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Why Do Women Get Acne In Adulthood (Part 1)

Why Do Women Get Acne In Adulthood (Part 1)

Over 25% of women have acne after the age of 21! A whopping 45% of women between 21 and 30 years of age have acne. Acne in women over 25 years of age is called Adult Female Acne. It has its own diagnostic name.
  • If the acne started in the teen years, and never stopped, it is called “persistent adult female acne”.
  • If you had clear skin up until 25 years of age, it is called “late onset adult female acne”.
A new study out of Italy was recently reported in the Journal of American Dermatology. This study was well-conducted and ties together many ‘loose ends’ regarding this condition. Hopefully the information will help you or someone you know suffering from this frustrating skin problem.

What Are The Common Characteristics of Adult Female Acne?

Adult female acne is usually on the face, and occasionally on the back and chest too. It most commonly manifests as inflammatory red and pustular acne lesions. This means pustules and inflamed red bumps around pores or deep painful cysts. There may be blackheads, but the problem is more one of inflammation. Most of the inflamed acne lesions are on the chin and cheeks, the middle and lower parts of the face. That’s one of the reasons this form of acne is so embarrassing – lesions are front and center where everyone can see! Complexion problems can be cruel and adult female acne certainly is. Facial seborrhea, rosacea, and adult female acne – all common and all visible. In my opinion, all dermatologists should treat these conditions well and never trivialize them.

The burning question in the mind of every woman with adult female acne is - WHY???

The Italian study identified some commonalities in women who suffered from adult female acne:
  1. Women with acne reported they were under higher levels of psychologic stress than the women without acne.
  2. The women with acne also appeared to be eating less fruits, veggies, and fish than the women without acne.
  3. They often had family members who suffered with acne too.
  4. Teenage acne was an issue for them.
  5. They were more likely to have office jobs.
  6. They had excess facial and body hair, and had not been pregnant even without a history of polycystic ovary syndrome. We know polycystic ovary syndrome is associated with acne in women. It may be even without PCOS, women with adult acne may have greater androgen (male) hormones. This certainly may explain why birth control pills often help control acne, even in the absence of PCOS.

Are Teen Acne and Adult Female Acne Different?

Yes, which is why treatment and counseling needs to be different. Differences between adolescent and female acne include:
  1. Teens with acne are more likely to have a high bmi (be overweight), meaning acne in teen years is associated with weight control, especially in boys. Teen boys with acne were also more likely have high levels of blood lipids (such as cholesterol). This was not found in women suffering from adult female acne.
  2. Teen acne is also worse in teens who drink a lot of milk. This was not found in adult female acne.

What can adult female acne patients do now that this study has identified lifestyle changes that might help?

3 Important Lifestyle Tips to Improve Adult Female Acne:

  1. I’ll tell my patients to eat more fruits, veggies, and fish. This fits with my food pyramid for a healthy diet. We know the classic western diet is rich in simple carbs, sugar, and ‘bad’ fats. This promotes inflammation of all sorts. When you flip the diet on its head, you control many inflammatory driven conditions, including adult female acne. To learn what I recommend, click here for my free diet guide.
  2. The connection between office work and stress is part of life. I recommend activities that reduce stress and get us outside. These are healthy overall. Go for regular walks in the fresh air – sun protected, of course. Other activities that help me de-stress are meditating, gardening, yoga, and writing blogs (it’s true, I love writing for you).
  3. For my patients who still can’t control their acne with good skin care, and a healthy/less stressful lifestyle, I would advise for them to see their gynecologist. Discuss hormone evaluation and whether birth control pills are a safe option.

 What Products Would I Recommend for My Patients Suffering from Adult Female Acne?

It depends on the characteristics of a woman’s acne and her skin type:
  • Is there pityrosporum folliculitis?
  • Are skin care products playing a part in clogging pores or causing pimples?
  • Is hyperpigmentation an issue for her?
  • Does she want to brighten her complexion and fight skin aging?
  • Sensitive or tolerant skin?
I usually end up mixing and matching a retinoid, glycolic acid, and pyrithione zinc. I may also use benzoyl peroxide to spot treat pimples. We will select products to match skin's tolerance and oiliness, as well as the feel of my patient desires to have during the day and night. I’ll give you some of the specific product selections in the next post.    Reference Di Landro, Anna MD, et. at., Adult female acne and associated risk factors: Results of a multicenter case-controlled study in Italy, J Am Acad Dermatol, 75 (6):1134-1141