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By Waldo Acebo, MD

Acne is often thought of as one of the rites of passage of being a teenager -- one that, fortunately, you get to grow out of. Yet, acne does not always disappear once you reach your 20s and beyond.

"Despite the fact that adult acne tends to be generally milder than teenage acne, this common medical condition can have a significant impact on a person's overall quality of life -- regardless of when it occurs," said Dr. Julie C. Harper, MD, associate professor of dermatology at the University of Alabama in Birmingham.

Harper and colleagues conducted a study to find out just how common acne is among adults. After surveying over 1,000 people aged 20 years and older, they found that:

• During their 20s, 51% of women and 43% of men reported experiencing acne.
• During their 30s, 35% of women and 20% of men reported experiencing acne.
• During their 40s, 26% of women and 12% of men reported experiencing acne.
• During their 50s or older, 15% of women and 7% of men reported experiencing acne.

What Causes Adult Acne?

Acne that doesn't disappear by your 20s is known as persistent acne or adult-onset acne. This results in deep-seated, inflamed pimples and nodules that may not respond to the treatments that worked during your teen years. Regardless of age, acne occurs when excess sebum (an oil produced by your body to moisturize your skin), skin cells, and bacteria accumulate. In adults, this can be triggered by:

• Hormones: Particularly during menstruation, pregnancy and menopause.
• Medications: Anticonvulsants, corticosteroids, sobriety drugs and certain birth control pills (those that contain only progestins).
• Family history of acne
• Stress: When you're under stress, your body produces more androgens (a type of hormone). These hormones stimulate the oil glands in your skin, which can lead to acne.
• Personal care products: Oily skin and hair products can cause acne.

How Can You Avoid Acne?

Acne can seem to take on a will of its own, flaring up when you least expect it (or want it). However, these tips can help to keep acne at bay:

1. Wash your face twice a day, gently with a mild facial cleanser. This will remove excess oil and dead skin cells.
2. Don't scrub your skin vigorously, as this can cause irritation that makes acne worse.
3. Use only natural skin care and hair care products. Look for water-based products labeled noncomedogenic" or "non-acnegenic."
4. Resist the habit of touching your face. This transfers extra bacteria onto your skin. (Also be careful of objects that touch your face, such as a phone receiver or hat.)
5. Change your pillowcases often, at least once a week. This helps prevent oils and bacteria from accumulating and rubbing on your skin at night.
6. Women should not go to sleep with your makeup on, as this can clog your pores and contribute to acne; also, clean your cosmetic brushes and applicators regularly with soap and water to avoid spreading bacteria.
7. Shower after exercise or other work that makes you sweat. The sweat can trap bacteria and dirt on your skin.
9. Don't pick or squeeze any existing blemishes, as this can cause infection or scarring.

There is still much debate on the topic of whether food can cause acne, but it turns out there may be a link between diet and acne after all. Here is what the research says:

  • In the Nurse's Study II, researchers analyzed teenage diet and acne in tens of thousands of women, and an association between milk intake and acne was found. The researchers suggested that hormones and other bioactive molecules in the milk may be to blame. This means that if you have trouble with acne, you may want to drink only organic milk, which does not have added hormones.
  • Vitamins A and E are important for healthy skin. In one study, people who had lower blood levels of these vitamins had more severe acne.
  • Eating a lot of refined carbs may also lead to acne, because this increases the production of insulin-like growth factor (IGF-1). Too much IGF-1 can lead to the production of too many skin cells called keratinocytes, which is associated with acne.
  • To keep your skin healthy, drinking plenty of water, and making sure you're getting enough omega-3 fatty acids, is also important.

The importance of keeping stress in your life under control to avoid acne cannot be ignored. Acne is well-known to flare up during times of stress, so learning some simple stress management tools may help your skin to stay healthy.

Finally, we recommend that you see your primary care doctor or dermatologist to get prescription-strength medications that will keep your acne under control. The appropriate combination of the above recommendations, medicines by prescription, and skin care products, constitute the key, for both teenagers and adults, to your success in the treatment of acne. 

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