Dr. Julie Harper, an associate professor of dermatology at the University of Alabama at Birmingham, and her colleagues published findings that adult acne is more common in women than in men in the Journal of the American Academy of Dermatology. There is a general misperception, Dr. Harper writes, that acne is only a disease of teenagers. Many dermatologists, however, treat patients who first developed acne as adults.
Dr. Harper’s Acne Survey
Harper and her colleagues sent3 1,013 men and women 20 years of age or older a one-page questionnaire. The survey asked respondents whether they had ever had acne-related skin blemishes or pimples during their teens or later in life. Respondents were queried whether their acne had gotten worse, gotten better, or stayed the same since their teenage years.
Asked whether they had ever had acne, 73% of people surveyed reported that they had. Nearly identical numbers of men and women reported that they had had acne during adolescence, 69% of men responding to the survey and 67% of women responding to the survey reporting that they had. In every age group among the adults answering the survey, however, significantly more women reported they currently had acne than men.
The most common form of adult acne in women is premenstrual acne. Among the women responding to survey who had not yet passed menopause, 62% reported that their acne is worse the days just before they had their periods. Among women participating in the survey who had already past menopause, 86 said their acne improved when they started using hormone replacement therapy, 75 said that hormone replacement therapy made no difference, and 2 said that hormone replacement therapy made their acne worse.
Here are some of the essential facts of acne care for adult women:
Sugaraggravates acne5 more than fat in adult women. High intake of sugar and other fast-acting carbohydrates increases blood sugar levels. Most tissues in a woman’s body can “switch off” their responses to insulin so that they are not flooded with sugar when women eat too much sugar, but the ovaries cannot. They use extra sugar to make extra hormones, both estrogen and testosterone. The excess estrogen interferes with menstruation and fertility, and the extra testosterone fuels unwanted hair growth and acne. Sometimes cutting back on sugar consumption enough to lose just 2 or 3 pounds (1-2 kilos) is enough to correct both acne and menstrual irregularities.
Women’s skin responds better to alpha-lipoic acid than men’s. Alpha-lipoic acid is a naturally occurring antioxidant that has the unique property of being soluble in both water and fat. It can circulate in the plasma underlying tissues of the face, and it can also cross through the fatty phospholipids that form the outer membrane of cells so it can be absorbed directly inside. Dur to this property, alpha-lipoic acid moves fluid from the spaces between tissues that make them “puffy” and into cells to make them strong. Taking supplemental alpha-lipoic acid (preferably with the B vitamin biotin) or using skin creams that contain alpha-lipoic acid can shrink pimples and also correct bags and sags of facial skin.
Women are usually more sensitive than men to sodium lauryl sulfate, a detergent and sudsing agent that is also known as SLS. This chemical is found in an astonishing range of personal hygiene products6 and cosmetics. It appears in many brands of toothpaste, shampoo, and mouthwash, and even in some acne products. The problem with SLS is that it can make your face break out wherever SLS comes in contact with your skin, especially at the corners of your mouth and your chin. It’s best to buy products that don’t contain SLS, but if you simply can’t afford products that are SLS-free, be sure to rinse your face with water after every use of toothpaste or mouthwash, and to rinse your hair after shampooing from front to back rather than from back to front.
The ingredients in women’s skin care products that are advertised as healing are often the very products that cause skin irritation and perpetuate acne-related blemishes on the skin. The biggest problem in most cosmetics is the addition of botanicals. Certain herb and spice extracts irritate the skin7, especially balsam, cinnamon, citrus, lemon, lime, mint, peppermint, wintergreen, and witch hazel. Your skin may be able to tolerate small amounts of these botanical additives, but if you have rosacea, or you have the kind of acne that is more likely to cause pimples rather than blackheads, these botanical ingredients can easily make acne harder to manage.
Oral contraceptiveshave a major effect on acne8, but not all brands are equally beneficial. In a woman’s menstrual cycle, acne tends to flare up as progesterone levels rise and estrogen levels fall, and tends to get better as estrogen levels rise and progesterone levels fall. Doctors used to think that the best way to treat acne in women who also used oral contraception would be simply to offer a high-estrogen version of the pill. Estrogen, as most women know, can cause water retention and muscle pain as well as other alterations of a woman’s metabolism. High-estrogen contraceptives are no longer recommended for treating premenstrual acne, and most women have to try several brands of the Pill before they get the results they seek. The skin usually does not begin to improve until 3 or 4 months after switching to a new brand of oral contraceptive.
Halvorsen J.A., Vleugels R.A., Bjertness E., Lien L. A population-based study of acne and body mass index in adolescents. Archives of Dermatology. 2012;148(1):131-2.
Skroza N., Tolino E., Mambrin A., Zuber S., Balduzzi V., Marchesiello A., Bernardini N., Proietti I,, Potenza C. Adult Acne Versus Adolescent Acne. The Journal of Clinical and Aesthetic Dermatology. 2018;11(1):21–25.
Collier C.N., Harper J.C., Cafardi J.A., Cantrell W.C., Wang W., Foster K.W., Elewski B.E. The prevalence of acne in adults 20 years and older. Journal of the American Academy of Dermatology. 2008;58(1):56-9.
Harper J.C., Stein Gold L.F., Alexis A.F., Tan J.K.L. Treating Acne in Adult Women. Seminars in Cutaneous Medicine and Surgery. 2018;37(3S):S67-S70.
Romańska-Gocka K., Woźniak M., Kaczmarek-Skamira E., Zegarska B. The possible role of diet in the pathogenesis of adult female acne. Postȩpy dermatologii i alergologii. 2016;33(6):416-420.
Draelos Z., Hornby S., Walters R.M., Appa Y. Hydrophobically modified polymers can minimize skin irritation potential caused by surfactant-based cleansers. Journal of Cosmetic Dermatology. 2013;12(4):314–321.
Niinimäki A. Delayed-type allergy to spices. Contact Dermatitis. 1984;11(1):34-40.
Effect of contraceptives on the skin. Australian Family Physician. 1988;17(10):853, 856.