baseline for all patients, says Dr. McIlwee. Dermatologists can recommend which are best for their patients. Prescription acne treatments generally fall into two categories: topical (medications applied to the skin, topical antibiotics, and benzoyl peroxide) and systemic (ingested medications, including antibiotics and oral contraceptives, among others).

“The topical treatments are generally considered first-line therapy for any kind of acne,” says Dr. McIlwee. “For people with a hormonal form of acne, we’ll often proceed to prescribe some type of oral medication that can counteract the causative factors, such as an oral contraceptive pill that is FDA-approved to treat acne.”

A patient may require a combination of topical and oral medications to best treat their acne. An individual treatment plan is determined by the dermatologist, depending on the patient’s history and exam. Dr. McIlwee adds that it is important for patients to understand that, due to the nature of acne, it can take weeks to months of daily use for acne treatments to have their full effect.