What you need to know about adult acne

shutterstock_32984437Skin problems are not exclusively teenage territory. With our frenetic lifestyles and the associated stress, more women are experiencing problem skin than ever before. Stress reduction is vital, says Dr Adam Geyer, Kiehl’s consulting dermatologist and instructor in Clinical Dermatology at Columbia University. “Cortisol is released when we are under stress and when our sleep cycles are off. This can impact on our sensitive hormonal balance and cause an increase in the number of circulating inflammatory cells in our bloodstream.

“It is a physiologic reality that if we are under stress for extended periods of time, it can take a real toll on our health. In the skin this is often manifested by worsening of inflammatory conditions such as acne, eczema and psoriasis.”

What is acne?

Acne is a very common condition and, although not life- threatening, can lead to serious mental-health issues such as depression and anxiety.
At the heart of acne lies the pimple – what doctors call a comedon. It’s a plug of fat, skin debris and keratin (the stuff nails, hair and skin are made of ) stuck in a hair duct. When it is open, it is called a blackhead; when it is closed over, it is a whitehead. Whiteheads often cause the walls of the hair duct to rupture. This leads to redness, infection, and the papules, pustules, nodules and cysts of acne.
Boys are more likely to suffer acne scarring than girls. Girls are more likely to have adult acne.

What causes acne?

Sebum overproduction, oxidative stress and inflammation are the main factors. Androgens and microbes are also at work. Puberty and adolescence, pregnancy, menstrual cycles, anxiety and stress are among the conditions associated with the appearance of acne. If you have dark skin, scarring and keloid formation are a debilitating consequence of this disorder.
Normally, oil produced at regular levels is excreted through the skin’s surface. When oil is overproduced, it combines with dead skin cells, which the body naturally sheds, clumping together to form a sticky plug, explains Erentia du Plessis, head of education for Placecol. This combination traps oil and bacteria, clogging the pore and causing inflammation. The inflammation sends a message to your body that something is wrong, and in defence, your body rushes white blood cells to the pore, causing a whitehead.
According to Geyer, there are four main factors that contribute to acne and blemishes: an increase in sebum production; the presence of bacteria within pores (due to the accumulation of dead skin cells at the opening of the pore); keratinisation, the buildup of skin cells along the lining of pores; and inflammation as a result of the other factors.
Well-known American dermatologist and creator of the Perricone MD cosmeceuticals range, Dr Nicholas Perricone, explains: “We know that acne forms when oily secretions from the sebaceous glands beneath the skin plug up the pores. But what causes the oil to form in the first place? High levels of the neuropeptide Substance P play a role in increasing the size and activity of the oil-producing gland. In addition, another hormone, the stress corticotropin-releasing hormone (CRH), is released in the sebaceous gland, also contributing to the production of excess oil, which sets the stage for acne.”

The causes of acne during your:

Puberty/teens:
Hormonal changes in puberty are the most common cause of acne, says Pretoria aesthetic physician Dr Riekie Smit. “When a teenager’s body starts to mature, it triggers a hormone imbalance. the teen’s hormones begin stimulating oil glands to produce more sebum, and then the oil glands become overactive.”
Dietary aspects (sugar, wheat and inflammatory foods), stress, PCOS (polycystic ovary syndrome) and certain medications also play a role, says Smit.
Perricone explains: “When we enter puberty, our body begins to produce testosterone. testosterone breaks down into a substance called dihydrotestosterone, which stimulates the sebaceous gland to start producing more sebum. it is sub-clinical inflammation that is the initiating factor in clogging the pores, which results in the formation of an acne lesion.”
Other triggers of teenage acne include improper skincare, food allergies and nutritional imbalances. Heredity can also be responsible for teen acne. if either of your parents experienced acne as a teenager, it is likely that you will too, says Du Plessis.

20s and 30s (adult acne):
Acne does not practise age discrimination. acne affects almost as many women in their late 20s, 30s and 40s as it does adolescents, says Perricone.
irrespective of your age, acne is caused by internal hormonal imbalances, says felicia Steyn, national training manager for environ.
the most significant difference between adult and teenage acne is that adult acne pops up in different places from the teen kind: it usually affects the jawline, chin and neck, rather than the forehead, cheeks and nose, notes Johannesburg dermatologist Dr Pholile Mpofu. it also heals more slowly, is more persistent and leaves more pigmentation.

Tip: A healthy skin begins from within. Ensuring a healthy diet goes a long way to a glowing, healthy skin.

40s and up (aging skin):
Aging skin is not immune to acne. excessive dryness in aging skin leads to acne breakouts through skin irritation.
“Changing hormones as we age can affect the onset of acne. When our blood sugar and insulin levels rise, whether from a poor diet or from stress, we experience a serious increase in inflammatory chemicals at a cellular level. this causes inflammatory diseases such as acne to worsen dramatically,” explains Perricone.
“Cortisol and other adrenal steroids can act as androgens (male hormones) and stimulate the sebaceous glands, resulting in a flare-up of acne.”
Steyn cautions: “through all the ages, it is important to realise that acne can cause scarring on the skin. So do not pick acne unnecessarily. in darker skin types (even Mediterranean skin), acne can cause pigmentation spots after it has cleared.”
treatment should therefore also focus on reducing the dark pigmentation, called PiH (post- inflammatory hyper pigmentation), adds Smit.

By: Elsa Kruger