Acne Attack
With adult acne on the rise, and a real problem in the Middle East, Georgia Seago speaks to experts from around the globe to find out how to treat and manage the condition
We all know acne isn’t something that only plagues teenagers, but lately therapists and dermatologists alike have reported a huge increase in clients suffering from the skin condition in their 30s, 40s and 50s. Though acne has always been a known side effect of hormonal changes in the body such as pregnancy, the contraceptive pill, polycystic ovary syndrome, and even menopause, more and more women outside of these groups are seeking help to tackle adult-onset acne.
“Adult acne can either be acne that is occurring for the first time in adulthood, or it can be something that the person has had from their teenage years onwards and just never grown out. It’s really rising in prevalence; it’s like an epidemic these days,” says Dr Stefanie Williams, founder and medical director of the European Dermatology London clinic. Stress and hormones are two of the biggest culprits and can work in tandem to produce the changes in the skin that we call acne, according to Dr Johanna Ward, a cosmetic doctor. “When we’re stressed our bodies produce more androgen (a male hormone), changing the hormone balance either internally or externally,” she explains.
It’s important to be aware of the various things that can put the body under stress such as poor sleep patterns and a busy lifestyle. “The stress of modern living is constant and pervasive,” adds Dr Howard Murad, a US board certified dermatologist.
Treatment plan
Androgens cause the sebaceous glands to produce excess oil, which combines with dead skin cells. This blocks pores, which then become infected with the naturally occurring P. acnes bacterium, resulting in inflamed lesions on the surface of the skin. Whereas adolescent acne commonly causes black and whiteheads all over the face, adult sufferers usually see bigger, more aggressive nodules, meaning the treatment approach has to be carefully considered.
Dietary causes are often suggested, but the link isn’t agreed upon across the board. “There have been exhaustive studies into the links between dietary intake and acne. These have failed to establish a very clear link but a few things to be aware of are dairy and sugar,” says Ward. “However, most people will find that it’s hormones rather than diet.” It wouldn’t hurt to advise clients to eat lots of anti-inflammatory-rich fruits and vegetables to take care of the skin internally.
The condition becomes even more complex in later years thanks to fine lines and wrinkles, pigmentation, dryness and other issues brought on by skin ageing. So how do you treat it without contributing to other problems? “As a teen you tend to have oilier skin and can use much stronger topical creams, but these might be too drying for someone with adult acne because the skin is more dehydrated. This, coupled with breakouts, is the trickiest situation because you can’t use the very strong drying creams,” says Williams. Clients in this age group are often most concerned with signs of ageing, such as fine lines and wrinkles and loss of elasticity, so it’s likely they’ll be using rich creams and facial oils – exactly what not to use on acneic skin. Oil on [acneic] skin, even if it feels dehydrated, is just never a good idea.”
Similarly, physical exfoliants with grains or beads should be avoided as they can irritate the skin and cause it to produce even more sebum to alleviate the dryness. Instead, the basic protocol for treating a client with acne (providing it isn’t so severe that they should be referred to a doctor for prescription treatment) is two-fold, as Williams explains: “Combine an antibacterial ingredient, which might be an antibiotic or an antiseptic like benzoyl peroxide, and a [pore-unclogging agent] such as vitamin A derivate retinol. It’s always that combination, anti-bacterial and something to resolve the keratin plug in the hair follicle.”
Essential ingredients
Salicylic acid, an oil-soluble BHA, is a good ingredient to start with for unclogging pores as it’s widely considered to be more gentle than most alternatives, with less chance of causing side effects like irritation, flaking and peeling. It works by breaking down sebum and clearing the congestion from pores. “It’s got a very rapid action so you’ll notice improvements quickly,” says Ward.
Retinol is the other ingredient considered an all-star when it comes to fighting acne. Luckily for older acne clients, research also shows it to be brilliant at stimulating collagen production, reducing wrinkles and fading discolouration from pigmentation. It sends signals to skin cells, instructing them to behave like a well-functioning young and healthy cell. It can be used for an overall improvement in the skin, making it perfect for treating signs of ageing and acne simultaneously.
It is recommend that clients use serums and creams containing retinol at night, rather than during the day, as some research suggests it can make skin more photosensitive, which can be a problem in our region. On that note, it’s still vital for adult acne clients to wear a broad-spectrum SPF daily. Advise them to choose an oil-free formula that doesn’t contain titanium dioxide as adult acne is typically exacerbated by the blocking and potentially irritating effects of titanium dioxide, particularly in high-SPF products.
Other ingredients can be effective in supporting these key actives in a skincare regime. Fruit acids like pineapple and papaya provide gentle exfoliation without irritation, are anti-inflammatory and skin brightening. Murad sings the praises of phyto-oestrogens like black cohosh, red clover and soy extracts, a group of plant extracts that mimic the actions of the female sex hormone oestrogen. “They are agents that improve the appearance of skin instead of actually putting on oestrogen. Adding that to the programme seems to get the best results because we’re treating the cause,” he says. Skin repairing ingredients like antioxidant vitamin E and resveratrol or anti-inflammatory extracts could also be incorporated into a regime to help heal scarring and redness. These could be effective in a calming mask used once a week. An appropriate skincare routine is one thing, but for clients to really begin tackling acne, regular professional-spa and salon treatments can be extremely beneficial.
Treatments that don’t require aggressive application but still penetrate the skin effectively are usually a good choice. Murad suggests facials using BHA salicylic acid combined with other carefully selected ingredients to “help the skin overall, firming it and helping it become more flexible and less inflamed, and at the same time helping reduce the appearance of acne.” Williams agrees that peels can be very beneficial in tandem with the right homecare. She also mentions that manual extractions with “needle scratching very superficially on the skin’s surface” can be helpful in getting rid of comedones before they turn to inflamed spots. However, she adds: “You have to be really well trained and be careful what you apply afterwards. Ideally you would apply some antiseptic to prevent it becoming inflamed.”
Continuity and consistence
Townshend and Ward agree that microdermabrasion can be great for clearing cellular debris but should be avoided on very inflamed, aggravated acne. They also suggest blue light treatments, which work by killing off the P. acnes bacteria with no downtime. Take a careful approach when combining actives like vitamin A, BHAs and AHAs. Using them together is likely to get the best results but it’s common for clients to experience redness and dry, peeling, flaking skin.
“If you have a relatively robust skin type it might be OK and it also depends on the concentration of those ingredients. It might be that putting a lot of actives on top of each other can be too irritating,” says Williams. In this case, Ward recommends you start very slowly. “If I introduce a salicylic I won’t introduce a vitamin A at the same time,” she says. Make sure clients are committed to the treatment programme and aware it will take at least six weeks to see any improvements in the skin.
“Make sure they don’t use something for a week or two and decide it doesn‘t work,” says Townshend, adding that skipping between several different products will make it impossible to understand what worked and what didn’t. Keep this momentum going by monitoring progress and taking pictures during regular salon visits. One final thing to remember – in order to treat adult acne and keep it at bay, treatment needs to be continuous. Williams says: “as soon as you stop treatment the acne just comes back because it’s not really a question of growing out of it anymore.”
