Typically, adolescence is the stage of life that acne is prone to, but acne caused by hormones, usually starts to act up in the early to middle twenties. This is known to continue well into a woman’s adult life. Hormonal acne is caused by over-stimulated androgens, oil glands and hair follicles. Acne breakouts occur when oil glands are stimulated excessively. Most, almost half in fact, of all women experience an increase in facial oiliness and acne flares about a week before menstruation. When constant acne is partnered with excess facial hair and hair loss or thinning hair, it is a sign that androgen production is excessive and can be a red flag to such medical condition such as polycystic ovaries and adrenal hyperplasia. If any of these signals are present a woman should seek medical advice. Hormonal acne can also cause women to have abnormal menstrual cycles, suffer from obesity, infertility and possibly diabetes. It is very important for women to talk with their doctor about their concerns; a blood test can determine the cause of the symptoms and help determine the best treatment.

Treatment options for hormonal acne are very effective and readily available. Some treatments available are Benzoyl peroxide, a topical antimicrobial, and also some oral antibiotics if the acne is more severe. Isotretinoin is a very popular and effective treatment for women with cystic acne that is accompanied by scarring. Oral contraceptive pills can be used successfully for women with hormonal acne who still develop premenstrual flares. Oral contraceptive pills contain estrogen and progestin that help regulate the menstrual cycle and decrease the androgen activity that contributes to the development of acne. By reducing the androgen activity it leads to decreased breakouts of acne. If the women are not planning to have children they can take oral contraceptive pills to control acne for extended periods. Spironolactone, an anti-androgen, is another medication that may be prescribed in along with an oral contraceptive to prevent and treat hormonal acne. It blocks androgen receptors and decreases androgen production in the ovaries and the adrenal glands to prevent excessive oil production. The result from this treatment is, of course, fewer acne flares. Oral contraceptive pills can cause several side effects that can be mild or severe. Mild side effects may include breast tenderness, bloating and nausea. More serious side effects such as blood clots and strokes are less common with pills that contain less estrogen. A woman considering oral contraceptive pills to control their acne should discuss the pros and cons with her doctor.

Women typically have drier, more sensitive skin as an adult than they did as a teenager and therefore should talk to their dermatologist about an appropriate skin care program. Gently washing the face with mild facial soap is usually recommended and scrubbing should be avoided. Scrubbing can irritate the skin and make acne worse. Toners containing glycolic acid or salicylic acid may help remove the oils that contribute to the development of acne during the premenstrual period. Toner can also be an effective tool for those with oily skin. Since some acne treatment can cause dryness women should try to use a light water based moisturizer. Daily sun protection is very important as some acne medications can increase the skin’s ability to burn and become damaged in the direct sunlight. When buying make up products always look for products labeled non-comedogenic, these do not clog or block the pores and will be less likely to cause acne. Your dermatologist is your guide to treatment options and skin care products that can work together with your acne treatment to improve the look of your skin.

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While there is no one authoritative answer on the causes of adult acne, there are some things that are known for sure:

Every hair on our bodies is anchored in a hair follicle and each hair follicle has a sebaceous gland attached to it.

Each one of these sebaceous glands produces an oily substance known as sebum. The sebum protects your skin and makes your hair shiny.

Some people’s bodies produce lots of sebum — this results in oily skin.

The oilier your skin is, the better chance you have of getting blackheads, whiteheads or pimples, and acne. This happens because hair follicles occasionally become plugged up with the sebum and with dead skin cells. In fact, every minute of the day, though you can’t see it happening, skin creates about 30,000 new skin cells. In addition, skin shed about 30,000 of the old, dead skin cells. There are always lots of dead skin cells to contribute to the process.

Since everyone of every age has hair follicles, sebaceous glands and dead skin cells everyone of every age can, at least theoretically, get acne.

There are some things, however, that are known to contribute to acne in adults of all ages:

Medication. There are some medications that are known to, at least in some people, cause acne. Acne is one of the principal side effects of the ‘anti-aging’ drug known as DHEA. Some other drugs that have acne as a undesired effect are: anabolic steroids, some anti-epileptic medications, the anti-tuberculosis drugs isoniazid and rifampin and also lithium and iodine-containing medications.

Chafing. A form of acne known as “acne mechanica” can arise from a repeated pressure on a particular area of your body. For example, wearing a heavy back pack every day, wearing a safety helmet or a tight cap or playing an instrument such as a  violin or cello will all put a repeated pressure on some area of your body and that area may develop an outbreak of acne.

Chemical exposure. An overexposure to certain chemicals can cause an acne condition known as chloracne to appear as an outbreak of blackheads, cysts, and pustules, most commonly on the cheeks, behind the ears, in the armpits and in the groin region. The chemicals known to cause this are forms of chlorinated dioxins (such as those used to produce herbicides) and dibenzofurans.

Metabolic conditions. We know that adolescent acne is caused by hormonal imbalances during puberty and have found that hormonal imbalances at any age will create the same condition — hormone imbalances such as those brought about by pregnancy and menstruation or hormonal abnormalities for any reason, such as an adverse effect of a medication, can induce acne.

Treatment: If you suspect you have adult acne you should make an appointment to see your doctor or get a referral to a dermatologist, if only to determine that it really is acne and not some skin condition that only resembles acne.

Aside from following your doctor’s advise and using whatever medication your doctor recommends by following the directions for its use, there is one other thing you can do to help cure acne. Be careful and gentle with your skin. Irritation of the skin can make acne worse and should be avoided. Don’t pick at acne or scratch at it with your fingernails (or anything else). When bathing, don not use a rough or abrasive wash cloth or a stiff brush. These things will irritate your skin and cause even more damage to your hair follicles.

Speaking of damaged hair follicles, there is one particular condition that looks very much like acne but is not acne. This condition is called folliculitis. Folliculitis occurs when hair follicles (usually damaged hair follicles)  become infected and inflamed due to contact with an external bacteria. A mild case of folliculitis will usually go away by itself after a few weeks but if it is really bothersome (itchy) or looks very irritated, it is best to consult your doctor for treatment.

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