Hormonal factors in adulthood
One of the underlying causes of acne can be changes in hormones, particularly androgens like testosterone and dihydrotestosterone (male hormones which we all have in our skin). Androgens can make the sebaceous glands produce more sebum, an oily substance that protects your skin from drying out, and a build-up of sebum in the pores leads to acne.
“Lots of people have undiagnosed conditions like polycystic ovaries and other hormonal imbalances which can lead to acne,” says Dr Jamil. Many women notice their acne worsens before their period. Hormonal changes can contribute to a noticeable increase in acene. Some hormonal birth control can either trigger or reduce acne as well.
Why acne is more common among women
Adult acne is much more common in women than in men. One study found that some degree of facial acne exists in 54 per cent of women compared with 40 per cent of men. “This is because of women’s menstrual cycles and changes during pregnancy, perimenopause and menopause, which make us more vulnerable to hormonal fluctuations,” says Dr Mahto.
During menopause, your oestrogen levels decline, and your androgen hormones remain stable or increase. This imbalance can lead to an increase in oil production that causes acne. According to a 2022 review published in the International Journal of Dermatology by Dr Brigitte Dreno of Nantes University, adult acne in women has increased 10 per cent worldwide over the past decade.
Methods include:
- Sticking with the right skincare routine (details below)
- Using oil-free products
- Avoiding over-exfoliation
- Changing pillowcases regularly
- Seeking bespoke skincare advice
Preventing acne breakouts means identifying the underlying cause, which is often impacted by your life stage. “The causes of acne are on a wide spectrum from the teenage years to middle age to menopause,” says Dr Jamil. While it’s hard to prevent acne completely, good skincare can make an enormous difference with minor breakouts. Sometimes using a very heavy moisturiser can clog your pores.
“If you are noticing that you’re starting to get a whitehead or blackhead, in the morning use a cleanser with salicylic acid, an oil-free moisturiser and then an oil-free gel-based sunscreen,” advises Dr Mahto. “Then in the evening, after the cleanser use retinol (a Vitamin A product) and oil-free moisturiser. That’s the backbone of a basic acne skincare routine if you are blemish-prone.” “Avoid over-exfoliating, which can irritate the skin. Make sure you change your pillowcases regularly – they can accumulate dirt, oil sweat and bacteria,” says Dr Jamil.
Don’t give up on a new skincare routine if you don’t see speedy results. “Your skin cycle is roughly 28 to 32 days, and you have to go through a couple of skin cycles before you see benefits,” says Dr Mahto. Also, seek professional help for bespoke skincare advice if your acne persists. “I see many active acne patients who are using completely inappropriate skincare which is worsening the status of their skin,” says Dr Chantrey.
Lifestyle changes to protect against acne include:
- A healthy, balanced diet
- Cutting back on some dairy or high glycaemic index (GI) foods
Lifestyle changes to help prevent adult acne include an anti-inflammatory diet. This can include fruits, vegetables, unsaturated fats, oily fish for omega-3 and wholegrains. “But you can’t prevent acne just by changing your diet or eliminating a particular food from it,” says Dr Jamil. “You also have to consider other factors that may be contributing to it.”
Many people with acne switch from dairy to plant-based milk, but Dr Mahto says there’s no quick fix. “The internet would have you believe that gluten, dairy and sugar are the devil and cutting them out would cure every skin disease going – but that doesn’t take into account the multifactorial nature of these skin conditions.”
However, there are exceptions. “There is data to show that foods with a high glycaemic index (e.g. white bread, breakfast cereals, white rice and potatoes) can contribute to female adult acne. As oat milk has the highest glycaemic index of all plant milk, if you want to switch to non-dairy, go for unsweetened almond milk or soy milk,” says Dr Mahto.