Causes of Adult Onset Acne
Acne is a condition that is commonly thought of as only affecting adolescents. However up to 51% of women between the ages 20-29 and 26% of women between 40-49 also suffer from this condition.
The pathogenesis of acne is multifactorial and involves four main pathways. These include:
Increased sebum production due to sebaceous gland stimulation by androgens
Abnormal follicular keratinization leading to plugging and comedone formation
The colonisation of the bacteria Cutibacterium acnes (formerly known as Propionibacterium acnes)
Inflammation of the follicle and the dermis surrounding the follicle.
For many individuals, acne can be a debilitating and impact quality of life.
Identifying the individual cause/s of acne in adults can be quite complex and isn't always due to elevated testosterone. So I thought I would share with you some of the top contributing factors to be aware of.
#1 Hormones
Let's start with the most common causes of adult onset acne, hormone imbalances. These can include:
Excessive production of androgens
Excessive androgens can contribute to acne formation in both sexes. This is because sebum glands in the skin are sensitive to androgens and excessive levels will increase sebum production.
Testosterone is known for its ability to potentially convert down to the more potent metabolite dihydrotestosterone (DHT), which can interact with androgen receptors in sebaceous glands. However less potent androgens such as DHEA and androstenedione which can be elevated in stress also have the ability to be metabolised directly within the skin to DHT influencing sebum production.
Post pill rebound acne
The oral contraceptive pill contains synthetic hormones that essentially stop women ovulating, therefore preventing pregnancy. These synthetic hormones actually suppress testosterone levels and thus sebum production to levels in line with prepubescent skin. So when the pill is stopped, the withdrawal causes the skin to have a rebound effect where it produces excessive amounts of sebum and androgens which causes acne.
Low oestrogen
I bet you weren't thinking your levels of oestrogen could influence your skin. While oestrogen can get a pretty bad wrap, it actually has many beneficial effects when in balance. When it comes to skin health, healthy oestrogen levels have the ability to suppress sebum production.
It's this reason some women can experience acne when they enter perimenopause/menopause. Even when testosterone levels are within range, it’s believed this protective mechanism of oestrogen is lacking.
#2 Diet
Diet is considered to be one of the main factors influencing the formation and aggravation of acne in adults. In particular the rise of the modern western diet which is high in refined sugars, refined carbohydrates and dairy products. This influences insulin and insulin-like growth factor (IGF)-1. IGF-1 can increase through puberty and with the consumption of dairy.
IGF-1 has a direct influence on androgen regulation in the skin and potentiates androgen signaling by activating the enzyme 5α-reductase and androgen receptors. This leads to increased inflammatory cytokines and sebum production, thereby promoting the development of acne. Read my blog Foods to avoid in acne prone skin for more on diet and acne.
Refined carbohydrates also influence acne pathogenesis through their impact on insulin levels.
A vegan diet can also increase the risk of acne due to the low level of protein and higher levels of lectins found in pulses and beans. Lectins are indigestible proteins that pass through the gut to the intestines unchanged. There they can bind to the cells lining the intestines causing irritation and prevent the absorption of nutrients, such as those needed for healthy skin, in the gut.
#3 Poor gut health
The skin is the biggest organ in the body. So when something occurs on the skin like acne, it’s usually a sign something within the body isn't right.
Digestive bacteria imbalances
Lipopolysaccharides or LPS’s are toxic metabolites produced by certain bacteria that can contribute to acne. These LPS toxins are pro inflammatory and can lead to leakiness of the gut lining. Once this occurs they can enter into the bloodstream causing more problems. High levels of LPS have also been associated with reduced nutritional status, poor wound healing and scaring.
Constipation
One of the most important aspects of health is that of regular bowel movements for removing toxins from the body. If your not passing a stool frequently then faeces is left to sit in the bowel. This then leads to reabsorption of toxins and metabolites into the bloodstream. Because the skin is one of the bodies routes of elimination, the body may then sends these toxins to the skin to be excreted causing a localised effect and lead to acne.
Food intolerances
It is thought that food intolerances in some individuals may present as adult onset acne. This is most likely due to the effect that an intolerant food would elicit on the digestive tract leading to inflammation and permeability of the gut wall.
#4 Stress
Ah stress! Is there any area of our health that stress doesn't affect? Like I mentioned above stress can cause elevations in adrenal androgens such as DHEA, DHEAs and androstenedione. Which can all be converted in the skin to the potent DHT to influence sebum production.
Prolonged stress can also cause an increase in blood sugar levels which can lead to insulin resistance. Insulin has an ability to cause the theca cells of the ovaries to produce more testosterone leading to acne.
#5 Choice of topical products
I see time and time again women coming to see me who have been using harsh chemicals to try to combat their acne topically. The problem with this is that these chemicals strip the skin of oil which then causes it to be dry and produce more sebum in response. many of these chemicals can alter the pH of the skin’s surface which can alter the skins microbiome and increase risk of microbial dysbiosis of the skin. What's more, these chemicals are pro inflammatory which means they contribute to the inflammation of the skin.
Acne is a multi faceted condition with many potential drivers. If you suffer from acne it’s important to work with a professional who can identify the triggers for you specifically so that you can have the clear skin you desire.
Melissa Briggs is an experienced Brisbane based Naturopath with a particular interest in women’s health and thyroid disorders. Need help with your health? Get in touch here.