Why adult acne is on the rise and what to do about it

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It sounds like a cruel trick from Mother Nature: in a time when you worry about fine lines and wrinkles on your face, you also find yourself dealing with acne breakouts. It has become a notable phenomenon during the coronavirus pandemic. A study in the December 2021 issue of the Journal of Cosmetic Dermatology assessed acne in 172 physicians during the pandemic and found that 45% reported their acne worsened, 27% reported relapses and more 7% said they had acne for the first time.

Dermatologists see similar trends in their patients. Recently, “I’ve seen more acne in adults, mostly women, than in the past 15 years,” said Joshua Zeichner, associate professor of dermatology at Mount Sinai Hospital in New York.

Although often thought of as a teenage problem, adult acne has been around for a long time. “Acne is unpredictable – it does what it wants when it wants,” said Rick Fried, a dermatologist and clinical psychologist in Yardley, Penn. “We have no predictor of when people will outgrow adult acne and what the trajectory of its evolution will be.”

Still, some of the recent increase in blemishes can be attributed to the pandemic, experts said. Friction from masks, for example, can cause a type of blemish called mechanical acne, while trapping exhaled breath, oil, and moisture can lead to other breakouts. “It’s an environment where heat, humidity and humidity mix with surface oils and whatever else is on your face – it’s almost like a greenhouse effect. [for pimples] under the mask,” explained Diane Berson, associate professor of dermatology at Weill Cornell Medicine/New York-Presbyterian Hospital.

Our faces are not used to being covered with a mask, which “increases the humidity [and] traps dead skin cells and bacteria on the skin,” added Nada Elbuluk, associate professor of clinical dermatology at USC’s Keck School of Medicine.

Another factor is the stress of the pandemic. When your body and mind are stressed, levels of the hormone cortisol rise, which stimulates the sebaceous glands in the skin to produce more sebum. Stress also activates the immune system, which promotes inflammation. More oil and more inflammation can trigger acne breakouts, said Zeichner, who is the medical advisor for JORI skincare, a new line of products designed to treat adult acne.

Additionally, lifestyle factors such as diet may play a role in recent flare-ups. During the pandemic, “our whole way of life has been interrupted and eating habits have mostly deteriorated, not improved,” Zeichner noted. A review of studies in a November 2021 issue of the International Journal of Environmental Research and Public Health found that during the pandemic, people increased their frequency of snacking and ate more sweets and ultra-processed foods (such such as sodas, packaged breads, frozen foods, french fries and salty snacks, cookies, cakes and sugary breakfast cereals).

Research has shown that a high glycemic diet—a diet full of those same sugary, processed foods that cause blood sugar levels to spike—can be a trigger for acne. When blood sugar rises, it increases inflammation and oil production in the skin, leading to acne breakouts, Zeichner explained. On the other hand, the consumption of fruits, vegetables, legumes, steel cut oats and foods rich in omega-3 fatty acids (such as fish, seafood, nuts and seeds), which maintain the level blood sugar, is associated with an improvement in acne.

While it’s possible to adjust your diet, stress and masks aren’t going to disappear from our lives anytime soon. So what can you do against acne? Mild cases can be treated with over-the-counter cleansers or treatments containing benzoyl peroxide, salicylic acid or retinoids — but “nothing works overnight,” said Elbuluk, who is also director of the USC Skin of Color program. Disorders clinic. “For many people, over-the-counter products alone are not enough. If you don’t see improvements in six to eight weeks, see a board-certified dermatologist.

Dermatologists have a wider and more powerful arsenal of weapons to fight acne in the long term, although the approach depends somewhat on the factors that contribute to a person’s acne. For hormonal acne (related to the menstrual cycle or perimenopause), there is a new topical cream called Winlevi (clascoterone), an androgen blocker, which can be used by both women and men. “This is a first-in-class topical androgen that is absorbed through the skin,” Fried explained. “It has no systemic effects. It does not affect the production or level of hormones in the body.

For non-hormonal acne breakouts, topical treatments include antibiotics (such as dapsone or clindamycin), retinoids (such as tretinoin, tazarotene, and adapalene), and newer combination products such as a preparation of benzoyl-peroxide-clindamycin and a benzoyl-peroxide-tretinoin mixture. If you’re applying topical retinoids, there’s an increased risk of irritation, so it’s important to also use a hydrating agent such as a moisturizer containing ceramides, niacinamide or hyaluronic acid, Berson said. . “You want to maintain the skin’s barrier function if you’re prone to acne breakouts.”

Acne-prone women should also use an oil-free foundation if they wear makeup — and wash it off well at the end of the day, Berson advised. Also, “wash your pillowcases regularly, at least once or twice a week.” Don’t wear disposable masks for days in a row, Elbuluk warned, and be sure to wash cloth masks regularly.

Medications for persistent acne triggered by hormonal fluctuations include oral contraceptives, which can put hormones on a more even keel, leading to fewer breakouts. Another option is spironolactone (a prescription diuretic), which blocks androgen receptors on the sebaceous glands, causing them to stop producing as much oil, Zeichner said. However, spironolactone can reduce testosterone levels.

Oral antibiotics, particularly of the tetracycline class, have long been used to treat recalcitrant acne, but this approach raises concerns about disruption of the gut microbiome and development of antibiotic resistance. A new antibiotic called sarecycline, a narrow-spectrum form of tetracycline, is as effective as doxycycline in treating acne, Fried said. And research has shown that sarecycline does not affect gut bacteria in the same way as doxycycline or minocycline. For severe acne prone to scarring, oral isotretinoin (aka Accutane) may be an option.

Given the influence stress can have on acne, it’s wise to take steps to reduce or relieve the stress in your life. “We don’t know what an individual’s stress threshold is when they cause enough inflammation to cause acne to appear or persist,” Fried said. “Anything that reduces stress can help reduce the severity of acne and improve the effectiveness of treatments.” The key is to find what works for you — whether it’s exercise, yoga, meditation, or other relaxation techniques — for the good of your skin, as well as the rest of your body and mind.

About Sally Dominguez

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