In The Clear

Get rid of adult acne once and for all.
By Trisha Gura

Once puberty had come and gone, I thought my pimples had followed my prom dress into the back closet. But the joke was on me. At 31, days after giving birth, my face began breaking out in a freak show that could rival any teenager’s.

Apparently, adults get acne too. In the October 1999 issue of the Journal of the American Academy of Dermatology (AAD), researchers reported that 54 percent of women and 40 percent of men surveyed had facial acne and they didn’t see it diminish until they turned, on average, 44.

What’s more, adults don’t suffer those zits in silence—they demand treatment advice. An online survey conducted in February 2008 by Harris International found that two-thirds of dermatologists reported that they currently see more adult acne patients than they did a year ago and the mature set now represents nearly half of their acne caseload.

Why so many pimples in the over-30 mix? The answer involves a complex jumble of hormonal, dietary, and environmental triggers that blend into a recipe for breakouts at any age.

Harsh treatments debunked
When it comes to pimples, people tend to think that dirty, oily skin is the main instigator, so the first instinct is to scrub those big, ugly whiteheads with abrasive cleansers and daub on harsh chemicals such as the benzoyl peroxide and salicylic acid found in many over-the-counter acne remedies. Big mistake.

“Certain soaps contain surfactants, which strip away the ‘good oils’ along with the ‘bad,’” says herbalist and aromatherapist Barbara Close, president and founder of Naturopathica.

Harsh cleansing devitalizes skin—and it backfires. The skin struggles to rebalance the outer lipid layer by pumping out more oil to make up for the loss. That means more breakouts. And more acne lasting later in life.

Add up the damage over time, and you get premature aging. “I have so many patients tell me, ‘I cannot believe I am dealing with acne and wrinkles at the same time,’ ” says Richard Fried, MD, PhD, author of Healing Adult Acne (New Harbinger, 2005). The psychological effects can be so devastating, he notes, that 34 percent of acne sufferers sink into depression (see “Beyond Vanity: Acne Dysmorphia” below).

Perhaps a few lessons in how acne works will help you avoid this scenario and give you gentler, more holistic ways to counter future outbreaks.

Acne 101: Clogged Pores
Deep in the pores of the skin lie special cells that divide constantly to replace dead cells sloughed off by daily washing and environmental factors such as wind. If the cells reproduce too often or become too “sticky,” they clump together and plug the pore (also called a follicle). Whiteheads are clogged pores sealed off from the air. Blackheads are clumped cells exposed to oxygen.

Many factors control cell reproduction and stickiness: diet, genetics, hormones, and even stress. You can’t change your genes, but you can manage “misbehaving cells,” says Fried.

Your lifestyle: In a study published in the February 2005 issue of AAD, researchers surveyed more than 47,000 women and found that those who consumed the fewest dairy products had the lowest number of breakouts. What does a cow have to do with a zit? The researchers—from the Harvard School of Public Health—suggested that hormones and bioactive molecules either normally present in or added to milk products might make pore-lining cells grow too fast. As an antiacne tactic, try cutting out or down on dairy.

Another good strategy? Come to terms with stress. Valori Treloar, coauthor of The Clear Skin Diet (Cumberland House Publishing, 2007), recommends relaxation techniques, yoga, and t’ai chi to her patients. And one more must: sleep. “Americans have this notion that you are a wuss if you sleep,” says Treloar, “but sleep recharges the body and its ability to fight acne.”

Your skin: Exfoliation can eliminate dead cells and make room for healthy ones, but don’t overdo it— one to two times a week is plenty.
Try: Naturopathica Pumpkin Enzyme Peel Mask ($56, 1.7 oz; Extracted from fruits and botanicals, this gentle, autumn-smelling exfoliant will help clean out dead skin cells without devitalizing the skin.

Acne 102: Oily Glands
Oil factories called sebaceous glands line the pores of the skin all over the body, but they occur in greater concentration on the face. They spew out “sebum” in response to myriad triggers. The oily sebum actually protects and lubricates the skin, but because of hormonal fluctuations during puberty, pregnancy, the postpartum time period, and perimenopause, it can cause acne flare-ups. The sex hormones released in times like these (called androgens, which are related to testosterone) over-stimulate the sebaceous glands. They go renegade and produce too much oil, which plugs dead cell–laden pores. The dreaded dénouement? Whopping zits.

Hormones play a starring role in cyclical outbreaks, too. Many women experience deep, painful welts along the jawline and chin, commonly called premenstrual “tumors.” The drop off of estrogen before the onset of menstruation allows testosterone to dominate the hormone mix and often results in these bumps, which are actually cysts. Birth-control pills offer a solution of sorts by keeping estrogen levels high and, thus, pimple eruption low. But the Pill creates a number of risks and side effects. “The hormones they contain can have many negative health impacts such as increased risk for heart attack, stroke, and breast and cervical cancer,” says internal medicine specialist Judith Stanton, MD, at the California Healing Institute in Albany, New York. In addition, Stanton says studies link the Pill to poor absorption of B and C vitamins. Taking the Pill just to solve your acne problem doesn’t sound like a great idea, but you’ll also eventually face one more Pill downside: According to Fried, the glands will adjust to the extra estrogen, only to be challenged again when you go off birth control.

Your lifestyle: To tame hormonal acne, Treloar recommends exercise, which reduces insulin production. Since excess insulin interferes with the production of sex hormone–binding globulin—a helpful hormone that binds to testosterone and takes it out of action, meaning less oil production—exercise actually boosts your body’s natural acne defenses. To reduce hormone sensitivity, you might also try eating foods rich in vitamin B6, including oily fish, avocados, and eggs.

Your skin: Most acne products tend to dry oily skin, even though that approach may make things worse, particularly for adults with “dry-skin acne.” If you have that problem, which often comes, alas, with age, you need to look for products that rebalance the oil layer rather than strip it completely away.
Try: Talulah Oma Face Serum No. 1 ($24, 30 ml;, an antiacne cornucopia of oils, including rosehip and olive, that rebalances the skin’s oil production and helps heal old scars.

Acne 103: The Acne Germ
A trapped, clogged pore makes the perfect breeding ground for a bacterium called Propioni acne (P. acne). It loves dark, oxygen-deprived, oil-rich places. When you get a pimple, the P. acne bug within it feasts on your skin oil and expands the pore into an angry red bump, an infection. Resist your urge to pop that zit! Squeezing causes the swollen pore to rupture, which spills its infectious contents into the tissue beneath the skin’s surface. This results in painful bumps called “cystic acne,” the same deep, tender pimples formed during menstruation. Many conventional dermatologists prescribe antibiotics to rein in P. acne. But the bug can build up resistance, so antibiotics stop working over time. Antibiotics taken over a long period of time can also kill off beneficial bacteria such as those lining the gut, and that can lead to digestion problems and yeast infections.

Your diet: Instead of antibiotics, try pumping up your immune system. Vegetables, berries, and red kidney beans all contain immune-boosting antioxidants, so try to add extra servings to your meals. Your skin: Opt for tea tree oil, a mild antibacterial agent.
Try: Suki Concentrated Facial Toner ($29.95, 5.1 oz; In addition to its calming organic herbs and flowers—including chamomile and rose petals—this herbal infusion also packs lots of antioxidant power. The key ingredient: white willow bark, the natural precursor to aspirin. In a 1999 study, Swedish researchers declared white willow bark one of the best antioxidants found in the non-edible plants.

Acne 104: Inflammation
The bacterium P. acne may trigger pimple fl are-ups, but inflammation causes the collateral skin damage. As bacteria over-grow the pores, the skin cells send out chemical alerts that attract inflammatory agents, which wall off and kill the bacteria, all within the red hump of a pimple. End of story, right? Not exactly. In their zeal, these pro-inflammatory agents can actually rupture the pore underneath the skin, causing the painful “tumors” found in cystic acne.

While research has debunked the food myths surrounding acne—thank heaven they took chocolate off the list—what we eat (or more importantly, don’t eat) plays a significant role in the condition. Like heart disease and diabetes (although far, far less serious), says Treloar, “acne is an inflammatory disease.” And the cause, she says, may lie in our food choices.

Your diet: From the 1920s onward, Americans have switched to a diet loaded with omega-6 fatty acids and trans fatty acids. Meanwhile, we have decreased our intake of anti-inflammatory omega-3 fatty acids, found in flaxseeds, fish, and avocados. Treloar suggests eating more omega-3–rich foods and fewer foods containing omega-6s to halt the inflammation that can contribute to acne.

Cutting down on refined sugar can also have an effect. A study published in the July 2007 issue of the American Journal of Clinical Nutrition found that 15- to 25-year-old male acne patients who ate a low-carb diet had dramatically fewer blemishes after 12 weeks than those who ate high-carb foods.

Carb-packed foods raise our blood sugar, which, in turn, triggers high insulin production, says Treloar. Insulin, a pro-inflammatory, also decreases the production of sex hormone-binding globulin. So to cut out the zits, you might cut down on the “white” flours and sugars.

Your skin: Many antiacne products contain aloe, calendula, and other botanicals to help soothe inflammation.
Try: MiEssence Purifying Blemish Gel ($24.50, 1 oz;, which offers an intense blend of organic herbs and flowers, including purifying thyme, healing plantain, and clarifying echinacea, to gently tame those inflamed bumps and welts.

By now, dear student, you must have surmised that breakouts are not simply a case of too many freedom fries. As you work to manage your acne, your choices can involve lifestyle and diet changes as well as revamping your cleansing habits. “Remember, rather than focusing only on what you put on your skin,” says Stanton, “focus on what you do to your body.” Healthy eating, exercise, and sleep, as well as regular relaxation, are our body’s best defense against stubborn acne.

Trisha Gura is a freelance health and science writer who lives in Brookline, Massachusetts.


Acne Treatment Mask

To deeply clean and tighten the pores, try the following:

Juice from half a lemon, strained
1 egg white

Beat together the egg white and lemon juice. Apply directly to your face, avoiding your eyes, and leave on for 10 minutes. Rinse your face with warm water. The lemon acts as a potent astringent, and egg whites have a firming effect.


Beyond Vanity: Acne Dysmorphia

No one covets a complexion dotted with zits, but when someone starts to obsess about bumps and blemishes, she may have developed a mental condition called acne dysmorphia. Like anorexia nervosa, acne dysmorphia spurs a love affair with the mirror—and sometimes a deep plunge into depression. When a person starts withdrawing from friends, family, and fun, the time for help has come. “This is real stuff,” says psychologist and dermatologist Richard Fried. A person with acne dysmorphia needs mental health treatment, which may include cognitive behavioral therapy (CBT). First created to treat depression, CBT works with the premise that negative thinking motivates negative actions and vice versa. The therapy works with both the thoughts (such as “No one loves me because my face looks this way”) and the behaviors (e.g. “I refuse to leave the house during the daytime so no one will see me”). This approach can help a woman with such a distorted body image move toward self-acceptance. To find out more about CBT and to locate a practitioner near you, go to