Thought your days of acne were long gone, only to find those spots have popped up again in your 20s and 30s?
Don’t worry, it’s very common... 50 percent of women aged 20 to 29 have acne, and it affects over 25 percent of women between 40 to 50 too.
What causes adult acne?
Adult acne most commonly appears on the chin, jawline and lower cheeks. This is the “Uzone” of the face, and blemishes in this area tend to be deep, red and painful spots which take a while to go down. Teenage acne however, tends to appear in the “T-zone”, which is the forehead and nose, as often shown in face mapping.
Chin, mouth and jawline spots usually have a hormonal cause. Androgen hormones are the common culprit when it comes to chin pimples, especially in adult women - with levels shown to be significantly higher in adult females with acne, than those without acne. Elevated androgens are also one of the main causes of bacne (back acne).
Androgens are a group of hormones including testosterone and it’s more potent dihydrotestosterone (DHT), which binds to androgen receptors in the oil glands, stimulating excess oil production. This excess oil causes clogged pores and allows P.acnes bacteria to grow; causing inflammation and hormonal acne breakouts. Hormonal spots are typically unresponsive to topical products, which don’t address the root cause from within the body.
What causes elevated androgens in women?
Menstrual Cycle Hormone Fluctuations
Some women might be naturally predisposed to higher androgen levels due to genetics, and might find acne is present regardless of the stage of the menstrual cycle. Whereas many women will notice an increase in chin, jawline and neck breakouts in the premenstrual week before their period. This is actually due to a drop in estrogen during this time. Estrogen usually keeps androgens in check, but before our period, estrogen drops and androgens are free to roam and wreak havoc on our oil glands.
One of the causes of excess androgens in females is polycystic ovary syndrome (PCOS).
PCOS is a condition in which women have low levels of estrogen and progesterone, and high androgen levels.
PCOS symptoms include irregular periods; hair on the chest, face/ chin and nipples (hirsutism); hair loss or thinning hair; oily skin and acne.
Other hormonal triggers of excess androgens include perimonopause, menopause and pregnancy, which can also cause acne breakouts.
Acne when coming off the pill
Combined birth control pills can have an anti-androgenic effect. When switching birth control, or stopping the pill, the androgen hormones can start to rise again and increase sebum in the oil glands.
Progesterone only pills (the mini pill) or the implant, can make acne worse by causing the androgen levels to fluctuate.