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All About Adult Acne

What is Adult Acne ?

Adult Acne is defined as occuring from the age of 24 and older, since follicles and their oil glands don't really stop developing until the age of 23.  Acne that occurs under the age of 24 is actually still considered teen acne.  For various reasons explained below, Adult Acne is very different from Teen Acne.  For more information on teen acne and why Daniela does not accept clients under the age of 24, please see "What About Teen Acne?"

The tendency to develop acne and related blemishes is hereditary. People who suffer with acne-prone skin inherit 2 major factors: the tendency to produce too many dead skin cells which build up in pores, known medically as “retention hyperkeratosis”, and to have overactive oil glands in the skin.  As dead skin cells build up inside pores, they are coated by oil (sebum) secreted by overactive glands. This causes a type of “sludge” which blocks pores (follicles), cutting off oxygen from the bottom of the follicle.

The beginning of this process in the follicle results in the formation of what is called a microcomedone, the small “sludge” within the follicle that cannot be seen by the naked eye. It is only in the later stages that this “sludge” results in a blackhead (open comedone), a colorless bump (closed comedone) or a pimple (papule or pustule). The trick in managing acne-prone skin is to squelch the development of the microcomedone.

Acne bacteria, called Propionibacterium Acnes, are anaerobic, which means they cannot survive in the presence of oxygen. Even though these bacteria exist normally in just about every pore on every person, acne does not manifest itself in most people because oxygen is penetrating the follicle, keeping bacterial growth in check.  When a blockage occurs in the follicle however, oxygen cannot penetrate as easily, which sets the stage for development of acne blemishes.

Acne bacteria create fatty acids as part of their waste process that actually make it easier to feed off of the abundance of sebaceous oil secreted by the oil glands into the pores they inhabit. This waste material is very irritating to the follicle lining. The resulting inflammation causes swelling that further blocks the follicle making it that much more difficult for oxygen to get in.

The signal that triggers oil production in the first place is sent by hormones called androgens.  These are male hormones that are present in both men and women.  Androgens, such as testosterone, are what cause pores to enlarge and acne problems to start at puberty.  They also cause adult women to sometimes develop acne problems, like those pesky pre-menstrual breakouts as well as at menopause. These premenstrual flares are theorized to be caused by sudden surges of oil triggered by androgens in the bloodstream.  About every 7 years or so, as the female body prepares for various life cycle and fertility events, the body goes through "mini puberties", which release more androgens than usual into the bloodstream, which prompt greater than normal oil production leading to greater potential for acne breakouts.

These oil surges inflame the follicles causing sudden acne flares, most often in the chin, sides of the nose and jawline areas due to facial contours making pores a little smaller there. They can also be caused by the kind of fight-or-flight stress women often experience in their jobs, since women produce testosterone in their adrenal glands as well as their ovaries; an adrenalin rush can cause the same oil surge as PMS.  In very extreme cases, these flares can be managed with hormonal therapy prescribed by an endocrinologist (hormone specialist physician), since there is a good likelihood there is an imbalance present, but watch for other symptoms for this to be the case, such as irregular periods, excess hair growth and mood swings.  In most cases, however, they can be treated and controlled with proper skincare.

Although there is still no real cure for acne, acne-prone skin can be managed by controlling cell buildup and managing the oil secreted by oil glands.  Because this is a never-ending cycle, adults with acne-prone skin must be forever vigilant in controlling the buildup that triggers the development of blemishes.

However, it must also be stressed that in the formation of acne blemishes and the persistence of recurring breakouts, inflammation is very much a part of the picture.  In order to prevent and heal painful, red blemishes or “pop-able zits”, inflammation must be cooled off or even prevented whenever possible.  Most acne remedies and programs fail because they don't do enough to actively calm the skin and the pores down, especially in adults!

Also in adults, it is even more imperative that all skincare and makeup should be appropriate for adults, with acne remedies that are not geared to teenagers or even those in their early twenties. In addition, because of the pore clogging nature of most anti-aging and makeup products marketed to women 25 and older, anti-aging products must be guaranteed non-clogging.

So what to do ?

Treatment of Acne

It's very important for the skincare consumer to know that there are 4 grades of acne.

Grades 3 and 4, where there are more than just a few pimples and quite a bit of infection (pimples on the vast majority of the face), are normally said to be the purview of doctors, but it can be treated with over the counter medications like a properly formulated Benzoyl Peroxide gel and Salicylic Acid along with an anti-inflammatory and hydrating skincare routine.  Keep in mind, even prescription medication must still be supplemented by good skincare, so with grade 3 or 4 acne, if you must use prescription medication, it is not advisable to use medication alone.

Grades 1 and 2, marked by varying degrees of blackheads and a smaller severity of pimples with or without white heads on them, are not medically related.  If you have anywhere from a few blackheads, to blackheads with three or four small pimples, to a few blackheads in the t-zone area with one or two large, even painful, “undergrounders” in the chin area, you most likely have grade 1 or grade 2 acne.  Even a severe case of those colorless bumps, also known as “closed comedones”, where they can cover much of the jawline and cheek areas, this is actually Grade 2 acne.

The truth is, going to a doctor for breakout problems like those seen in grades 1 and 2 acne is like going to a podiatrist for a pedicure.  It is totally unnecessary to use prescription medication for adult acne that is not infectious, highly inflamed or cystic.  Oral antibiotics can cause systemic problems, over-drying, sun sensitivity, and sometimes permanent pore sensitivity, and topical medications can cause potentially irritating dryness, can often be ineffective, or worse, contain pore clogging inactive ingredients.  But with all the claims, choices, fancy marketing and products out there, the question remains, how does one get rid of annoying breakouts that should have been left behind with adolescence?  Not to mention acne that wasn't even present at adolescence but is a problem in your 30's or 40's?

Mild to moderate adult acne for most people is more often a problem of pore clogging than anything else.  Bacteria are most often a secondary issue, as they really only become a problem when a pore is completely clogged or swollen shut.  As long as oxygen can enter the pore, bacteria are kept under control. Therefore, whether the problem is pore-clogging ingredients, dead skin cell build-up, or irritation inside a pore from oil surges caused by hormonal fluctuations, if the pores are kept flowing, acne will not be a severe problem. In cases where there is a true hormonal imbalance, however, even unclogging and calming of pores might be of little help.  In this case, a hormone doctor should be consulted.  Generally speaking, however, and this is really important, a true hormonal imbalance will not have acne as the only symptom!

Elimination of the use of comedogenic (pore-clogging) cosmetics and skincare is imperative in helping problem adult skin. Various fats and waxes used in cosmetics, particularly moisturizers and treatment products, foundations, powders, bronzers and blush, contribute to the pore-clogging process (especially many that are marketed as “oil-free”!).  In addition, choosing the right exfoliants for your skin's condition to keep pores free of dead skin cell build up is also paramount.  Use of the right products recommended by the right professional can make the difference between years of trial and error, or maybe even unnecessary medications, and a regimen that can finally control your breakouts and give you beautiful skin.

Here are a few guidelines that can help you deal with Adult Acne breakout problems :

1)  You must cleanse your skin twice a day!  Your skin should feel clean and comfortable after washing.  If it feels a little slippery and not very clean, your cleanser is not adequate.  If it feels tight or dry, the pH is too high and your skin will try to balance itself by overproducing oil !  This is one major cause of excess blackheads, especially in the t-zone.

2)  An alcohol-free, balancing toner must be used after cleansing every time to prevent excess oil production and to augment the hydrating aspects of your moisturizer.  This is especially true if your cleanser is foaming rather than a lotion type.

3)  A soothing, antioxidant, hydrating serum will help speed healing of acne lesions and will help clear up those dark spots as they heal.  “Dark Marks” are a part of the way the skin comes to its own rescue when it gets inflamed.  Since this rescue job involves oxidation and pigment, if an antioxidant is used while the skin is healing from acne lesions, the chance of proliferation of pigmented cells is quite diminished.

4)  For exfoliation, the use of Alpha Hydroxy Acids (AHAs) or Beta Hydroxy Acids (BHAs) is wonderful for unclogging pores and keeping them unclogged (if you are allergic to citrus or aspirin, these acids might not be appropriate – there are alternatives such as enzymes or mild scrubs).  DO NOT USE APRICOT SCRUB!!  Scratchy scrubs cause microscopic tears in the skin, which are repaired by oil and dead skin cells, resulting in small white heads, or milia.  It can also cause small red breakouts from irritation.  If your breakouts are very minor, use a creamy scrub that contains small jojoba beads or crushed pumice, instead of crushed pits or shells.

5)  Benzoyl Peroxide (BPO) not only kills bacteria inside pores by exposing these anaerobic bacteria to oxygen, but it also “flushes out” pores with mild exfoliation, and dries up excess oil.  However, BPO can sometimes be irritating when used too often or in doses that are too high.  Some people do indeed benefit from making BPO a permanent part of their skin care routine.  In this case, a low percentage, used either in a gel form each night or in a wash, can keep pores flushed and healthy. For many people, however, if not used with the right protocol, BPO can backfire and cause irritation from its oxygenating nature that can lead to inflamed pores, sometimes resulting in those nasty “undergrounders”.  For severe breakouts of the colorless bumps called “closed comedones”, you can use BPO in increasing time increments and amounts, starting small in short spurts of use, leading up to applying every night until the breakouts subside for a straight three months, then taper back down in the same increments until your improved skin care routine can take over.  It's also a great idea to use a thin layer of BPO under a clay mask on breakout areas every night until the breakout goes away.  As soon as it starts to clear up, stop the procedure.  Let the skin heal the rest itself.  Many people believe they are allergic to BPO but could have been using the wrong formulation or the wrong amount and had irritation problems.  Actual allergy to BPO is quite rare.  Salicylic Acid is a great alternative, and is also good for breakouts that only involve irritated and inflamed pores like those “undergrounders”.

6)  DO NOT use any moisturizer that is not approved by a licensed skincare professional who knows ingredients!  90% of the moisturizers out there are the main cause of the breakouts you experience.  You must use a non-comedogenic (that means non-clogging) moisturizer that adds water to the skin, even if you are oily – remember, the more hydrated your skin is, the more pliable it is, the more pliable it is, the more it's able to release it's excess oil that otherwise would get solid while mixing with dead skin cells which results in more blackheads.  So, a hydrating SPF in the morning, and a hydrating lotion at night will help your skin control your blackhead problem because they will help your pores and the skin around them function properly.

7)  Consider the products your boyfriend or husband may be using, especially if he has a beard or goatee.

8)  If your breakout is more severe along the hairline or the “side burns”, it's very likely that a hair styling product or leave-in conditioner is causing the problem. It doesn't matter how often or how seldom you use a product !  It's molecule by molecule - even a little can cause a big problem. Pomades and mousses are especially clogging, and gels can be as well.  Hairspray is a problem if too much is directed at the front of the head.  Either way, styling your hair either before washing your face or running a cotton pad with toner along the hairline after styling, and once in the middle of the day, can help.  Of course, the most effective solution is either to stop using the offending product, or keep it as far away from your hairline and upper cheeks as possible.  But remember, even if you only apply it to the ends of your hair, it can still get onto your skin if you ever sleep on your hair or when hair brushes against your skin on a windy day.  It only takes a few molecules of a clogging ingredient to clog a pore!  You might also want to consider that you're not washing your face properly.  You'd be surprised how many people don't pay attention to the periphery of their faces!

9)  You must be very careful about the foundation, powder, bronzer and blush you use.  Unfortunately, when dealing with acne-prone skin, one makeup product that contains irritating dyes or clogging emollients can often spoil the whole routine.  Be very careful not to spoil a good skincare program with makeup that is waxy or irritating.  “Oil-free” does not necessarily mean that the foundation is free of all emollients that can cause or aggravate flares!  Bronzer is notorious for causing breakouts, especially pressed.  Most blushes also can cause problems because of the cheap red and yellow dyes that are used, which irritate pores very slightly, enough to cause excess oil production inside a pore and irritate the lining just a little bit.  As I always tell people, “it's not the brush, it's the blush!”  If you are breaking out along your cheeks, it's not because of your blush brush – that is a myth started by a very sweet and well-meaning makeup artist (may he rest in peace) who knew makeup very well, but didn't know skin.  The cause is the dyes in the blush.  Look for a pure mineral line that uses iron oxides for color rather than dyes with numbers in their names.

Some Facts To Clear Up Some Myths About Acne:

•  There is little scientifically proven connection between the food that you eat and your breakouts.  Oily foods do not contribute oil to the skin, and if you are convinced that you break out whenever you eat chocolate (or anything else), just ask yourself this question; when are you most likely to eat chocolate?? (answer: before your period, and any time you're under stress!) Having said that, there is much scientific evidence that there is a connection between breakouts and the consumption of iodine (such as in shellfish, seaweed, kelp supplements, and iodized salt). The possibility that junk food can cause breakouts is not from the salt, which is not iodized in commercial products, but from the fact that it's junk - there can be a link between worsening acne and a high glycemic diet (think sugar, corn, potato and white flour), because junk food can cause inflammation in the body which can weaken the skin's ability to fight off irritation and even infection.  There are also those who claim that sugar can contribute to breakouts because of contribution to yeast overgrowth, though there is no scientific evidence that this is true.  However, there is evidence that insulin resistance can lead to breakouts.  Some also claim that dairy very much contributes to acne, due to hormones added into the diets of dairy cows.  There are many things that can happen in the body when hormones are artificially introduced; acne can't be the only one.  There is, however, a single naturally occurring hormone in dairy milk that can trigger excess oil production as it passes by oil gland receptors at the bottom of genetically sensitive pores.  However, a much more compelling reason dairy can contribute to an acne problem is the content of iodine in some dairy products like yogurt.  Of course, if you feel there is a possibility that any of this applies to you, stop these foods for six weeks and see what happens.

•  Sun exposure does not get rid of acne breakouts!  A tan only camouflages a breakout, and even if the UV rays do clear up a problem short term, especially when peeling happens after a burn, do you really want to damage your skin to that extent to clear up a breakout when there are so many other safer ways to do it ?

•  The skin does not have to be dried up with alcohol in order to clear up a breakout.  However, Salicylic Acid needs alcohol to properly penetrate the skin.  There are some skin types that can benefit from this.  Consult your Esthetician.

•  Good skincare at home can compliment a dermatologist's care.  If your dermatologist tells you that facials or estheticians make problems worse, sorry to say, your doctor is very “old school” and is not up to date on the latest developments in skincare and health.  You may want to switch doctors.

•  Facials do not cause “toxins” to come up to the surface causing breakouts.  The skin simply does not work that way.  When a breakout occurs after a facial, it's usually because pores are traumatized by extractions that are too rough and oil subsequently spills into pores causing irritation and swelling.  In addition, if prior to the facial, pore congestion had been a problem in your skin for long enough, newly released oil from pores that are now able to flow properly can cause a bit of irritation leading to a breakout.  BPO (Benzoyl Peroxide) can take care of both of these issues.  Other times a breakout after a facial can occur from allergic reaction or sensitivity.  It can also occur from cheap, pore-irritating products being used by estheticians that have not studied problem skin or ingredients.  Be sure to get your facials at a reputable skincare salon that specializes in problem skin by a licensed skincare professional who understands acne-causing ingredients, and who knows how to prevent problems as well as advise you on what to use at home.

Follow this tried and true skin care routine for adult acne skin :

1)  Cleanse with a foaming cleanser that rinses well, but that doesn't make your skin tight or dry after rinsing.  You may want to try a few samples before you purchase, to be sure of what's right for your skin.

2)  Use a toner that will address your problem based on the amount of oil your skin produces – if you tend to get shiny or greasy before noon and you have more severe breakouts, use a toner with salicylic acid.  If you get oily later, use an alcohol-free toner with a spray.  

3)  While toner is still wet on your skin, apply a specialty serum.

4)  If acne medication is recommended - every other night, apply your acne medication following given instructions.  On nights without medication, apply your nighttime lotion.  In the morning, apply your specialty serum and then your AHA serum.

4)  Apply a hydrating SPF in the morning, and a hydrating lotion at night.

5)  Once to three times a week, as professionally recommended, use a clay or gel mask to clear your skin and keep it clear.

A word about what to expect

If your current skin care routine has been either very pore clogging or dehydrating (usually it's both), there is a possibility of a breakout after starting a better routine.  As pores become cleared out, oil can finally come through to the skin's surface instead of getting backed up all the time.  As this happens, not only will there be an increase in oiliness on the skin, pores that have been irritated in the past by recurring blemishes will be sensitive to this new flow of oil.  In addition, there is dormant acne hiding under a dehydrated, clogged surface.  An improved skincare routine will allow this dormant acne to finish their growth cycles and come out to be healed by your new routine.  Please be patient !  This breakout will clear up as your skin gets softer and more calmed.  This is the reason it's so important that a good skin care routine include elements that help calm the skin down as well as control new oil.  More detailed informtation can be found at "What Can I Expect?"

Professional help

Evaluations and skincare consultations for Adult Acne with Daniela are possible via email correspondence even without a facial, and in fact, will help even more by preparing the skin for a more effective facial later by softening skin and the impactions inside pores.  Your $120 full skin care evaluation includes a free sample packet tailored just for you, so you can try before you buy.  This service is also available to those who live outside Chicago, so do not worry that you don't have an opportunity to see Daniela for a service! (please note - as Daniela's expertise is in adult acne and not teen acne, this service is only made available to adults 24 years old and older, since follicles and oil glands continue to develop all the way to age 23, which means an acne condition in anyone 23 years old and younger is still considered teen acne and this requires a different approach.)  If you only want to know what to use without a full evaluation, a new free service called Eval by Email® Lite will tell you all you need to know without extra handholding or analysis.

The most important thing to remember is that getting facials without a good skincare routine at home is like jogging to a donut shop !

Are you on a budget and want to know where to spend your money?  Get yourself a good skincare routine at home and skip the facial !

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