In fact, according to a professor of medicine at the University of Melbourne, up to half of all men and women experience acne into their 30s.2
Approximately 85 percent of people between the ages of 12 and 24 experience at least minor acne and, according to a recent study, it is impacting individuals at increasingly younger ages – approximately 20 percent more young people than in years past. While it still remains most prevalent among teenagers, it is now spreading on both sides of the age spectrum.
In fact, over the past 10 years, the average age of those experiencing acne has increased from approximately 20.5 years old to 26.5 years old.3 According to the Journal of American Academy of Dermatology, 54 percent of women older than age 25 have some facial acne. Another study published in The Journal of Clinical and Aesthetic Dermatology further supported this trend, noting that acne vulgaris is increasing among adult women, with one third of total acne office visits made by women over 25 years old.
While the majority of cases in adult women (75 to 85 percent) is persistent acne – acne that developed in adolescence and has continued – 20 to 40 percent is late-onset acne, meaning they are experiencing acne for the first time. Though adult acne is more common among women, men are not immune. What can this growing trend be attributed to? And more importantly, how can clients battling adult acne achieve healthy, radiant skin?
While there are many theories as to the exact cause of acne, there are a number of triggers, including hormonal imbalances, nutrient deficiencies, medications, stress, improper facial cleansing, and genetics. Though it is a challenge to trace the increase in acne back to one root cause, it could be an overall rise in stress levels, pollutants in the environment, and various ingredients found in many food sources and cosmetics that have been linked to hormone imbalances.
As aesthetic professionals, it is part of the job to properly diagnosis the root cause before outlining the best course of treatment. With that in mind, here are some of the common acne triggers.
Hormones: Oil production is regulated heavily by hormones, specifically testosterone, which stimulates the development of sebaceous follicles and attached oil glands. This explains why acne is most common during puberty, pregnancy, menstrual cycles, and menopause. Because of this, women are five times more prone to acne later in life than men.
Stress: Stress is one of the top triggers of acne, as it stimulates the adrenal glands to produce more cortisol, which can cause excess sebum and inflammation. Acne flareups can occur within 14 days to a month after the stress response.
Medication: The hormones (adrenals) may be affected by some medications and drug use and can spur blemishes. Many female adults also experience acne as result of certain birth control methods and in vitro fertilization (IVF). This does not impact all women, but since these do alter hormones, some skins will respond negatively.
Nutrition and Diet: Alcohol, caffeine, and foods with iodides (salt, processed and fast foods, MSG, excess dairy) can trigger existing acne. When foods high in starch or sugar are consumed, it can spike insulin, and some research suggests that this can also instigate sebum production. It is worth talking to clients about eating an organic diet, when possible, to eliminate the possibility of foods that may contain hormones, preservatives or pesticides, as these can all have adverse effects on the skin.
Improper Cleansing: When oil builds up on the skin, bacteria will form, which creates blemishes. Sleeping in makeup, along with exposure to debris from the day, sets up a perfect opportunity for more bacteria. In some cases, simply training clients how to cleanse properly and regularly will eliminate the issue. That said, acne is not an indicator of hygiene. There is often much more going on beneath the surface.
Skin Irritants: Detergents, fabric softeners, certain shampoos and conditioners, and fragrances or dyes can irritate existing acne conditions.
Picking: Improper squeezing and picking and inept extractions may rupture the follicle wall, causing bacteria to spread. It may also lead to deeper impaction and scarring. Educate clients about icing as a way to reduce inflammation as soon as they feel the pressure of a lesion. In the treatment room and at home, icing can be very valuable.
Over Stripping the Skin: Overuse of certain drying skin care products may cause the skin to over-produce sebum. This is because the skin needs a healthy level of oils. However, when it is stripped of all oils, the responder will start to produce more, which can then get trapped and cause more bacteria.
Genetics: Some may be predisposed to acne based on certain genes that are passed along, but it is believed it is polygenic – a grouping of genes, as opposed to one singular gene.
There are numerous triggers behind acne, so the most important thing is to get a dialogue going with clients. The goal is to try to get to the root cause by understanding their skin histology, as well as their lifestyle. With this insight, professionals will be better able to map out the best course of treatment. However, note that it is also important to consider the type of acne being treated.
Prevalent Acne Types
There are numerous types of acne, including acne vulgaris, cystic acne, and acne mechanica. Understanding root causes and how each displays in the skin will help with proper diagnosis, which is imperative to determining the best course of care.
With that in mind, the following are the primary types of acne that are most common among adults.
Hormonal Acne (Acne Vulgaris): This is the most common type of acne. It is characterized by comedones, papules, pustules, nodules, cysts, and sequelae – such as pitted or hypertrophic scars.
Acne vulgaris is caused by propionibacterium acnes, also known as the P acnes bacteria. It typically allows for good extractions; however, the right enzymes, alpha hydroxy acids, and other exfoliating ingredients can help do most of the work. A quality at-home system and lifestyle changes will be extremely important to remedying this type of acne.
Acne Cosmetica: Acne caused or stimulated by cosmetics is usually non-inflammatory and indicated by small, slightly-raised, red lesions, whiteheads, and occasional pustules. Today, this type of acne is not as common, as cosmetics have improved significantly, and, now, many products are labeled as non-comedogenic. It is still important, however, to know every product a client is using to rule this out. This can usually be corrected by eliminating the acne-producing cosmetic and replacing it with a home regimen focused on cleansing and protecting.
Acne Rosacea: This primarily impacts adults and is more predominant in women than men. It is characterized by erythema with telangiectasia (small, dilated blood vessels near the surface of the skin). Lesions tend to follow the blood vessel dilation, with papules and pustules forming in the center of the face, cheeks, and chin. They are typically large and painful. Acne rosacea is genetic, chronic, and progressive. Eliminating irritants – such as excessive spicy foods, caffeine, tobacco, alcohol, saunas, and stress – will support the healing of this type of acne. Professional peel treatments and consistent homecare are also essential.
Pseudofolliculitis Barbae: This is more common in men and occurs when coarse, curved hair penetrates into the skin before it leaves the follicle (also known as ingrown hairs). Salicylic acid is a key ingredient to help prevent the formation of this type acne. Mandelic acid is also a great alternative for a gentler approach. For treatment, focus on exfoliation – both physical and chemical.
Should adult acne be treated differently than teenage acne? Not necessarily. But, there is often more that can be done, in terms of exfoliation, with adult clients than with teenagers. This is primarily because teenagers tend to be involved in sports or some sort of physical education at school, which is not optimal for rejuvenating treatments such as chemical peels.
While no two skins are the same and each of the aforementioned types of acne will require a customized approach to restoring the skin’s health, there are three key factors important to the treatment of acne, no matter the type.
When it comes to acne, whether in adult or adolescent clients, it is important to address it as soon as possible to help prevent scarring and restore the skin to optimum health. Acne left untreated will only worsen. It is also extremely important to always keep these three key factors on the forefront of approach: reduce inflammation and bacteria, increase cellular exfoliation, and begin wound repair.
With that in mind, to help clients restore healthy skin in the treatment room:
Cleanse and Prep: Cleanse skin with a salicylic or glycolic-based cleanser to start the exfoliation process. Salicylic acid will work as a surface exfoliant and provide antiseptic and antioxidant benefits while softening comedones and promoting cell turnover. Glycolic acid, an alpha hydroxy acid, provides rapid penetration and desquamation and improves the structural integrity of the skin.
Exfoliation: Papaya enzymes, or a solution of hydrogen peroxide combined with salicylic, lactic, and glycolic acids, will help regenerate, brighten, and heal acneic skin. For a peel treatment, a tomato-based formula will provide regenerating, exfoliating, and antioxidant benefits. Tomato contains lycopene, which is one of nature’s most powerful antioxidants, along with several acids that work to control acne - glycolic, ascorbic, acetic, chlorogenic, malic, lactic and tartaric. This is also ideal for clients who may have acne-related scarring.
Repair: Finish with a blemish serum containing salicylic acid, resorcinol for antiseptic properties; B vitamins for tissue repair; and green tea, totarol, and tea tree oil for antioxidant and antiseptic support. To soothe, protect, and proliferate cell renewal, healing, and tissue regeneration, apply a nourishing cocktail of epidermal growth factors, natural arnica and a zinc-based sun protection formula.
Masks are also a good choice in the treatment room. Look to green tea, sulfur, bentonite, and kaolin-based masks to heal, absorb excess oil, and detoxify the skin. Additionally, after the enzyme, extractions may be performed if necessary.
In building a homecare routine, first, look at the internal and external factors that could be impacting the client’s skin. For instance, where are they in their lifecycle? Pregnancy and menopause commonly aggravate acne conditions in adult women, as they tend to stimulate testosterone production and, thus, the development of sebaceous follicles and oil glands. Another important factor to look at is how prone the client is to cellular buildup, in which case, ingredients like salicylic acid or mandelic acid will support surface exfoliation.
For external factors, ask if the client is involved in any high-intensity training or physical activities. Depending on the activity, it can aggravate, and in some cases, cause acne. This is primarily due to sweat becoming trapped in the pores, along with bacteria that can accumulate on the skin, particularly if the activity involves a hat or helmet. Also, talk to clients about regularly washing and changing out pillow cases, as these can become a hotbed for bacteria. They should also avoid touching their skin or picking at blemishes. It spreads bacteria and slows the healing process.
Homecare is also vital to achieving results with acneic skin. It is best to keep it simple, incorporating ingredients such as green tea, epidermal growth factors, and mandelic acid to manage bacteria and inflammation, gently exfoliate, and repair wounded, damaged skin. Beginning with a few simple steps, professionals can determine progress and add to the regimen appropriately as time goes on.
Serums containing mandelic acid, arginine, salicylic, resorcinol, or green tea extract will offer antibacterial and antioxidant support, as well as important wound healing benefits that are key in ridding the skin of acne. Masks with green tea and wasabi root, along with exfoliants containing papaya and pineapple enzymes, will further provide antibacterial and antioxidant support, stimulate blood flow, and assist in wound healing and rejuvenation.
To help rebuild and protect the skin, turn to epidermal growth factor. It is essential for acne clients to use as part of their daily regimen as it helps promote the growth of new, healthy cells. Allantoin is a keratolytic agent that increases hydration in the extracellular matrix and enhances the desquamation of dead cells in the top layers. It increases cell proliferation, promotes wound healing, and supports smooth, moisturized skin. It also soothes, protects, and acts as an anti-inflammatory. Every client should also be armed with a good zinc-based sun protection formula to protect and support overall skin health.
Sometimes when working with acneic skin, purging can occur. This can be an important process to help eliminate acne and other toxins in the skin, however, it should not continue for more than three to four weeks. Also, not all acneic skin will go through purging, but it is valuable to understand and inform clients, so the expectation is clear.
Finally, another key concern with acne clients is their makeup choice, which can irritate and worsen the skin. If they use mineral powder or cream, recommend one that provides ultraviolet protection and gives the skin antioxidant support while covering blemishes. Keep in mind, not all mineral lines are created equally. Look into the purity of the minerals, as well as the full ingredient deck to determine possible irritants and skin aggravators, like synthetic fragrances, parabens, formaldehyde, and petroleum distillates.
Beyond the homecare regimen, it is a good idea to send clients home with a tip sheet. This might include: a healthy eating guide – consuming antioxidants and avoiding things like dairy, sugary drinks, alcohol, caffeine and foods with iodides; tips for stress management; a step-by-step on proper cleansing – and reminding clients to cleanse every morning and night and to never go to sleep with makeup on; reminders to keep pillowcases and sheets clean; and a guide on what to avoid: picking at blemishes, touching the skin, using products that dry their skin out, and so forth.
This tip sheet might also have a few notes on what they can expect on their journey to healthy skin, such as the stages they may experience and how long it typically takes to restore their skin to optimal health.
Finally, caution clients not to perform extractions at home, as improper technique may lead to deeper impaction, inflammation, pigmentation issues, or scarring.
When it comes to skin care, particularly acne care, there is no one-size-fits all. Take a customized approach with every client. Take time to get to know each client’s skin history and lifestyle to get a clear picture of the various factors that could be causing their acne and that could impact their treatment plan. Remember, healing starts with proper diagnosis and frequent check-ins with each client to ensure proper management and effective treatment.
Shannon Esau is the CEO and National Educator at Rhonda Allison Cosmeceuticals. She has more than 20 years’ experience in the aesthetic industry. Esau owned skin care salons in the Dallas and Ft. Worth, Texas area, has studied chemistry in skin care formulations, and has been mentored by Rhonda Allison for decades. rhondaallison.com and redmethod.com.
1 Bickers DR, HW Lim, D Margolis, MA Weinstock, C Goodman, E Faulkner, et al. “The
burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology.” Journal of the American Academy of Dermatology 55(2006). 490-500. https://doi.org/10.1016/j.jaad.2006.05.048.
2 Carey, Patrick. “When acne isn’t just a teenage phase.” News. Accessed Aug. 8, 2018.
3 Di Landro, Anna, M.D., Simone Cazzaniga, MS, Francesco Cusano, MD, Angela Bonci,
MD, Cardinali Carla, MD, Maria Letizia Musumeci, MD, PhD, Annalisa Patrizi, MD, et
al. “Adult female acne and associated risk factors: Results of a multicenter case-control
study in Italy.” Journal of the American Academy of Dermatology. 75, no. 6 (2016).