Black heads, white heads, pustules, sores and spots: acne can present itself in many ways and on many different parts of your body. And it’s not just teens who get it. We spoke to Vhi Consultant Dermatologist Dr Rupert Barry to get a deeper understanding of what acne is, what causes it, and why females can be more prone to developing it as adults.

What Causes Acne?

Most young people from 12 to 22 will get some acne at one stage or another, though it can affect all age groups, including, although infrequently, infants. Acne is a chronic inflammatory condition that generally affects the hair follicle. ‘Think of the hair follicle apparatus like an onion stalk and bulb,’ says Dr Barry, ‘the growth centre of the hair is equivalent to the onion bulb, and the hair (hair shaft) is the equivalent of the onion stalk.’ As the hair grows up through the tube, there is a special gland called a sebaceous gland, which releases a substance called sebum, which usually passes up the hair shaft and then helps to protect and lubricate the surface of the skin.

Sometimes, there is either too much sebum or its composition changes to become thicker and harder to push through the ‘tube’. If a person produces an excess amount of sebum, then their skin may look ‘oily’. This can be one of the factors contributing to a person developing acne.

An overproduction of the skin cells lining the tube can also become an issue. This can lead to a build-up of skin cells in the hair follicle shaft. The combination of the excess ‘sticky’ sebum and skin cell debris can then block up the hair follicle shaft and give rise to an acne spot. In addition, there is a bacteria―Propionibacterium acnes― that can flourish in this type of environment of the blocked hair shaft. This can also add to the inflammation seen in the person’s skin. Eventually, the congealed debris (sebum, shed skin cells and bacteria) can cause a breakage through the hair shaft wall and this then triggers the sore, red and inflamed acne spot that all of us are familiar with.

In addition to these factors, there can also be other triggers. These include hormones and exposure to certain chemicals and medicines such as using very oily and occlusive (obstructive) cosmetics, or even certain medical treatments. Across the general population, there doesn’t seem to be a correlation between diet and acne, though some individuals will find their acne is triggered by foods high in sugar or dairy. It could be the case for those people that their diet is leading to a change in the composition of their sebum, which causes their acne to flare-up.

Getting Acne As An Adult

Dr Barry said that ‘any gender can develop adult-onset acne, though we tend to see it more in females as adult-onset acne is strongly hormonally driven’. In fact, the appearance and distribution of acne in adult females often follow a very recognisable pattern. Dr Barry said, ‘it’s often along the jawline and on the outer cheeks, and the patient will report that the spots are sore. Spots in these areas can be more pronounced than other types of acne, appearing like irregularities of the skin and being very red or angry-looking.’ Although adult-onset acne is often hormonally driven, only a small percentage of female patients will have an underlying hormonal disorder (such as polycystic ovary syndrome).    

Impact of Adult-Onset Acne on Mental Health

With young adults, sometimes the mental toll is heavier than the physical, as acne is often on the parts of our body that are visible to others. ‘During consultation, I often ask patients if their acne is affecting their mental health day-to-day,’ says Dr Barry, ‘or if they are starting to isolate themselves due to self-consciousness.’ If you have acne and feel it is impacting your mental health, be sure to seek help from your healthcare provider. 

When to Seek Medical Advice

It’s good to make a judgement call when it comes to seeking medical help for your skin. For instance, if you’re going through a period of higher stress and have noticed a change in your skin, you could wait a couple of weeks to see if it passes. However, if you’ve been chronically suffering with acne for months and there’s a pattern to it or it’s badly affecting your self-esteem, it’s a good idea to see a healthcare provider to have a consultation and find the best treatment for you.

This content is for information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your GP or an appropriate medical professional if you have concerns about your health, or before commencing a new healthcare regime. If you believe that you are experiencing a medical emergency call 999 / 112 or seek emergency assistance immediately.

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