So just what is acne? Despite all the research into adult acne, the debate continues to rage about its causes. Pharmacist and dermatologist Dr John Sullivan says acne affects 85 percent of Australians aged 15 to 24, although its reach is far wider. ‘This often continues into adulthood, with figures suggesting 15 percent of people in their 20s and 30s are sufferers, resulting from hormones and substances on the skin's oil glands and hair follicles, plugged pores and outbreaks,' he says.

Marie Enna-Cocciolone, the CEO and founder of Inskincosmedics, says understanding adult acne and what your triggers are is key to treating your skin. ‘Although the root of acne is consistent at any age, this is where the similarity between adult and teenage acne ends,' she says. ‘Teen acne commonly appears on the forehead and T zone and is seen as blackheads, whiteheads and pustules. An adult breakout is more commonly seen on the chin and jaw line and can include cysts as well as spots and pimples. Adult acne can be more complicated since concerns are normally two-fold: acne and skin ageing.'

Experts believe acne is triggered by several related factors that can be broken down into two categories: intrinsic and extrinsic. Intrinsic factors are genetics and the body's response and sensitivity to hormones, over which we have little control. Extrinsic factors are a wide and comprehensive range that we have much more control over.

Intrinsic

Hormones are a star player, given the body's levels fluctuate at different points of the month and affect oil production. Things like stress, menstrual cycle, pregnancy or breastfeeding can raise hormone levels and subsequently lead to breakouts.

Genetics also play a significant role as they can determine defective oil glands, pore lining that does not shed dead cells properly and the production of abnormal sebum. ‘Rarely do people consider their condition might be hereditary, so this factor should not be overlooked,' says Sharon McGlinchey from organic skincare company MV Skincare. ‘One of the first questions I ask a new client with acne is whether anyone in their family, past or present, suffered from acne.'

Extrinsic

There are plenty of extrinsic factors that disturb the skin's delicate balance and cause those dreaded spots.
Our modern-day diet plays a significant role in our skin's health. ‘Over the past 15 to 20 years foods have become more refined, lacking essential nutrients to fully support our immune system and failing to provide us with all the vitamins and minerals necessary for resilient skin,' says Sharon. ‘Refined grains lack the necessary fibre for healthy digestion, which can then lead to skin problems as wastes are not effectively removed from the body. Also, our obsession with weight has led to a reduction of our intake of all the good oils, which include plant oils and omegas rich in essential fatty acids and mono-unsaturated oils such as olive oil - all essential for healthy skin.'

Dr Sullivan recommends a high protein, low GI diet, which he says can lead to a 20 percent improvement in your skin. ‘Small indulgences don't make acne flare up, but maintain a healthy weight and get 30 minutes of exercise each day,' he says.

Deep fried or sugary and refined foods (biscuits, cakes, pasta, white bread, fizzy drinks) and even dairy are often on the to-be-avoided list. Sugar plays havoc with the skin by causing disruption to the pituitary gland, which helps balance our hormones.

Another culprit is pthalates. These are found in the plastic our food is wrapped in but also in many supermarket packaged foods. ‘Pthalates are also hormone disruptors, which can upset the delicate balance,' says Sharon.

Over-use of topical corticosteroids, using oily makeup and the misuse of skincare products can all lead to acne. One of the more common forms of acne is caused by a build-up of cosmetics over a long period of time. ‘Cosmetics contain many chemicals and synthetics which are comedogenic (blackhead forming) so daily use of cream foundation and blush can accumulate over many years and adversely affect the health of the underlying skin tissue, leading to breakouts,' says Sharon. ‘When we consistently consume unhealthy foods our body quite quickly tells us it's not happy - we feel sluggish and lacking in energy. Unfortunately the skin can take many years before it finally lets us know it's not happy with all the chemicals and pigments we've been applying to our skin.'

Overly harsh and strong skincare products can also destroy the outer layer of the epidermis and kick skin processes into high gear. This irritated, overly dry skin can begin over-producing oil to make up for the lack of moisture, perpetuating a cycle of breakouts.

‘One of the most common misconceptions is that frequent scrubbing can clean and prevent breakouts. I do not recommend overly or harshly exfoliating the skin,' says Dr Sullivan. ‘The best routine is to keep skin healthy by cleansing, treating acne with the appropriate therapy and protecting your skin with moisturiser and UV blockers as many acne treatments make the skin more vulnerable. As a rule, look for labels with "oil-free" and "non-comedogenic" on them, and experiment to find out what works for your skin personally.'

A regular skincare routine is a must for healthy skin function and acne treatment; you just need to be particular about your products. Marie from Inskincosmedics says a basic skincare routine that includes daily cleansing, morning and evening, is mandatory. ‘The key is to keep the skin clean, free of dead skin cells and bacteria,' she says. ‘Finding skincare that works well for your skin will ensure you have all the tools needed to maintain skin balance and reduce breakouts. I believe in a routine that includes AHAs, BHA and retinol to exfoliate the skin from the inside and out, pushing out dead skin cells that mix with oil and dirt to clog the skin.'
‘If we strip the skin, the oil glands will simply produce more oil,' says Sharon. ‘My advice is to avoid the foaming cleaners, alcohol-based toning lotions, spot treatments and strong peels. I like a gentle and nurturing cream-style cleanser to calm and sooth irritated skin.

‘Moisturising is an important step, even for oily skin. I like to use jojoba oil as it's similar to the skin's own oil in structure. It can balance an overactive skin quite quickly and, as it's superfine and non-clogging, it's the perfect light moisturiser for those suffering from acne.'
Dr Sullivan says common acne treatments include topical formulations with ingredients such as benzoyl peroxide, salicylic acid, azelaic acid, retinoids, antibiotics and systemic medications such as the contraceptive pill, antibiotics and isotretinoin. Medical-grade therapies such as laser, cryotherapy and photodynamic therapy may also be useful.

Stress plays a significant roll in adult acne as it overstimulates our adrenal glands which in turn produce too much of the hormone cortisol. ‘This hormone stimulates the skin's sebaceous glands, increasing oil production and creating a skin that is more prone to breakouts and blackheads,' explains Sharon. ‘Stress also inhibits the skin's ability to heal properly, which only exacerbates the condition and further fuels stress and anxiety.'
Taking up yoga, meditation or getting outdoors by taking a walk in a park or near the beach are grounding and help reduce stress.

Certain medical conditions, such as polycystic ovary disease, may also trigger adult acne. ‘Smoking, along with the use of steroids, certain birth control treatments, hormone therapies and other medications can also contribute to acne breakouts,' Sharon concludes.

What is acne?

Pharmacist and dermatologist Dr John Sullivan says acne is a result of epithelial cells failing to undergo certain natural changes, so they do not shed normally. ‘Squeezing or pinching the skin, scrubbing, stress, family history, oily skincare, changing hormone levels and environmental irritants make acne worse,' he says.

A pimple or spot begins when a follicle is blocked due to normal build-up of dead epithelial and sebum, which causes a plug. ‘Blackheads are caused when the sebum and dead skin oxides under the skin's surfaces - just like when an apple turns brown when exposed,' he says. ‘Whiteheads are the same as blackheads, they just haven't oxidised. We also see the papules and pustules, nodules and cysts of acne, which cause longer term scarring which may affect up to 95 percent of acne sufferers.'