Adolescent Acne: Adolescence acne is defined as acne in people with the age of not more than 25 years old. Statistical analysis from data worldwide indicates that the peak incidence of acne is at 14 and 17 years old for girls and 16 and 19 years old for boys.1
During teenage years, the following factors contribute to acne:
Secretion of sex hormones increased substantially during the teen years. These hormones stimulate the changes in oil (sebum) composition amount of oil produced by oil glands in the skin that lead to acne cycle. Changes in the oil components at the oil gland in skin can cause some bacteria to dominate, thereby decreasing natural skin microbial diversity. Pro-inflammatory activity of the unbalanced microbiome (microbiome that has lost microbial diversity) starts inflammation which results in acne cycle.2,3
Anxiety and stress
Mental stress promotes anxiety that can affect skin through the intertwining of the central nervous system and endocrine system (hypothalamic-pituitary-adrenal axis). Upon sensing stress, neurons in the brain (hypothalamus) secrete hormone that promotes oil (sebum) production in oil glands in the skin, and increase level of some biochemicals (IL-6 and IL-11 cytoclines) in skin tissue that contribute to inflammation.4
Skin irritation and skin barrier disturbance from skin cares and cosmetics
Alteration of skin pH has been shown as one of the cause of acne. The normal pH of skin is 5.5 for male and 5.4–6.0 for female. Cosmetic formulations with too acidic pH (lower than 4) or neutral (around 7) or slightly basic (higher than 7) can easily aggravate acne, probably through damaging skin barrier function and altering microbiome on skin. Washing skin with cleanser that increase the skin pH leaves skin with dryness and tightness, and damages skin barrier function, causing inflammation that resulting in increased acne risk.5 The appropriate skin care should have pH similar to natural skin pH value. The new understanding of acne identifies acne as an inflammatory disease, with micro‐inflammation being the root cause that starts the acne cycle.6,7 Therefore, makeup or skincare that disturbs skin barrier or irritates skin can lead to acne.
The hyperglycemic food (food that increases sugar level in blood easily and quickly such as sugar and white flour), saturated fat and milk product play the primary role in development of acne by promoting the oil secretion by oil glands in skin.8 Teens need more energy and may consume more of these food types.
Adult Acne: Although acne occurs mostly in teens, over the past several years, acne in the adult female has become widespread.9 Adult acne is defined as acne in people of 25 – 45 years old and is broadly divided into persistent, new-onset, and recurrent subtypes. Persistent acne is acne that presented in adolescence and continues into adulthood. New onset acne is acne that appears for the first time in adulthood. Recurrent acne is acne that is present in adolescence, clears for some time, then comes back in adult.9,10 Experts suggest that acne in women 18 to 24 years old are more similar to adolescent acne than to adult acne, thus they are included in the adolescent acne.10,11
Adult acne is found mostly on the lower half of the face. Acne flare‐ups before menstruation is more common in older women. These flares are caused by increased water content of the pore wall of the skin in the last week of the period cycle. Persistent, relapsing and new‐onset types of adult female acne are often associated with inflammation (deep nodules).12
Adult women experiences many high stress triggers, including menstruation‐related hormonal fluctuations, sleep deprivation, emotional crush from various burdens and pressure, all of which trigger acne cycle.13
Menopausal Acne: Menopausal acne means acne in woman who is in the menopausal stage-a stage when monthly period has stopped. Mechanisms that lead to menopausal acne are still unclear.
However, imbalance of various hormones is considered to be the major factors. In the postmenopausal period, the ovary keeps secreting varied amounts of androgens and estrogen.14 Secretion of estrogen falls sharply after menopause, while androgens decrease more slowly.15,16 This hormonal imbalance between estrogen and androgen can lead to acne flare.17 Stress, dietary changes, lack of sleep and exercise, emotional roller and other lifestyle changes can also trigger acne.
- 1. Dréno, B. et. al., Nonprescription acne vulgaris treatments: Their role in our treatment armamentarium—An international panel discussion. Journal of Cosmetic Dermatology 2020, 19 (9), 2201-2211.
- Dréno, B.; Dagnelie, M. A.; Khammari, A.; Corvec, S., The Skin Microbiome: A New Actor in Inflammatory Acne. American Journal of Clinical Dermatology 2020.
- Kowalska, H.; Sysa-Jȩdrzejowska, A.; Woźniacka, A., Role of diet in the aetiopathogenesis of acne. Przeglad Dermatologiczny 2018, 105 (1), 51-62.
- Chen, Y.; Lyga, J. Brain-skin connection: stress, inflammation and skin aging. Inflamm Allergy Drug Targets 2014, 13, 177-190.
- Pluetrattanabha, N.; Kulthanan, K.; Nuchkull, P.; Varothai, S. The pH of skin cleansers for acne. Indian J Dermatol Venereol Leprol 2015, 81, 181-185.
- Dréno, B., What is new in the pathophysiology of acne, an overview. J Eur Acad Dermatol Venereol 2017, 31 Suppl 5, 8-12.
- Dreno, B.; Pecastaings, S.; Corvec, S.; Veraldi, S.; Khammari, A.; Roques, C., Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. Journal of the European Academy of Dermatology and Venereology 2018, 32, 5-14.
- Melnik, B. C., Linking diet to acne metabolomics, inflammation, and comedogenesis: An update. Clinical, Cosmetic and Investigational Dermatology 2015, 8, 371-388.
- Rocha, M. A.; Bagatin, E., Adult-onset acne: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol 2018, 11, 59-69.
- Skroza, Nevena et al. “Adult Acne Versus Adolescent Acne: A Retrospective Study of 1,167 Patients.” The Journal of clinical and aesthetic dermatology vol. 11,1 (2018): 21-25.
- Zeichner J.A., Baldwin HE, Cook-Bolden FE, Eichenfield LF, Fallon-Friedlander S, Rodriguez DA. Emerging Issues in Adult Female Acne. J Clin Aesthet Dermatol. 2017;10(1):37-46.
- Bagatin, E.; Freitas, T. H. P.; Rivitti Machado, M. C.; Ribeiro, B. M.; Nunes, S.; Rocha, M. A. D., Adult female acne: A guide to clinical practice. Anais Brasileiros de Dermatologia 2019, 94 (1), 62-75.
- Dreno, B.; Bagatin, E.; Blume-Peytavi, U.; Rocha, M.; Gollnick, H., Female type of adult acne: Physiological and psychological considerations and management. JDDG: Journal der Deutschen Dermatologischen Gesellschaft 2018, 16 (10), 1185-1194.
- Fogle RH, Stanczyk FZ, Zhang X, Paulson RJ. Ovarian androgen production in postmenopausal women. J Clin Endocrinol Metab. 2007;92:3040–3043.
- Sluijmer AV, Heineman MJ, De Jong FH, Evers JL. Endocrine activity of the postmenopausal ovary: the effects of pituitary down-regulation and oophorectomy. J Clin Endocrinol Metab. 1995;80:2163–2167.
- Adashi EY. The climacteric ovary as a functional gonadotropin-driven androgen-producing gland. Fertil Steril. 1994;62:20–27.
- Markopoulos MC, Kassi E, Alexandraki KI, Mastorakos G, Kaltsas G. Hyperandrogenism after menopause. Eur J Endocrinol. 2015;172:R79–R91.
Sciences of Acne