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Understanding the Development of Acne in Adults

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Once regarded as a rite of passage that accompanies young adulthood, acne is today challenging those conventions by making its presence known in just about every decade of life that follows puberty. In fact, the world-over, an estimated 40% of adults experience acne, with researchers widely agreeing that those numbers are on the rise within the last half century. While men and women are both affected by the condition in adulthood, women are far more likely to suffer its effects. In fact, one recent study showed that 12% of women aged 41 to 50 suffer from clinical acne, a demographic generally considered well beyond pimples.

Given the growing incidence of acne, researchers have begun focusing their attention to the question of why the increase is occurring. To understand the issues that may be influencing these higher rates, however, it’s important to comprehend the factors involved in the onset of the disease. (You heard that right – acne is indeed a disease.) The four main factors are:

1.Follicular Keratinization.

Those with acne tend to have skin cells that are abnormally “sticky” and, thus, the process of shedding dead skin cells is compromised. Instead of falling away, these cells have a tendency to block the pore, causing a backup of sebum in the follicle.

2.Excess Sebum Production.

Clinical acne is often associated with larger sebaceous glands that produce higher quantities of sebum than is normal.

3.Prevalence of Acne Bacteria.

Propionibacterium Acnes (P. acnes) is the bacteria responsible for acne and is found on the skin of nearly all healthy adults. Researchers recently published the results of a  study whereby samples of P. acnes taken from individuals with healthy skin, as well as those with acne, demonstrated that more than 11,000 strains of P. acnes exist. Of these, just 10 of them are commonly found on the skin and not all of them result in acne. Rather, as one of the researchers  stated, “certain P. acnes strains may protect the skin, much like yogurt’s live bacteria help defend the gut from harmful bugs."

4.Inflammation.

While it was long believed that acne led to inflammation, there is  evidence that the opposite may now be the case. Free-radical damage to skin causes a release of inflammatory chemicals, which are intended to repair this damage. In some individuals, however, the inflammation response is overly vigorous. This creates a scenario whereby the skin environment is modified, making it perfectly suited for the colonization of P. acnes. What’s more, when inflammatory processes intensify, the follicular wall can rupture and leak sebum, keratin, bacteria, and cellular debris into the dermis. These substances are recognized as foreign invaders to the dermis and, thus, in an attempt to offset the potential for damage, inflammation at this deeper layer occurs. This deeper inflammation leads to the development of nodulocystic acne lesions.

Those that suffer from chronic acne are shown to have diminished levels of antioxidants, such as vitamin A and vitamin E, than is normal. Because antioxidants act like soldiers in our bodies, fighting free-radical damage, it is clear that a diminished antioxidant count and increased inflammation response go hand-in-hand.

During adolescence, many of these factors are provoked by the hormone surges that accompany puberty, which is why the condition has traditionally waned in the years afterward. And while hormones fluctuations, like those during menstruation, pregnancy and menopause, can certainly be identified as a cause of acne in adult women, they don’t explain every occurrence. Rather, certain lifestyle factors appear to antagonize the onset or continuation of the condition. Specifically, evidence of links to the following issues exist:


Diet. The relationship between diet and acne has been a controversial topic for decades, as science long found little evidence of a link. Recently, however, researchers have turned a closer eye to this hypothesized relationship and found, with much certainty, that the Western diet plays a contributing role in the onset of the disease. As our food supply has become increasingly processed, the severity of acne has worsened in response.

Of particular note are dairy products and high-glycemic foods – groups that affect hormone levels, including insulin, and cause an increase in the skin’s sebum production. While most dairy products are proven to affect the onset of acne, more severe breakouts are seen in individuals who consume large quantities of skim milk, which contains more hormones.

Stress. Patients often suggest that their acne worsens during times of increased stress, a scenario that has been proven in numerous studies. In  one, college students who were under significant stress, as evidenced by changes in sleep hours, number of meals per day and diet quality, showed the greatest exacerbations in acne severity. However, the connection between acne and stress is not yet well understood. It is assumed that stress also encourages an increase in the production of sebum. Alternative hypotheses include the increased likelihood for individuals to “pick” at their skin when stressed, thereby causing inflammation that worsens acne.

Illness. Acne can provide one of the first signs of illness, including polycystic ovary disease, Cushing syndrome, and more. Therefore, those with acne that has been particularly resistant to treatment should consult their doctor for further examination.

Minimizing Lifestyle Factors

Acne treatments have evolved to the point where, today, a host of effective ingredients and therapies have the potential to stop a breakout in its tracks. Yet, there are many individuals for whom conventional treatments have been ineffective. In fact, 81% of women fail multiple courses of antibiotics, while failures with isotretinoin range from 15 to 30 percent.

As we better understand the factors that encourage the development of acne, as well as the factors that do not cause it, researchers are developing more targeted treatments. For example, the previously mentioned study regarding the existence of beneficial P. acnes strains demonstrates that traditional treatments that blanket eradicate the bacteria may actually do more harm than good. Despite this, no one is suggesting the end of antibiotics or benzoyl peroxide just yet.

Rather, today’s research related to acne is showing us that there are some things adults can do today to improve their acne. For starters, consider reducing your weekly consumption of dairy products, white flour, soda and sugary snacks. Fruits, vegetables and other foods rich in antioxidants should be a major part of the diet, while dairy and foods with a high-glycemic index should be minimized as much as possible.

To further reduce acne, skin inflammation should be minimized. This may be accomplished by limiting exposure to a range of conditions, including the use of irritating topical products, sun exposure, cigarette smoke, pollution, and more.

Finally, controlling stress is essential, not only to reduce acne, but to improve overall quality of life. While all adults must be mindful of getting enough sleep, eating properly and regularly throughout the day and controlling our response to challenging situations, it appears to be all the more important for those attempting to get their acne under control.

While these simple lifestyle changes can make an impact, don’t diminish the importance of topical treatments that utilize ingredients proven effective in the fight against acne, including alpha- and beta-hydroxy acids, retinoids, sulfur, niacinamide, benzoyl peroxide, tea tree oil and aloe vera. These ingredients are found in the  Lexli Acne Kit, which targets the four main causes of acne to not only heal breakouts but minimize future acne symptoms.

It’s an exciting time to monitor the field of acne research, as studies that present new findings into the pathogenesis of the disease and its contributing factors are introduced at a feverish pace. Our team at Lexli is staying on top of developments related to acne so we can continue to offer the most advanced over-the-counter treatments available.

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