Adult acne is real, and terrible – Here's how to control it

Just when we thought our Clearasil days were behind us…

Most of us spent our teen years trying to grow up as fast as we can. There was so much to look forward to… no more homework and curfews. You’d make your own money, have your own house (and house rules), wake up whenever you want and eat dessert for breakfast. Things became a lot less fun when we actually became adults. Bills, landlord troubles, job burnout and horrifyingly, adult acne we thought we’d left behind in our teen years.

Sadly, blackheads, zits and monstrous pimples don’t magically vanish as soon as the clock strikes midnight and you turn 20. There’s no Cinderella moment when it comes to acne – the pumpkin was always a pumpkin, except now instead of just acne, we have adult acne.

It’s normal and manageable, if that’s what you want to do, says cosmetic dermatologist Dr Niketa Sonavane of Ambrosia Aesthetics.

Is adult acne different from teenage acne?

Both cases have some culprits in common – hormones and pores being clogged with excess oil, dead skin cells, bacteria and pollutants. “Teenage acne is mainly caused by hormonal changes that happen at puberty,” she says. “These hormonal changes are normal but they lead to excess oil production in the skin called ‘seborrhea’. Adult acne is mainly caused by hormonal imbalance and stress. Adults with acne may have normal skin with no overt oiliness. The oil, however, tends to be sticky and inflammatory in nature called ‘dyssebacia’.”

What leads to adult acne?

Whiteheads, blackheads, fungal acne, sebaceous filaments, pustules, closed comedones, cysts – there seems to be no end to the list of things that want to call our faces home. And of course, life doesn’t make our desire for the all-day flawless glow any easier. These external and internal irritants can wreak havoc on our skin:

1. Hormones

As Sonavane says, hormones play a huge factor in acne flare-ups. “Polycystic ovarian syndrome or PCOS is the most commonly known imbalance. Currently, I am also seeing an increasing number of patients that have other forms of imbalance such as hyperandrogenism and hyperprolactinaemia in my clinical practice,” she comments.

Our hormones can play a major role when it comes to our skin’s oil production. There are plenty of beauty products and over-the-counter treatments that are marketed with claims of clearing it all up, but it most cases, this is a situation best treated with the guidance of a dermatologist who can identify hormonal acne for what it is and devise a treatment plan accordingly.

2. Stress

The sick joke of the universe is the vicious cycle of it all. Stress leads to acne -> acne leads to stress. Stressors can impair the functioning of the immune system. It increases inflammation in your body and researchers have theorised that cortisol, also known as the ‘stress hormone’, combines with androgens (male hormones present in our body) to trigger flare-ups.

The regulation of oil production gets thrown out of whack, even possibly causing impairment of our skin barrier. The best advice would be to indulge in some self-care, distracting hobbies and meditation to de-stress.

3. Diet

A radically fluctuating diet can not only disturb our digestion and gut health but also that of our skin. Everyone’s bodies react differently to different foods, but a well-balanced diet of fruits, vegetables and lean proteins will do a whole lot of good.

Sonavane says, “Adult acne responds well to a dairy-free and low carb diet. Avoid food that contains refined flour and added sugar. Try to have home-cooked meals and avoid packaged food containing preservatives. Switch to organic groceries if possible and include healthy fat such as desi ghee in your daily meals. Drink lots of water and avoid sugary drinks altogether. Avoid having whey protein, biotin and fish oil as these can increase inflammation in the body.”

4. Skincare routine messes

Who doesn’t love trying out new products? There’s no shortage of cute packaging and deliciously named products out there. It’s easy to get caught up in the hype and unknowingly use ingredients that we could be allergic to or those that are comedogenic. The worst of all is when we get to exfoliation.

The thought of scrubbing away the top layer of our skin to unveil the baby softness underneath – *sigh*. But in all seriousness, physical exfoliation (all your walnut, coffee, apricot scrubs), exfoliating tools and chemical peels might only make the situation worse.

Beauty acids need to be understood and used in moderation. If we exfoliate every day, we can end up irritating our skin, drying it out, leading to another breakout. All you need to cleanse your face is your fingertips. Be gentle. Start with a low-strength acid and work your way up to 1-2 times a week. Most importantly, get your little fingers away from that pimple.

Ok, so how do I treat adult acne?

If you’re dealing with a minimal amount of acne for the first time in your life (lucky you), then you may want to start with simple daily skincare. Choose a gentle fragrance-free cleanser (add an oil cleanser for the night if you wear makeup), follow it up with a light fragrance-free moisturiser that will hydrate and moisturise your skin, restore your skin barrier and curb transepidermal water loss. And always protect your skin by using sunscreen during the day.

Now coming to our favourite part – let’s talk products and ingredients.

Sonavane suggests using clay masks to control excess oil and soothe the skin. “Try the Aztec Indian healing clay mask twice a week. Add a light, water-based moisturizer in your daily routine. You will be surprised at how much better your skin will feel.

Avoid all products that contain silicones, such as your makeup primer and your so-called ‘dry-touch sunscreen’. Silicones can build up on the skin and add to skin congestion. Pick a sulfate-free face wash and body wash. Sulfates can get absorbed through your skin. Once absorbed they work as exogenous hormones and add to your hormonal imbalance.”

Salicylic acid is a BHA and the go-to for many acne-prone skin types to combat breakouts. It can be used in the form of a serum (if your skin can handle it), a mask, and it’s even effective as a face wash (a better choice if you have drier, irritated skin). It can control oil production, break up the dirt in our pores and gently exfoliate the skin. Some acne-fighting products contain Willow Bark extract, which contains salicylic acid. Sulphur is also anti-inflammatory and anti-bacterial and can help control oil production and curb acne. It should be used with caution as it can be irritating and drying if used excessively.

Benzoyl Peroxide and Vitamin A (retinoid), are often the last resort for people with severe acne. However, with serious side effects if misused (severe dryness, peeling and burning), these should only be used if prescribed by dermatologists.