One in five adults aged 20 to 45, acne never really goes away
The causes of common acne in adults are very similar to the causes of common acne in teenagers, but the cures are very different.
In both teens and adults the first step in the creation of blackheads, whiteheads, and pimples is a phenomenon called retention hyperkeratosis. Ordinarily, the skin produces a waxy oil called sebum. This oil lubricates the skin so that it slides over the underlying tissues with wrinkling or bunching up. Sebum, or oil, is fundamentally a good thing.
In acne, however, sebum becomes the source of a serious skin problem. The process of hyperkeratosis makes the tough, outermost layer of skin to thicken around the openings of pores. Any pores surrounded by thick skin retain sebum. This ordinarily healthy skin oil gets trapped with the Propionibacterium acnes bacteria that ordinarily feed on it to keep sebum from building up on the skin.
Acne bacteria serve as a natural backup system
If you think about it, it's not hard to understand that for most of human history, not only were there no commercial skin care products, there were no faucets with running hot and cold water, either. Acne bacteria serve as a natural backup system for occasions people can't wash.
When these bacteria are trapped in the pore, however, they emit waste products containing peroxides. The peroxides irritate the skin and cause redness, inflammation, and itch. Even without inflammation, however, the skin can trap plugs of sebum in a pore to cause whiteheads, or tightly packed sebum can oxidize in the pore to form blackheads.
Medical researchers don't really know what causes hyperkeratosis. One possibility is that this thickening of the skin is caused by surges in the sex hormone testosterone. This hormone is produced by both males and females, and it is created in greatest amounts during adolescence. Testosterone probably explains why teenagers get acne about the same time they become interested in sex.
One of the most important adults acne facts, however, is that then when adults get acne, the cause probably is not testosterone. Taking testosterone injections can cause acne, but most adults who have acne do not have high testosterone levels. The unfortunate minority of adults who continue to have acne typically have unusually sensitive testosterone sensors in their skin, and the skin continues to be stimulated to toughen and thicken around pores until hormone levels begin to decline around age 45.
Adults who get acne have developed an "allergy" to the bacteria
In some cases adults who get acne have developed an "allergy" to the bacteria that live in the pores and feed on sebum. Unfortunately, taking antibiotics to get rid of acne bacteria also kills the bacteria that protect the skin against infections with staph bacteria, the kind of bacteria that cause "pimples" with yellow, circular centers.
If the causes of acne are basically similar in adults and teens, the cures are fundamentally different. Adult acne treatment requires a much gentler approach than usually works for teens. Teenage skin is still growing and isn't easily damaged. Adult skin is more easily damaged by acne but slower to repair itself.
Teenagers often respond well to treatment with benzoyl peroxide, an antibacterial cream or foam that specifically kills acne bacteria. When adults use benzoyl peroxide, unfortunately, there can be a nasty side effect—more acne!
The problem with benzoyl peroxide use in adult skin is that it makes the skin too dry. The chemical does kill the bacteria in the pore and the foaming action can indeed remove sebum, but all the chemical cleansing dries out the skin. Microscopic flakes of dried skin then lodge over previously open pores, trapping oil and bacteria inside, perpetuating the cycle. This side effect is great for product manufacturers, of course, since benzoyl peroxide clears up old pimples only to keep on generating new ones.
Fighting acne infection sometimes is done best with herbal remedies
It's one of the most important adult acne facts that fighting acne infection sometimes is done best with herbal remedies. Tea tree oil, for instance, kills Propionibacterium acnes just as well as benzoyl peroxide, but without drying out the skin. It does not work quite as quickly as benzoyl peroxide, but it does not cause new breakouts. Soaps and washes made with calendula (marigold flowers) stop the pain of acne, and kill the bacteria that cause staph and strep infections, both of which can be even more disfiguring and painful than common acne.
Adults who have acne also have to be more careful about how they wash their skin. Slapping some soap on a washcloth and giving your face a good rubdown really is not the best approach. It is far better to work your cleanser into a lather, and then apply the lather to your skin with your clean fingertips. Allow the cleanser to work on your skin for about 30 seconds, and then wash off with warm water. Pat your face dry.
The details of how you wash you face make an important difference. Cold water closes pores, and hot water dries out the skin. Warm water is always best.
Rubbing a washcloth on your face can leave soap film on the skin. Soap film blocks pores. Any vigorous rubbing of the skin with either a washcloth or a face towel lifts tiny flakes of skin that can trap sebum in pores, and using a dirty washcloth or towel can reinfect the skin with the very same bacteria that the cleansing routine is meant to remove.
Adults who have acne usually should use toners
Teenagers who have acne usually don't need to use toners. Adults who have acne usually do.
Toners remove residual oils from the skin. You apply just a little bit a time, making sure you apply the toner with clean fingertips. The toner is removed with a pad until it no longer picks up a faint hue of yellow or gray. This extra step doesn't just leave the skin feeling fresh, it also compensates for the thickening of the skin caused by retention hyperkeratosis.
Adults who have acne usually benefit from using gentle, natural face peels, especially if they have unusually oily skin or enlarged pores. Any natural face peel that contains lactic or glycolic acid is a good way to deal with visible pores. The most effective way to use a face peel, however, is often not information that can be found with the product. Another important adult acne fact is that toners should be applied:
- First, do your cleansing routine and pat dry, then
- Apply two or three drops of the product with your fingertips across your face, and then
- Gently massage your face until the product is completely absorbed.
The result is normal pores, smoother skin, and a deeper skin tone.
Can adults overcome acne?
Of course, adults are far more likely than teens to use cosmetic cover-ups for visible, red pimples. Just remember that there are two steps. First, cancel out the red of the pimple with the green of concealer, and then be sure to cover up the green with flesh tones! Women may also want to use powder as a last step to make sure the same tone and texture is achieved over the entire face.
Diet is also useful in overcoming acne, but the dietary changes that support healthy skin are not what most adults expect. It's far more important to avoid sugar and easily digested carbohydrates (white bread, white potatoes, white rice) than it is to avoid fats. And chocolate and nuts, in reasonable quantities (up to 1 oz/30 g a day of either) can actually be helpful. The kind of skin condition that causes redness after eating chocolate or nuts is herpes, not acne.
The fact is, for the overwhelming majority of adults who have common acne, the answer is simple, daily skin care. Deep-seated acne problems like cysts and nodules may require a doctor's care, but after initial medical treatment, daily skin care is the most important element in keeping acne gone for good.