Managing Acne and Skin Imbalance
Some adults continue to get acne well into their 30s, 40s, and even 50s. It is even possible to get acne for the first time as an adult. Adult acne has many similarities to adolescent acne with regard to both causes and treatments. But there are some unique qualities to adult acne as well, such as hormone imbalance. Some medications, including corticosteroids, anabolic steroids, and lithium, can also cause acne.
Before thinking of radical solutions like Benzoyl Peroxide (see below), there might be some simple things to do first with regards to the balance of your skin: similar to the gut’s microbial disruption-disease cycle, skin microbial dysbiosis (aka imbalance) can lead to skin problems ranging from redness, irritation, rosacea, rashes, eczema, resurgence of acne and adult acne to photosensitization.
In this article, we'll provide some skincare tips to restore and preserve balance, and avoid over-colonization by disease-causing pathogens.
At the root of all acne is a clogged pore
The pore is the opening that surrounds each hair follicle, and an important part of your skin because pores also house the sebaceous glands. These glands secrete sebum (oil) through the pore opening, which helps keep your skin soft and protected.
Now, meet microbe Propionibacterium acnes: P. acnes lives in the sebaceous glands and hydrolyses sebum into free fatty acids and propionic acid (hence its name), thus greatly assisting in maintaining proper skin barrier function.
A microbe that inhabits all skin, healthy and acneic alike, it only starts to become problematic when pores become clogged with excess sebum, dead skin cells or dirt (or all 3). New research reveals that there are some strains of P. acnes found in acneic skin that are not found in healthy skin, leading scientists to believe that not all species of P. acnes create acne—just some strains.
Acne is the most common skin condition in the US
According to the Academy of Dermatology, mild to moderate acne affects between 40 and 50 million Americans. And while acne usually begins in puberty and affects almost 100% of teenagers, acne is not restricted to any age group. In fact, acne affects 20% of adults between the ages of 25 and 44.
Exfoliate to prime the skin
Over time, dead skin cells can build up on the surface of the skin, making it more difficult for the skin microbiome to do its job. Apply a gentle enzyme peel once or twice a week to sweep away dead skin cells, accelerate cell turnover and increase the absorption of other products into the skin.
Choose the right cleanser
Many regular soaps have an acidity, or pH, that is too high and can irritate the skin, making acne worse.
Choose cleansers, rinses, and washes with a pH closer to the skin’s natural pH of around 5.5 to reduce the risk of acne flare-ups and let sores heal.
Use oil-free skincare
Oil-based or greasy products can block pores, increasing the risk of them becoming clogged and forming acne sores.
Look for skin care products and cosmetics labeled as ‘oil-free’ or ‘non-comedogenic,’ which contain ingredients that allow pores to breathe.
Benzoyl Peroxide
Benzoyl peroxide (BP) is a powerful antimicrobial that is banned in the European Union in all over-the-counter skin care products. While BP is still approved for use in the U.S., the FDA has issued warnings about it: “The use of certain acne products containing the active ingredients benzoyl peroxide or salicylic acid can cause rare but serious and potentially life-threatening allergic reactions or severe irritation.”
Some people find that BP works for a time to clear their acne, then simply stops working. Scientists don't exactly know why, but tend to think it might have to do with the repeated killing off of P. acnes, the microbe that helps maintain proper skin barrier function, bringing all new kinds of problems.
Isotretinoin
A form of vitamin A, has been prescribed to treat acne for decades. It reduces oil production in the skin, which helps prevent acne from forming. new research from Washington University School of Medicine in St. Louis has uncovered a previously unknown benefit of the medication. It shifts the skin microbiome of acne patients to more closely resemble that of people with normal skin.
Frequently Asked Questions
Can sunlight or artificial UV light help with acne?
There are a number of very different theories about how sunlight and artificial UV light (e.g. in tanning beds) affect acne. Some people think that UV light improves acne, while others believe that it makes acne worse. There's no evidence that it has any benefits on acne. But exposing your skin to sunlight or artificial UV rays for too long is known to damage your skin. Everyone should use sunscreen to protect their skin when it's sunny – including people who have acne.
Does diet play a role?
It is often claimed that there's a link between what you eat and acne. People sometimes change their diet as a result, in the hope that their acne will improve. But scientists disagree about the role of diet in acne.
Some believe that the typical carbohydrate-rich diet in Western countries contributes to the development of acne. These are mainly carbohydrates that cause sudden increases in blood sugar levels. They are often found in very sugary foods, potatoes and white bread, for instance. But studies haven't shown that acne improves when you eat less of these kinds of carbohydrates. It's also not clear whether avoiding meat, milk or chocolate helps to improve your complexion.
How can hair impact acne?
If you have oily hair, you may need to wash it more often than people who have dry hair. Keeping your hair clean — and off of your face — will help prevent breakouts on the forehead and face.
Some hair products, including pomades and gels, may worsen acne. So if you have acne on your forehead and tend to use a lot of hair product, consider avoiding it.
Headbands that cover your forehead can encourage acne, too, by keeping sweat in place.
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