Acne is aggravating at any age, but at a time in their lives when most women would be re-tooling their skin care regimens to address the signs of aging, they are distressed to find that controlling the outbreak of blemishes is their main focus. Adult acne has steadily drawn the attention of the skin care industry over the last decade. This refocusing is a natural response to the demand by the largest and most discerning block of consumers: the baby boomers. It is estimated that 20% of U.S. adults suffer from acne, and 6% carry that problem into their fifties. While younger clients might be somewhat resigned to the woes of acne, clients in the 25-45 year age bracket will tenaciously pursue a solution to this problem until it is resolved to their satisfaction.
What is Acne?
Acne is described as a disease of the pilosebaceous units that can occur at any stage in life. Found over most of the body, pilosebaceous units consist of a sebaceous (oil) gland connected to a hair-containing canal called a follicle. These glands are largest and most numerous on the face, upper back, and chest areas where acne tends to occur. The sebaceous glands manufacture the oily substance called sebum that normally empties onto the skin surface through the opening of the follicle.
At a glance, the pilosebaceous units appear to be part of the dermis or what is sometimes called the true skin, and in a way they are; but only in that they extend down into the dermal region of the tissue. While this is not depicted above, the follicle is actually lined with cells that are classified as part of the epidermis; and that is where the dysfunction begins.
For reasons still not understood by medical researchers, a change occurs to those cells that make up the inner lining of the follicle. This change prevents sebum from flowing through the pore as it normally would. Specifically, there are indications that the cells from the lining of the follicle are shed too fast and remain clumped together. Much like leaves that fall in bunches during a autumn storm and clog up your gutters, this clumped cellular debris plugs up the follicle's opening, thereby disallowing the sebum to reach the surface of the skin.
Another factor in the cycle of acne is the overall increase in sebum production. This abundance of sebum, both inside the follicles and on the surface of the skin, produces an ever-increasing alkalinity, thereby creating a hospitable environment for Propionibacterium acnes (P. acnes) the normally harmless bacteria that live on the skin. As these bacteria grow in the plugged follicles, they produce chemicals and enzymes that can cause inflammation, the skins characteristic reaction to disease or injury which is marked by four signs: swelling, redness, heat, and pain. When the plugged follicle can no longer hold its contents, it ruptures, spilling its contents onto the nearby skin.
This series of imbalances allows a number of different types of lesions to develop, including the following:
- Papules: inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch.
- Pustules (pimples): inflamed, pus-filled lesions that can be red at the base.
- Nodules: large, painful, solid lesions that are lodged deep within the skin.
- Cysts: deep, inflamed, pus-filled lesions that can cause pain and scarring.
What Causes Acne?
Most research seems to point to hormonal fluctuations as the underlying cause of the series of imbalances that trigger the onset of adult acne. Some researchers now hypothesize that this hormonal disruption is linked to xenoestrogens. Xenoestrogens are common chemical substances, found in numerous environmental sources, that mimic estrogens when they are assimilated into the body. Another theory, is that the surge of bio-chemicals that contribute to the development of acne, may be associated with the high level of stress that has been documented in women in this age group. According to Dr. Brent Boost, a Texas gynecologist who has studied the phenomenon and written a book on it, some 50 million women between the ages of 25 and 55 are affected by what he has termed: Hurried Woman Syndrome. He points to the hormone cortisol as the trigger for a host of health problems that stem from a decrease in natural immunity and can include: skin problems, thyroid dysfunction, and weight gain.
There is also a growing suspicion among skin care professionals that, in some cases, the stage is set for adult acne in our teens and twenties. Aggressive treatment of the skin during these years may engender an over-active cycle of sebaceous activity that continues into the future as the skin becomes programmed to protect and defend itself.
Call a Professional
Those who seek professional help in dealing with persistent bouts of adult onset acne will find a multitude of options both inside and outside of the medical establishment. For milder cases, a homecare program structured by a skilled esthetician may be an alternative to a physicians prescriptive care or as an adjunct to medical protocols. In either case, the goal is the same: to improve the health, function and appearance of the skin. This is accomplished only when the dysfunctions, as outlined previously, are countered with a treatment program and products that initiate these actions which can serve as your checklist when discussing a treatment program and homecare with a skin care professional:
- Inhibit the growth of the bacteria P. acnes
- Normalize the skins pH
- Increase cellular turnover, in order to:
- Decreases the formation of microcomedones
- Enhances the penetration of other beneficial actives
- Increases the rate of healing
- Refines the surface texture of the skin
- Regulate sebaceous (oil) production
- Reduce Inflammation
The Treatment of Adult Acne
Sufferers of adult acne should bear in mind that there are also a few age-specific challenges that are likely to be encountered during the course of treatment. As we age, the skin is much more vulnerable to the damaging effects of improper care than the resilient skin of our youth. The rate of skin cell renewal decreases, and this sluggish cellular turnover translates to a slower improvement in the superficial texture, as well as a slower rate of healing for acne lesions. Additionally, the natural thinning of the skin can not only make cystic lesions more apparent and more likely to produce scarring, but a thinner dermal barrier also becomes less efficient at binding moisture thus, becoming dehydrated.
Since the majority of acne care products contain ingredients that can be drying to the skin, this problem can be amplified exponentially with improper treatments, or treatments formulated specifically for younger skin. This decreased level of hydration in the skin substantially hampers the healing process and, thus, the visible improvement of the skin. So, to the list above I would add: Restore hydration levels. To be clear, we are taking about water not oil. The skin requires both for optimum function, and the presence of water in the skin is critical for both the short-term appearance and comfort of the skin but, also the long-term appearance, because of its role in the skins overall health.
A Final Word
Because of the increasing number of cases of adult acne, many new consumer products and pharmaceuticals have risen to the challenge of developing treatments that address the entire spectrum of care that is needed to treat the problem. So, if you think there is nothing new, think again, and contact a skin care professional or dermatologist to find out about the latest solutions and treatments. After all, at your age, you have earned the right to a beautiful complexion.
Caring for Adult Acne
Clean Skin Gently
You may be tempted to try to stop outbreaks and oil production by scrubbing your skin and using strong detergent soaps. However, scrubbing will not improve acne; in fact, it can make the problem worse by increasing the spread of bacteria. Esthetic professionals recommend gently washing the skin with a mild cleanser that does not strip the skin of its natural balance of oil and surface moisture. This protective layer is referred to as the hydro-lipidic (hydro=water/lipdic=oil) film. This invisible barrier plays an important role in providing the skin with a vital layer of protection against dehydration and the proliferation of bacteria.
Wash the face from under the jaw to the hairline, once in the morning and once in the evening. Avoid rough scrubs or pads as they can rupture the pustules on the surface of the skin, leaving traces of bacteria that may contribute to future lesions.
It is important to thoroughly rinse their skin after cleansing and tone with a mildly acidic toner. This will calm any irritation, close the pores and balance the skins pH. It is also beneficial to regularly shampoo the hair, as it can also contribute to the accumulation of oil in certain areas.
Avoid Frequent Handling of the Skin
People who squeeze, pinch, or pick their blemishes risk developing scars. Acne lesions can form in areas where pressure is frequently applied to the skin. Frequent rubbing and touching of skin lesions should be avoided.
Avoid Sun Tanning
Exposure to the sun darkens the skin, which can make blemishes less visible, lessen inflammation and make the skin feel drier for a little while. But the benefits are very temporary and can actually damage the specialized cells (called Langerhans) that are responsible for protecting the skin against free radicals, as well as infection. The sun also promotes aging of skin, and causes skin cancer. (Note: Many of the prescription medications used to treat acne can make a person more prone to sunburn.)
Choose Cosmetics Carefully
People being treated for acne often need to change some of the cosmetics they use. Products that are labeled as non-comedogenic (do not promote the formation of congested pores) should be used. Most mineral makeup work well for acneic individuals however, in some people, even these products may need to be avoided until the problem is under control.
Seek Professional Advice
A skin care professional can offer treatments that will deep clean the pores and a home-care program (perhaps the most critical factor in seeking improvement in the skin) that can be altered as the skin regains its normal function. Their knowledge and expertise will take some of the guesswork out of determining what will benefit your particular skin type and will speed the healing process.
From http://womenshealth.about.com/mbiopage.htm Tracee Cornforth, Your Guide to Women's Health. Reprinted from The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
Ladies Home Journal, Ending the Stress Epidemic by Lisa Collier Cool (August , 2003).