Acne is not a modern phenomenon. Teenage acne has existed for as long as teenagers, and has been documented in ancient Roman, Greek, and Indian cultures (to name a few). Regardless of what year we are in or what culture we find ourselves to be apart of, teenagers experience a surge of hormones that drive development. Most notably, particular hormones affect skin oil production keratinization (the making of skin cells).
What is a modern phenomenon is adult acne. Adults in America make up a greater portion of acne sufferers than teenagers. According to the American Academy of Dermatology, 66.3% of patients who visited a physician for acne were 18 years of age or older.
Adult acne is not just an American disease. It is a disease of western civilization. And as non-western cultures become more westernized, we see a rise in adult acne.
The Blemish of Western Society
In South Africa, dermatologists found a difference in acne rates for people who resided in the same country but lived in either a rural village or city. There were lower rates of acne among the Bantu, who live in rural villages than among city-dwelling white in Pretoria. Bantu adolescents (aged 15-19 years; n = 510) maintained a 16% incidence rate of acne, while the white adolescents (n = 1822), had a much higher incidence of 45%. The full sample size of the Bantu population, which included all ages (n = 3905) found a low 2% overall occurrence of acne. The white population (n=16676) sat in stark contrast with an incidence of acne 5 times that of the Bantu population at 10%. The Zulus are another rural population who only began to report acne upon moving from their traditional African villages to cities.
Adult Acne is a Woman's Issue
Adult acne does not affect all adults equally, women experience acne at a higher rate than men.
The above figure was taken from a Journal of American Academy of Dermatology study that examined the prevalence of adult acne in American patients over 20 years of age. You can see from the graph that in the teenage years, males experience acne at a slightly higher rate than females. However acne in adulthood is experienced more by females than males.
Why is adult acne primarily a modern woman's problem? From my experience, both as a biologist and as a skin care expert I believe that I have determined the main culprits:
1. Women Wear Makeup
Most women in modern society wear makeup every day. Makeup can both create acne and make existing acne worse. Makeup creates acne (and other skin issues) and makes existing acne worse by:
1. Breaking your skin down from the skin-damaging ingredients.
2. Makeup interferes with the beneficial bacteria present on your skin. Some bacteria is good, and the natural bacteria microbiome present on your skin keeps bad bacteria away. When you put makeup on your skin, it causes a disruption of the natural ecosystem and destruction of the beneficial bacteria present. The result is a weakened defense against pathogens and an increased susceptibility to skin disease.
3. Infecting your skin with bacteria and other microbes. Makeup such as foundation, concealer, and their applicators quickly become hotbeds for bacterial growth. When you put infected makeup on your skin, which has already been weakened, your skin becomes infected. The result is bacterial and/or fungal acne.
4. Trapping heat which causes inflammation and impedes the body's ability to heal. This is also a concern for those with rosacea.
5. Soaking up the skin's natural oils (such as with powders) will cause an increase in sebum (which is inflammatory), making pimples, redness and oiliness worse.
6. Makeup application is abrasive, which breaks the skin down. Makeup removal requires harsh cleansing that strips the skin's natural oils, which are protective. When oils are stripped, more oil is produced by the sebaceous glands, which makes acne worse.
Makeup should never be worn on skin with acne. Although it's tempting to cover up blemishes, covering up your skin will make your condition worse and will prevent any chance of your skin healing. Wearing makeup over acne will also increase the likelihood of permanent acne scarring. Many of my clients refused to forgo makeup for various reasons, and they did not see the improvement of their acne until I convinced them to go makeup free. Once makeup free, most saw significant acne improvement within 2 weeks.
2. Women Use Damaging Skin Care
In a past article I write about how I lived an acne-free existence until I turned 25. The culprit was damaging skin care, which is ubiquitous. It was for this reason why I created OUMERE, and the products I formulated were the only things that were able to cure my acne.
Damaging skin care includes:
1. Ingredients such as essential oils, vitamin C, fragrance, drying alcohols, and a high concentration of inflammatory plant oils without a proper anti-inflammatory oil counterpart.
2. Skin peels, which kill live skin, destroy the skin's protective barrier, microbial biome and cause inflammation
3. Harsh measures such as microneedling / dermarolling, which kills live skin, causes inflammation and scarring
4. Over-cleansing the skin and cleansing with alkaline, skin-stripping products. Alkaline cleansers raise your skin's pH, which kills beneficial bacteria, breaks your skin down, and causes dryness (or oiliness).v
5. Scrubs, polishes, microdermabrasion
6. Long term use of Retinols for non-acne treating purposes
Men generally do not wear any skin care at all, which is better than wearing damaging skin care. However, we all need a proper skin care regimen, whether it is to properly cure acne, for skin health, or to improve the look of our skin in general.
3. Women Go to a Dermatologist for Mild Acne
Women are more likely to go to the doctor, in general, and most women with acne seek treatment from a doctor at some point during their illness.
If you visit a dermatologist for acne, they are going to prescribe an antibiotic or Accutane. I think for severe acne, Accutane may be the best option. For all other cases, medication has the potential to be harmful, and antibiotics will make your acne worse.
Antibiotics will make your acne worse because it will kill off the beneficial bacteria on your skin. So while your acne will subside while you are on the medication, it will come back once you complete the treatment. And when you go off the antibiotics, the acne will come back more severely because antibiotics do nothing to address the reason why acne was there in the first place. Antibiotics will also make it harder to treat acne and make it go away for good because the bad bacteria will come back and there will be no beneficial bacteria to defend your skin from pathogenic invasion.
Dermatologists also recommend harsh treatments such as lasers and peels, which like antibiotics, do not address the underlying cause of acne. If you don't address the underlying cause, you are just doing damage to the skin for the sake of a temporary fix. And this is a problem because it prolongs the illness and makes your skin worse for wear in the process.
When I hear of all of these quick and cheap fixes for acne, I'm reminded of this ice cream I saw at a grocery store once. It was a big tub of some sort of chocolate flavor, and it was advertised that the entire tub was 100 calories. This ultra low-calorie dessert was no doubt for people who have weight to lose, and yet it is the exact sort of product that perpetuates weight issues. Although someone may choose that low calorie ice cream in an attempt to lose weight, the ice cream doesn't address the reason why weight loss was necessary the first place: a long-standing habit of over-eating unhealthy foods. Maybe the problem isn't ice-cream, maybe the problem is the inability to be satisfied with a few bites, and the need to eat the entire tub. The low cal ice cream still teaches the habit of over-eating of calorically devoid food. And then one day when the 100 calorie option isn't available, it'll be too easy to reach for that 1000 calorie tub and eat the whole thing.
The same thing is true for acne and their treatments.
4. Hormones and Diet Affect Women Differently
Although a westernized diet has health consequences for both men and women, women may experience different effects than men. Eating too much dairy, meat and sugar while not having enough fruit, vegetables, and healthy fats may cause the disruption of normal hormonal function and result in acne.
Eating dairy, meat, or sugary food influences circulating concentrations of free insulin like growth factor I (IGF-1) and insulin like growth factor binding protein 3 (IGFBP-3). IGF's play a role in acne because they directly regulate keratinocyte proliferation. Too much IGF may lead to over-keratinization, a hallmark of acne.
Elevated levels of IGF have been found in the blood of female adult-acne patients, and increased and prolonged circulating concentration of IGF may affect women more than men.
Aizawa, H., & Niimura, M. (1995). Elevated serum insulin‐like growth factor‐1 (IGF‐1) levels in women with postadolescent acne. The Journal of dermatology, 22(4), 249-252.
Cordain, L., Lindeberg, S., Hurtado, M., Hill, K., Eaton, S. B., & Brand-Miller, J. (2002). Acne vulgaris: a disease of Western civilization. Archives of dermatology, 138(12), 1584-1590.
Grice, E. A., & Segre, J. A. (2011). The skin microbiome. Nature Reviews Microbiology, 9(4), 244.
Hay, R. J., Johns, N. E., Williams, H. C., Bolliger, I. W., Dellavalle, R. P., Margolis, D. J., ... & Michaud, C. (2014). The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. Journal of Investigative Dermatology, 134(6), 1527-1534.
Lynn, D. D., Umari, T., Dunnick, C. A., & Dellavalle, R. P. (2016). The epidemiology of acne vulgaris in late adolescence. Adolescent health, medicine and therapeutics, 7, 13.
Peper, J. S., & Dahl, R. E. (2013). The teenage brain: Surging hormones—Brain-behavior interactions during puberty. Current directions in psychological science, 22(2), 134-139.
Smith, R. N., Mann, N. J., Braue, A., Mäkeläinen, H., & Varigos, G. A. (2007). The effect of a high-protein, low glycemic–load diet versus a conventional, high glycemic–load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial. Journal of the American Academy of Dermatology, 57(2), 247-256.
Tan, J. K. L., & Bhate, K. (2015). A global perspective on the epidemiology of acne. British Journal of Dermatology, 172, 3-12.Chicago