Here’s how adult acne differs from hormonal acne

Acne at 45 can be slightly more galling than acne at 18; we spoke to experts to understand the causes and possible treatment

Acne is a common phenomenon when puberty hits; your body goes through a host of transitions, forwarding your hormonal system to a major reorientation. According to a report by the National Library of Medicine, acne is prevalent in almost 95 per cent of adolescents. So when your skin is engulfed in pustules in your teenage years and early twenties, it only seems like the most normal thing to happen. However, when you experience acne flare-ups in your 30s, 40s and 50s, most—if not all—are clueless about its occurrence in the very first place, making acne a matter of graver concern than fine lines and wrinkles. A report by the American Academy of Dermatology revealed that adult acne is on an all-time rise. We ask two dermatologists to shed light on the science-backed and mindful ways to approach the condition. 

What is adult acne?

It is key to understand when exactly your acne qualifies as ‘adult acne’. “Adult acne is a condition where acne develops usually in the late 20s, 30s and even 40s, or later. Although acne is more commonly associated with adolescent skin, about 25 per cent of men and 50 per cent of women experience acne as adults,” shares Mumbai-based celebrity dermatologist and author of The Skincare Answer Book, Dr Jaishree Sharad.

Cataloguing the most common symptoms of adult acne, Mumbai-based celebrity dermatologist and founder of Yavana Aesthetics, Dr Madhuri Agarwal, says, “Adult acne occurs mainly in the lower areas of the face such as the chin, jawline, sides of the face and upper neck. The breakouts are mostly present in the form of big and painful nodules or cysts without any opening, which could last for days and then settle down, leaving behind bad scarring.” Blackheads and whiteheads aren’t usual accompaniments, believes Agarwal. “It is mostly around the time of your periods, so you may experience it at a particular time every month. Adult acne could also occur around menopause and pregnancy,” she adds, highlighting the play of hormonal metamorphosis in the body in the acne on your skin.

More often than not, adult acne is caused by the agency of hormonal imbalances or a major transposition in the body, think pregnancy, for one. “The causes of adult acne are multifactorial and can be influenced by factors like genetics, hormonal changes, stress, diet, skincare products and medications. Hormonal imbalances, such as those that occur during the menstrual cycle, pregnancy or menopause, can cause adult acne. Stress can also cause an increase in hormone production and inflammation, leading to acne breakouts. Additionally, the use of certain skincare products or make-up—particularly those containing oils or comedogenic ingredients—can clog pores and lead to acne,” states Sharad. 

“The causes are multiple,” says Agarwal, echoing Sharad. “There is the presence of resistant P acnes bacteria in adult acne. There can be a strong family history of adult acne. The interplay and imbalance of hormones—primarily estrogen and progesterone—levels will lead to adult acne. At times, testosterone levels are also affected by the imbalance contributing to adult acne in women. The stress hormone cortisol also leads to increased oil production,” says Agarwal, who believes that changes in cycles, PCOS, an unhealthy diet and certain medications like steroids or fertility treatments can aggravate adult acne.

Adult acne versus hormonal acne

“Adult acne is typically characterised by deeper, cystic blemishes that appear primarily on the lower part of the face,’ says Sharad. “Hormonal acne, on the other hand, is associated with the menstrual cycle in females and is caused by an increase in androgen hormone levels. This type of acne is often located along the chin and jawline. Acne that occurs in one’s teenage years is typically caused by hormonal changes associated with puberty and is often characterised by blackheads, whiteheads and small pimples that appear on the forehead, nose and cheeks,” explains the dermatologist.

According to Agarwal, the difference lies in the way they show up on the face as well as recover. For some, acne can be an ongoing concern from adolescence to much later in life. “This type of acne is called persistent acne,” says Agarwal.

An ideal treatment plan

“When it is adult acne, never self-treat it,” suggests Agarwal. “You need to consult a dermatologist to get the correct diagnosis, who can advise oral medications such as antiandrogens, birth control pills, isotretinoin or other applications of medications after assessing the acne clinically.” Sharad advises keeping away from oil-based and comedogenic products, which can aggravate acne by clogging the pores. Agarwal, meanwhile, recommends sticking to one single anti-acne ingredient consistently instead of trying different ingredients every day. “Apply it as short contact (and wash it after an hour or two) instead of keeping it overnight,” she advises. Sharad’s also recommends salicylic acid and benzoyl peroxide. “Avoid using products that contain alcohol or other harsh chemical ingredients that can strip the skin of its natural oils,” she mentions.

However, if you think slapping a salicylic acid cream or dabbing some benzoyl peroxide treatment at home, alone, will make the cut, that may not be helpful. Tackling adult acne also demands restructuring your lifestyle habits. “Stress can trigger acne flare-ups, so find ways to manage stress such as exercise, meditation, or relaxation techniques,” affirms Sharad. She also emphasises the importance of staying hydrated. “Eating a diet rich in fruits and vegetables can provide essential vitamins and minerals that support healthy skin. Avoid dairy, since studies have shown that high glycemic index foods can cause acne or worsen it.” Agarwal advises against self-extracting acne at home as it can push it in deeper and worsen the problem.

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