Alice,

I am a thirty-year-old woman. Recently I have experienced terrible acne on my chest, neck, upper back, and face. No matter what I do, the problem will not go away. Could it be serious? What should I do?

Dear Reader,

Thanks for popping this question! Often considered specifically associated with the teenage years, acne (also commonly referred to as breakouts, zits, pimples, etc.) can affect people throughout their life cycle. About half of all women and a quarter of all men experience adult acne. There are many contributors to the development of adult acne, including fluctuating hormone levels, acne rosacea, and stress; diet may also play a role. Specifically, as people age, testosterone levels and cortisone levels (associated with stress) both increase. Both of these two factors increase oil production in skin glands, thereby leading to a suitable environment for bacteria to clog pores and lead to whiteheads, blackheads, pustules, and cysts. However, fret not — working with a health care professional may ensure clearer skin and a calmer outlook!

Specifically looking at fluctuating hormone levels, typically estrogen decreases and testosterone increases as people age. Testosterone directly leads to the production of oily skin, which increases pore size and creates a suitable environment for bacteria to replicate in number, leading directly to increased rates of acne. In addition, hormone levels can be affected by starting or stopping birth control pills, undergoing menopause, or becoming pregnant. All of these can contribute to suppressed estrogen levels, leading to a buildup of oil in the skin. 

On the other hand, it's typical to experience increased stress while aging, leading to an imbalance of androgens and hormones that regulate the skin. In response to stress, the human body produces an increased quantity of androgen, which is a type of hormone that stimulates oil glands and hair follicles to produce more oil, thereby leading to an increase in acne. Cortisol, which is known as the stress hormone, also increases the probability of developing adult acne. Higher rates of stress, which stimulate cortisol, coupled with an increase in testosterone as we age, promotes the production of oil on the skin and plugs up the glands.

In addition, a few other, less common, factors may contribute to adult acne. First, although there isn't empirical evidence to link a specific diet to increased acne, some people have found that specific foods trigger their acne. In this case, those individuals may find that avoiding those particular foods helps to clear up their skin. Another cause of pimples cropping up in thirtysomethings is a condition called acne rosacea. This condition causes redness and flushing of the face (which may become more pronounced when a person drinks hot beverages, alcohol, or eats spicy foods), pimples, dry skin, and reddish-purple streaks that look similar to broken blood vessels (called telangiectasias). This type of acne doesn't cause whiteheads or blackheads. Acne rosacea can be treated with antibiotics: pills, gels, lotions, or a combination of these products.

Reaching out to a health care provider may help you figure out the best way to regulate your acne. Given the number of options available over-the-counter and by prescription, they'll be able to best advise you on the cause of your adult acne, how to treat your skin, and how to prevent it from getting worse. In more severe cases, a referral to a dermatologist may be necessary.

Best of luck breaking away from breakouts!

Alice!

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