Welcome to the new era of acne, where more and more people experience breakouts for the first time as adults—sometimes even into their fifties and sixties. How lucky that we get to worry about aging and acne simultaneously! According to the Journal of American Academy of Dermatology, 54% of women over the age of 25 have some facial acne. And research at The International Dermal Institute indicates that the type of acne that arises in adulthood is different than that which plagues teenage years—adult acne is more likely to be inflammatory with lesions primarily located around the mouth, chin and jaw line, and with fewer comedones (whiteheads).
This research supports the findings of Kristina Holey, facialist extraordinaire and co-creator of the Kristina Holey + Marie Veronique collection. Kristina’s typical client presents with symptoms that fit the description above: some type of atopic dermatitis (frequently perioral), jawline acne and facial redness, dryness and irritation. If this sounds familiar, join the growing throng—and keep reading for good news.
About two years ago, Kristina brought to my attention the repeatability of the symptom clusters she was seeing in her clients, and I started noticing how many of my customers were similarly afflicted. We were looking at near-epidemic levels of a distinctive type of adult acne among, predominantly, thirty-something women. Many of our clients were additionally stressed by treatments that seemed to be aggravating their problems. All too often, mainstream treatments, such as steroid therapy, benzoyl peroxide and antibiotics, deliver short term gain at the price of undesirable long-term consequences. Not surprisingly, treating symptoms while ignoring causes can create issues: steroids suppress inflammation for a time but can also trigger the inflammation to return with a vengeance, making the successful treatment of conditions like rosacea almost impossible. Benzoyl peroxide controls Propionibacterium acnes, but prolonged use can cause skin photosensitization and accelerated aging. And the ever-popular antibiotics disrupt microbial balance, which will likely create more inflammation over time.
Kristina and I decided we needed something that didn’t presently exist, so for two years, we worked to develop products specifically aimed at treating the various manifestations of adult acne we were seeing. We began by searching for underlying causes that conventional treatments were not addressing. The problems adults were experiencing didn’t fit the usual etiology of acne vulgaris found in teenagers, where excess sebum and dead skin cells clog pores, leading to Propionibacterium acnes over-colonization and the spread of infection and inflammation. Adult acne tended to be more of a mixed bag: while there was sometimes congestion related to hormonal jawline breakouts, the perioral dermatitis and overall inflammation without the lesions suggested other contributing factors. To complicate matters, adults often come to us with a combination of skin conditions in addition to their acne (such as rosacea) which made treatment more challenging than with teens, who generally have more resilient, uniform and oily skin.
In observing hundreds of people, we developed a few conjectures:
From these hypotheses, we created products and protocols that sought to alleviate the “new” adult acne in its various and sundry manifestations. We wanted to give adult acne sufferers more choices than the antibiotics and benzoyl peroxide that are still being used today, as they were forty years ago, but above all we wanted to broaden the scope of investigation into effective acne treatments centered around adults.
Virtually all acne formation is linked to hormones, so most of us notice at least a little at the onset of puberty, when hormones begin triggering sebum production that can lead to infection and inflammation. Men produce enormous amounts of testosterone and one of its by-products, sebum, during their teenage years. Once the puberty storm settles down, their skin tends to clear up, though they may continue to have mild break-outs because they have more sebaceous glands in their skin than women. Women, on the other hand, have to deal with fluctuating hormones. Different periods in their lives, such as puberty, pregnancy, perimenopause and menopause, can turn previously clear skin into a landscape of clogged pores, whiteheads, blackheads and blemishes.
How to tell if it’s hormonal acne:
Ingredients that regulate sebum:
Ingredients that clear clogged pores:
Part of the dermatological canon is that barrier function impairment is one of the major causes of atopic dermatitis. The International Dermal Institute’s assertion that some sort of atopic dermatitis, especially perioral or seborrheic dermatitis, is increasingly a feature of adult acne leads to the obvious corollary: growing numbers of adults are suffering from barrier malfunction.
The stratum corneum (SC), the top five layers of the epidermis, make up the barrier layer responsible for regulating moisture levels in the skin. Compromised barrier function is governed by a variety of factors: aging, daily wear and tear, external skin stressors such as over-exfoliation and use of antimicrobial products, and internal factors such as nutrient-poor diets. Topical ingredients that supply the SC with the building materials it needs to create and maintain its protective barrier suggest a partial solution to barrier malfunction.
How does dermatitis look different than hormonal acne?
Ingredients that improve barrier function:
Inflammation is the root of all evil, implicated in everything from arthritis to skin aging. We are seeing more and more dry, irritated and inflamed skin, which we attribute to the overuse of harsh exfoliants, skin products that contain strongly anti-microbial preservatives, anti-bacterial acne products and so on. Teenage skin can weather these daily insults, but adults too often end up with a variety of complaints, from rosacea to inflammatory acne—and adults with inflammatory acne, especially, do not want to dry their skin with harsh exfoliants or disrupt microbial balance by using too many anti-microbials.
How do you know if its inflammatory acne?
This is the most serious type of acne, and one that requires the attention of a dermatologist to resolve. Whatever treatment is recommended, these ingredients can complement it.
Ingredients that reduce inflammation: