And How to Manage It

 

It is a common misconception that acne is exclusively an adolescent condition. In reality, adult acne is incredibly common. If you’re anything like us, you have acne in your 30s, 40s, and even into your 50s. We’re here to tell you—adult acne is normal.

No matter your challenges, stressors, or life-phase, learning to love your skin is a crucial step toward self-acceptance, and treating your skin correctly is the first phase of this journey. Our goal at ph-In is to help you understand your skin, and to guide you toward adult acne treatment that is healthy and effective. 

What Is Adult Acne?

"Adult acne is simply the persistence or appearance of acne after adolescence."  

Key Facts

• The term ‘adult acne’ applies to any acne that appears after adolescence
• Adult acne can appear anywhere on the face, neck, and body
• Adult acne is typically more inflammatory than adolescent acne

Adult acne simply describes the persistence or appearance of acne after adolescence. At any age, acne is not an acute disease, but rather a chronic skin condition that continuously changes in its distribution and severity.1 Adult acne is observed to appear in multiple facial zones including the cheeks, forehead, jawline, and neck.2 As an adult, you can expect acne to show up anywhere on the face and neck and for it to migrate and change over time.  

 It has been observed that adult acne is more inflammatory than adolescent acne.3 Non-inflammatory blemishes are often found closer to the surface of the skin, respond more readily to traditional acne treatments, and heal faster. Conversely, inflammatory acne is located deeper in the skin and is characterized by inflammation (swelling) that may cause pain and discomfort. Adult cystic acne, for example, is a type of blemish associated with inflammatory acne. In some cases, inflammatory acne does not respond to harsh acne treatments like benzoyl peroxides, requiring approaches to treatment that are more maintenance-based than defensive.

 

What Causes Adult Acne?

"Overuse of certain cosmetics such as make-up, creams, and harsh peeling techniques also pose a risk to adult skin."     

Key Facts 

• Adult acne may be genetic, as you are more likely to develop it if close family members have it too 
• Overuse of harsh cosmetics may pose a great risk to adult skin
• Many complex physiological factors cause and contribute to adult acne 

The causes of adult acne are extremely complex, with several contributing genetic, hormonal, environmental, and physiological factors. A 1998 study suggests that familial factors are significant in determining an individual’s susceptibility to adult acne, because genetics may account for a failure of acne-prone follicles to evolve into acne-resistant follicles in adult life.4 Flare-ups before menstruation are shown to be more common in adults than in adolescents, and are observed in about 50% of menstruating adults and adult women with acne, suggesting a prevalence of adult hormonal acne.2 Further, it is shown that overuse of certain cosmetics such as make-up, creams, and harsh peeling techniques also pose a risk to adult skin.5

More recent research sheds light on the numerous physiological factors contributing to adult acne by revealing complex microbial activity on the surface of the skin. Acne can develop as a biproduct of keratin buildup in hair follicles (follicular hyperkeratinization), an overproduction of sebum, or proliferations of C. acnes.6 The lipids, bacteria, fungi, and viruses that are involved in these processes are characteristic of a dermal system called the skin microbiome and its interactions with the immune system.

 

What is the Microbiome? 

"Our skin is host to millions of microorganisms including bacteria, fungi, and viruses."

Key Facts 

• Millions of microorganisms live on the surface of our skin 
• These microorganisms contribute to both our skin health and our overall health 
• Some microbes are harmful, and some are not 

The skin microbiome refers to these organisms (microbes) and their environment. Microbes play a crucial role in defending us against harmful pathogens, chemicals, and radiation, and perform an overwhelming number of immune functions.7 The skin microbiome is therefore an essential component of human health.

There are two main categories of bacteria on the surface of our skin. Resident microbes exist there permanently. These resident microbes are called commensal or ‘good’ microbes and are important for normal skin functions. Transient microbes enter the ecosystem from the surrounding environment and exist on our skin temporarily. Some transient microbes are pathogenic ‘bad’ bacteria that can lead to skin concerns, while other transient microbes are harmless, or even important for maintaining normal skin.6

 

Microbial Imbalance and Adult Acne

"In adulthood, acne is caused by an overproduction of C. acnes."

Key Facts 

• Many factors influence the composition of the skin microbiome 
• When C. acnes outnumber other microbes, the microbiome is in dysbiosis (imbalance) 
• Microbial dysbiosis is a leading cause of acne 

 

Throughout our lives, factors like skin pH, humidity, and sebaceous gland density contribute to the fluctuation of microbiome composition. During puberty, for example, sebaceous glands are activated, resulting in increased sebum production. In adulthood, acne is caused by an overproduction of C. acnes. When C. acnes outnumber other important microbes on our skin, the microbiome is said to be in a state of dysbiosis (imbalance) that is responsible for much of adult acne.7

Adult Acne Skincare Solutions

"Each step of pH-In's Healthy Skin System is Microbiome Friendly, and targets harmful C. acne microbes while preserving other healthy microbes."

Key Facts 

• The most important way to prevent adult acne is to preserve the good bacteria, and target the harmful bacteria 
• Traditional acne treatments are non-selective, meaning they kill all bacteria whether it is harmful or not
• pH-In’s Healthy Skin System specifically targets harmful bacteria, and preserves the rest 

Managing adult acne requires a holistic approach that considers the distinctive features and circumstances of each individual case. But, when it comes to adult acne, the main objective is not to kill bacteria on the skin, but rather to prevent or treat microbial dysbiosis by targeting specific, acne-inducing microbes.

Traditional acne treatments like benzoyl peroxide and salicylic acid are anti-microbial and non-selective; these treatments kill off both bad and good bacteria on the surface of the skin. This process promotes an imbalance in the skin’s microbiome, worsening the appearance of acne over time. 

Each step of pH-In’s innovative Healthy Skin System is Microbiome Friendly Certified, and targets harmful C. acne microbes while preserving other healthy microbes. By targeting the bad bacteria and protecting the good, with continued use this system will reduce the appearance of acne, fight post-acne marks, and hydrate to strengthen the skin’s moisture barrier. By supporting a healthy microbiome and maintaining a healthy skin pH, each step in this system plays a role in easing the appearance of acne. 

Additionally, maintaining healthy skin habits such as avoiding touching the face, washing pillowcases regularly, and protecting the skin from the sun can also help reduce the risk of developing adult acne. 

Frequently Asked Questions 

 

Why is the skin microbiome important? 

• The skin microbiome is an essential function of human health, and it is in our best interest to preserve it. 
• Human skin is the body’s largest organ and provides the first line of defense against all external agents. The skin is a physical barrier, but also an immunological one. This means that the colony of microbes on the surface of the skin perform a wide range of innate and adaptive immune functions, fighting off pathogens, interacting with immune cells on the skin, and modifying host immunity. 

What is hormonal adult acne? 

• The term “hormonal acne” is used to describe acne that is supposed to be caused by certain fluctuations or production of hormones in the body. 

• The truth is that it is unclear exactly what fluctuations and productions of hormones cause acne and why. Some relationships are proven, for example between the overproduction of androgens and presence of inflammatory acne, but for the most part the exact nature of these relationships is unclear. 
• Hormonal acne therefore describes a vague relationship between hormone production and the appearance of blemishes on the skin. 

Is hormonal acne different from regular adult acne? 

• No. Hormones are one of many factors that contribute to adult acne. “Hormonal acne” is therefore not a type of acne in itself. 

Are all facial cleansers the same?  

• No! It is a common misconception that all cleansers work the same, and achieve the same results. This is absolutely not the case. 
• Many facial cleansers use harsh ingredients that strip the askin of natural oils. This can pose a risk especially to those with acne-prone skin. 

What type of facial cleanser should I use? 

• It is important to look for cleansers that remove dirt and debris from the skin without disrupting the skin’s microbiome. 
• Avoid cleansers with ingredients like sulfates, salicylic acid, benzoyl peroxide, and glycolic acid, and fragrances, and opt for a cleanser that is microbiome friendly certified. 

 

 

 

Citations: 

1. Gollnick HPM, Finlay AY, Shear N, on behalf of the Global Alliance to Improve Outcomes in Acne. Can We Define Acne as a Chronic Disease? Am J Clin Dermatol. 2008;9(5):279-284. doi:10.2165/00128071-200809050-00001
2. Dreno B, Bagatin E, Blume-Peytavi U, Rocha M, Gollnick H. Female type of adult acne: Physiological and psychological considerations and management. JDDG J Dtsch Dermatol Ges. 2018;16(10):1185-1194. doi:10.1111/ddg.13664
3. Khunger N, Kumar C. A clinico-epidemiological study of adult acne: Is it different from adolescent acne? Indian J Dermatol Venereol Leprol. 2012;78:335. doi:10.4103/0378-6323.95450
4. Goulden, Mcgeown, Cunliffe. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals: FAMILY RISK OF ACNE. Br J Dermatol. 1999;141(2):297-300. doi:10.1046/j.1365-2133.1999.02979.x
5. Acne Vulgaris in Skin of Color: Understanding Nuances and Optimizing Treatment Outcomes - JDDonline - Journal of Drugs in Dermatology. Accessed March 30, 2023. https://jddonline.com/articles/acne-vulgaris-in-skin-of-color-understanding-nuances-and-optimizing-treatment-outcomes-S1545961614S0061X/
6. Dréno B, Dagnelie MA, Khammari A, Corvec S. The Skin Microbiome: A New Actor in Inflammatory Acne. Am J Clin Dermatol. 2020;21(S1):18-24. doi:10.1007/s40257-020-00531-1
7. Lee, Byun, Kim. Potential Role of the Microbiome in Acne: A Comprehensive Review. J Clin Med. 2019;8(7):987. doi:10.3390/jcm8070987