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.
Acne is caused by multiple factors such as increased sebum secretion, inflammation, follicular keratinization, and Propionibacterium acnes. For many women, the onset of acne can have a huge impact on mental wellbeing.
The pathogenesis of acne in adult women can be quite complex and isn't always due to hormonal imbalances. So I am going to share with you the top contributing factors to be aware of.
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. While the more potent androgens like testosterone and dihydrotestosterone (DHT) are more commonly the cause, weaker androgens can also contribute. Sebum glands within the skin are sensitive to androgens and excessive levels will increase sebum production.
Insulin like growth factor 1 (IGF-1)
IGF-1 has a direct influence on androgen regulation in the skin and potentiates androgen signaling by the activation of 5α-reductase and the androgen receptor.
This leads to increased inflammatory proteins and sebum production, thereby promoting the development of acne.
Post pill rebound acne
The oral contraceptive pill contains synthetic hormones that essentially stop women ovulating, therefore preventing pregnancy. Some of these synthetic hormones actually suppress sebum production. So when you finally decide to stop the pill, the withdrawal causes the skin to produce excessive amounts of sebum and androgens which causes acne to occur.
Some women experience a resurgence of acne when they enter menopause. This is thought to be due to the decline in oestrogen which has a protective effect against acne and an increase in androgen that, as we saw above, can cause acne.
Recent research suggests that diet may influence the development of acne. A diet with a high glycemic load may have a potentiating effect on the levels of serum insulin and IGF-1.
Read my blog Foods to avoid in acne prone skin for more on diet and acne.
#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 poor wound healing and scaring.
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.
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.
Ah stress! Is there any area of our health this doesn't affect. Prolonged durations of stress can 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 androgens like 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. What's more is that some of 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.