Acne in adults: causes of acne

It is believed that the problem of acne occurs in adolescents during their puberty. However, unfortunately, adults after 25 years of age also suffer from acne (post-pubertal acne). Usually it all starts with a greasy shine and enlarged pores. As a result, there are open comedones (black dots) and closed pustules abscesses, as well as large internal nodular or cystic painful acne. 

To understand the possible treatments for acne in adults, it is important to study the causes of their occurrence. It is believed that the root of the disease is in the sebaceous follicle, and more precisely in the mouth of the sebaceous gland, which is “clogged” with dead cells due to insufficient exfoliation. Further, the outflow of sebum is disturbed, and sometimes it is infected with various bacteria.

The development and intensity of acne in adults contributes to many different factors:

  • Increased activity of the sebaceous glands, due to which there is an excess of sebum
  • Hyperkeratosis of the sebaceous duct
  • Propionibacterium acne and, as a consequence, a decrease in skin immunity, a change in the ratio of microorganisms living on the skin with an increase in the number of pathogenic flora
  • Stress
  • Smoking, as sebum begins to actively release under the influence of nicotine
  • Exposure to sunlight: under the influence of ultraviolet radiation, inflammation develops, against the background of which squalene peroxides are produced, which are extremely toxic substances 
  • The use of decorative cosmetics, especially foundation

The development of foci of acne contributes to the use of some cosmetics. For example, compact sunscreen powders and creams that have not been tested for their comedogenicity, that is, the ability of various substances to clog skin pores, can cause acne. Such comedogenic ingredients in cosmetics are lanolin, petroleum jelly, mineral oils and some types of vegetable oils. Therefore, the choice of various decorative and skin care products should be approached carefully, checking their composition. 

The microbiology of the disease itself is the same in both adolescents and adults. However, the inefficiency of many oral antibiotics suggests that adult acne is characterized by antibiotic resistance of propionibacteria acne. When acne occurs in adults, resistant strains can provoke chronic stimulation of innate immunity. This leads to aggravation of existing inflammatory lesions.  

The role of hormones in the appearance of acne in adults

Despite the fact that many factors underlie the pathogenesis of acne, the most important role is played by the stimulation of the sebaceous glands by the male sex hormones androgens. True, in the course of some studies, a specific model of endocrine disorders in the occurrence of acne in adults was not revealed.

For women over the age of 25, a common sign of hyperandrogenemia is often an irregular cycle or excessive hair growth. The results of various studies have shown that in 40-85% of women, acne symptoms are aggravated a few days before the onset of menstruation. Premenstrual exacerbation of acne is caused by an increase in testosterone levels in relation to estrogen in the luteal phase of the cycle. Hormone therapy aimed at lowering the level of androgens in the blood is effective enough to combat acne in adults. However, its use is much more side effects. Therefore, a competent doctor, most likely, will not prescribe hormone therapy to an adult patient suffering from acne.

The activity of sebum formation is also regulated by estrogens, insulin, insulin-like growth factor-1 (IGF-1), glucocorticosteroids (GCS), adrenocorticotropic hormone and melanocortins.

In clinical observations of patients, the role of IGF-1 in the occurrence of acne during puberty, when the maximum concentration of androgens and insulin in the blood is observed, was shown. Moreover, the study revealed a relationship between the concentration of IGF-1 and the number of affected lesions on the skin of women older than 25 years. Insulin-like growth factor-1 stimulates the formation of fat in the sebaceous glands, affecting the colonization of propionibacteria acne. Therefore, the presence of insulin resistance, namely, a decrease in the sensitivity of cells to insulin when there is a sufficient amount of it in the blood, is one of the main factors in the appearance of acne in adults. How can I influence the concentration of IGF-1, this will be discussed further.

Nutrition for Acne Treatment

The study found a connection between the occurrence of acne and a nutritional system, including the use of dairy products. The fact is that milk protein, which usually contains growth hormones and steroids, has a tremendous effect on IGF-1, forcing the latter to actively signal. However, milk has a low glycemic index, but increases the level of IGF-1 and thereby contributes to the deterioration of the skin with acne.

Also, the sensitivity of receptors to androgens in women is increased by foods with a high calorie content and high glycemic index. Such food is absorbed very quickly, thereby dramatically increasing the level of insulin in the blood serum and helping to reduce the concentration of sex hormone-binding globulin. In contrast, it has been proven that products with a low glycemic index contribute to an increase in the level of globulin that binds sex hormones in the blood serum, and as a result, a decrease in the concentration of androgens. The results of pathological and immunohistochemical studies have shown that in people who eat low-GI foods, sebaceous glands even decrease in size. 

In modern research, scientists have clearly demonstrated that acne almost never develops in people who have excluded refined sugar, some cereals, milk and dairy products from the diet.

Thus, the first thing you need to start acne treatment before going to the doctor is to correct your diet. And, if you have a manifestation of acne on the skin, you can already exclude some products from the diet today. For the convenience of calculating the glycemic index, you can use the following table.

Laboratory diagnosis and treatment of acne in adults from the inside

Many doctors use antibiotics to treat acne, and prescribe retinoids and hormonal drugs inside. It is worth remembering the side effects of all these funds. In addition, any doctor’s prescription should be based on laboratory tests. Therefore, for the successful treatment of acne in adults, it is necessary to pass the following tests:

  • General blood analysis,
    • ESR
    • C-reactive protein,
    • Homocysteine,
    • Blood biochemical parameters, 
    • Glucose
    • Insulin,
  • Determining Vitamin D Levels,
    • Omega-3 Index,
    • Determination of ferritin content
    • Trace analysis (magnesium, zinc, selenium, copper),
    • Vitamins B12 and B6,
    • Thyroid hormones-TSH, St. T4,
  • Lactose and gluten intolerance,
    • Analysis by Osipov.
    • If there is a violation of the menstrual cycle, then an additional analysis is given for luteinizing pituitary hormones (FSH and LH) from 3 to 5 days, as well as urinary estrogen metabolites from 19-25 days of the cycle. 

The basis for successful treatment of acne in adults is the correction of nutrition and internal deficiencies. As a rule, deficits are interconnected. Therefore, in addition to the nutritional principle for acne described above, it is important to add vitamins and dietary supplements, but only after the results of tests and consultation with a doctor. The danger of self-appointment without analysis is the possibility of an overdose of these vitamins and elements, which can lead to serious malfunctions in the body.   

Most often, in the treatment of acne in adults, it is prescribed:

  • Vitamin D – in a dosage of 5000 IU daily (dose is selected only after analysis and consultation with a doctor)
  • Omega-3 1-3 times depending on tests with meals  
  • Vitamin A at a dosage of 10.000 – 1 time per day for 2 months
  • Complex of B vitamins for 2 months
  • Chelated forms of zinc and copper for 2 months 
    • Selenium 200 mcr – 1 time per day, 3 months
    • Magnesium Citrate for 2 months 
  • Ant tree bark as an antibacterial agent 1.5 – 2 months
  • Caprylic acid to prevent fungal infections 1 capsule 2 times a day with food
  • Evening primrose oil in capsules (1300 mg) for 3 months
  • Spirullina 30 minutes before dinner 2 grams for 2 months
  • Enzymes – 1 capsule before breakfast for 3 months
  • Pepsin + Betaine for normal digestion – 1 capsule with each meal
  • Probiotics that need to be changed every 1-1.5 months, take up to 6 months

External Acne Therapy in Adults

In order for pathogenic bacteria to receive less nutritious sebum secretion, the skin must be properly cleaned, or rather degreased. However, do not confuse the concept of fat-free and dehydrated skin, as even oily skin can be dehydrated from the inside. This often happens when using aggressive agents, for example, containing alcohol or alkali (soap). Therefore, it is important to select external acne medications with a specialist. Based on the cause of acne and manifestations, the specialist will build the correct external acne therapy. As a rule, the following stages of acne prone skin care are needed: 

  1. Reduced seboregulation due to proper skin cleansing with the help of gels, foams and tonics containing acids.
  2.  Elimination of propionbacteria acne with antibacterial creams containing benzoyl peroxide, water, tea tree oil, azelaic and glycolic acid, zinc oxide.
  3. Improving epidermal cell renewal. To do this, you can use acids and peels based on them (glycolic, lactic, almond, etc.). Scrubs can only be used if there are no active inflammatory elements. Cell renewal procedures, such as microdermabrasion, are also suitable.
event_note April 19, 2020

account_box Dr. Peter B Milburn

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