To put it simply, acne occurs when the oil glands (pores) in the skin become blocked with oil, dead skin cells and bacteria.
Our sebaceous glands are meant to produce sebum, which is an ‘oil’ designed to keep the skin lubricated and soft. However, when hormonal changes and other factors cause the gland to produce an excess of sebum (OR thicker than normal sebum) the problem arises. The pore becomes blocked and there is a higher chance that bacteria will multiply, leading to inflammation and acne.
Acne usually starts at puberty when increased levels of certain sex hormones (known as androgens) create an increase in the size and oil production of glands.
Hormonal acne can return again in our 30’s, as our levels of androgen hormones increase. Testosterone (an androgen hormone) stimulates sebaceous glands in women to secrete ‘thicker’ sebum. This can cause clogged pores and an increase the likeliness of ‘adult Acne’.
What else might be going on??
1) Polycystic ovary syndrome (PCOS)
What is PCOS?
Polycystic ovary syndrome (PCOS) is a condition that affects a woman’s hormone levels. The condition usually effects women between the ages of 15 to 44.
Women with PCOS produce higher-than-normal amounts of male hormones (androgens). This hormonal imbalance causes menstrual cycle irregularities (including missed periods) and leads to other unwanted side effects.
In PCOS; many small, fluid-filled sacs grow inside the ovaries. The word “polycystic” means “many cysts.” These sacs are actually follicles, each one containing an immature egg. The eggs rarely mature enough to trigger ovulation (making getting pregnant more difficult).
The lack of ovulation results in estrogen and progesterone levels being lower than usual, while androgen levels (masculine hormones) become higher than usual. This causes a disruption of the menstrual cycle and other side effects.
The increase in testosterone triggers excess oil production in the sebaceous glands, which creates the perfect breeding ground for infection and acne.
PCOS-related acne tends to flare in areas that are usually considered ‘hormonally sensitive’ -especially the lower third of the face. This includes the cheeks, jawline, chin, and upper neck.
Those with PCOS tend to get acne that involves tender knots under the skin, rather than fine surface bumps. Breakouts commonly flare up before menstruation and can take several days to go away.
Other common PCOS symptoms are:
• Unwanted Hair growth: Due to excess testosterone, more than 70 percent of women with this condition grow excess hair on their face and body.
• Thinking of hair on the head – Due to excess testosterone women can also experience male pattern baldness.
• Weight gain
• Darkening of the skin: Dark patches of skin can form in body creases like those on the neck, in the groin, and under the breasts.
• Headaches: Hormone changes can trigger headaches in some women.
What causes it?
Doctors aren’t 100% sure what causes PCOS. They believe that high levels of male hormones prevent the ovaries from producing hormones and making eggs normally.
Genes, insulin resistance, and inflammation have all been linked to excess androgen production.
Women with PCOS often have increased levels of inflammation in their body. Being overweight can also contribute to inflammation. Studies have linked excess inflammation to higher androgen levels.
Treatment for PCOS usually starts with lifestyle changes like weight loss, diet, and exercise.
For some, Rosacea is actually the problem NOT acne. Click here to find out wether you may actually have rosacea.
3) Hormonal fluctuations
As previously discussed, certain hormones rise during puberty. These hormones cause an increase in the production of sebum. This results in hair follicles becoming blocked, forming comedones or “clogged pores.” These clogged pores then commonly become infected and inflamed – AKA acne!
Hormonal adult acne tends to flare up at predictable times during our menstrual cycle. For many women, this occurs the week leading up to menstruation or during. However the menstrual cycle is the time when symptoms peak. Some women may also experience a breakout during ovulation.
Perimenopause is the period (which can last for several years) prior to menopause. During this time, hormonal fluctuations are increased which can lead to acne.
Acne located on the Lower third of the face and along the jawline is often more likely to be related to hormonal issues than acne across the forehead or the bridge of the nose.
Hormonal adult acne is often deep, cystic, and sensitive to touch.
See link to find out what you can do to help
4) Poor Gut Health
see Gut Article
During times of stress, cortisol (the stress hormone) increases oil production which can stimulate acne. The Skin-Gut connection has been scientifically proven.
6) An Inflammatory diet
A high glycemic (GI) diet
Foods that increase insulin levels have a high ‘glycaemic index’ (GI). The glycaemic index is a measurement of how carbohydrates have an effect on our blood sugar levels. Foods with a high glycaemic index break down super fast in our body causing a rise in blood sugar levels. This then causes a spike in the amount of insulin our body produces (in hope to re balance the blood sugar level). This spike in blood sugar and insulin then leads to inflammation.
High GI foods include white carbohydrates (eg white bread, chips, pasta, white rice, potatoes, processed biscuits etc) and of course sugar.
SO ….instead switch to low GI food such as non starchy vegetables (swop potato for sweet potato), some fruit, whole grains, nuts, fermented dairy such as yogurt, meat, poultry, fish and eggs.
Non fermented diary (milk) and gluten also cause inflammation in most people.
See adult acne article
See gut health
USA or Canadian readers can click here for clinically proven anti-acne skincare products. Australian readers …check back soon as this great product will be available soon here in Auz.
For severe cases of acne or hormonal imbalances please see your healthcare professional or Dermatologist.
🙂 Victoria Isherwood (Registered Nurse -Dermatology)