Understanding and Addressing Adult Acne: A Holistic Perspective

Adult acne is a complex and frustrating condition that affects millions. Unlike adolescent acne, which is primarily driven by hormonal surges and excess oil production, adult acne tends to have alternative contributing factors, involving topical products, lifestyle choices, medication side effects, internal imbalances, inflammation, stress, and even gut health. Understanding the interconnected factors that contribute to adult acne is crucial for developing a sustainable and effective approach to clear skin.

With so much misinformation about acne, it's important to recognize that it stems from multiple factors rather than a single cause. Treating it effectively means looking at the bigger picture, as focusing on just one trigger or symptom may only offer short-term relief—or even make things worse. It's also important to recognize that while many people believe aggressive, drying treatments are the most effective approach to acne, these methods often provide only temporary relief. Their inflammatory effects can weaken the skin barrier, leading to increased sensitivity, prolonged breakouts, and even accelerating the aging process over time.

The Unique Challenges of Adult Acne

A major reason adult acne behaves differently is the skin microbiome and barrier function. The balance of bacteria on our skin plays a big role in inflammation and acne development. Research shows that adults with acne tend to have less bacterial diversity, making their skin more prone to irritation and breakouts. Certain bacteria types are more common in adults and are linked to more stubborn, inflammatory acne.

Additionally, as we age, our skin barrier weakens. The production of essential lipids like ceramides and fatty acids declines, leading to dehydration, increased sensitivity, and a compromised skin defense system. This is why adult skin reacts more negatively to harsh treatments—what worked as a teen might now lead to dryness, irritation, and even worse breakouts.

A balanced skin microbiome helps prevent the overgrowth of harmful bacteria and fungi that can weaken the barrier and lead to skin issues like acne and inflammation. When the microbiome is disrupted—whether through a loss of beneficial bacteria or an increase in harmful species—it compromises the skin’s defenses, making it more susceptible to irritation, breakouts, and dehydration. This imbalance, combined with the natural decline of vital lipids as we age, can further weaken the skin’s resilience and overall health.

The gut-skin axis also plays a key role in inflammation, hormone regulation, and detoxification—all of which impact adult acne. When gut bacteria become imbalanced or the gut lining is compromised, systemic inflammation increases, often leading to persistent breakouts. Additionally, poor digestion and food triggers that upregulate the mTor pathway, can contribute to inflammation, further fueling adult acne. Unlike teen acne, which is primarily driven by oil production, adult acne is often a sign that the body is struggling to process inflammation and hormones efficiently. By identifying gut imbalances through testing—such as a GI-MAP, OATs test, bloodwork and the DUTCH test—we can gain a clearer understanding of how internal dysfunctions may be contributing to acne.

Key Internal Factors Contributing to Adult Acne

• Hormonal Fluctuations & Androgen Activity

• Hormonal imbalances, particularly fluctuations in estrogen, progesterone, and androgens (testosterone and DHT), play a significant role in adult acne.

• Increased androgen levels can lead to excess sebum production and clogged pores, often exacerbated by conditions like polycystic ovary syndrome (PCOS).

• Postpartum and perimenopausal shifts also contribute to acne as the body adjusts to changing hormone levels.

• Gut-Skin Connection & Inflammation

• Research has shown a direct link between gut health and acne, often referred to as the gut-skin axis.

• Dysbiosis (imbalanced gut bacteria), leaky gut, and inflammation caused by food triggers (such as dairy and high-glycemic foods) can all trigger acne flare-ups.

• Certain foods are known to upregulate inflammatory and growth pathways that contribute to the pathophysiology of acne. A significant pathway that contributes to acne in the body is called the mTOR pathway. When mTOR is unregulated, it promotes inflammation, sebum production, and skin cell proliferation, which all contribute to acne formation.

• The presence of pathogenic bacteria in the gut or overgrowth of fungi (like candida) may contribute to systemic inflammation that manifests as breakouts.

• Chronic Stress & Cortisol Dysregulation

  • The body's stress response, particularly the overproduction of cortisol, can increase inflammation, disrupt the skin barrier, and lead to increased oil production.

  • Chronic stress affects digestion and liver detoxification, both of which play critical roles in clearing excess hormones and toxins that could contribute to acne.

• Liver Detoxification & Acne

  • The liver processes hormones, toxins, and excess androgens. When detoxification pathways are sluggish due to poor diet, alcohol consumption, or environmental toxins, acne may worsen.

  • Supporting liver function through proper nutrition (cruciferous vegetables, turmeric, dandelion root) and hydration can help balance hormones and reduce acne.

• Nutrient Deficiencies

  • Deficiencies in zinc, omega-3 fatty acids, vitamin A, vitamin D, and magnesium can impair skin function and increase inflammation.

  • Zinc plays a crucial role in wound healing, sebum regulation, and immune function, while supplementing things like omega-3s help lower systemic inflammation.

• Medications and Supplements

  • There are some medications and supplements that have been shown to exacerbate acne in certain people such as B12, Iodine, Creatine, etc.

• Low Fiber or Poor Diet

  • Fiber plays a crucial role in gut and skin health. Found in plant foods like vegetables, fruits, nuts, seeds, and legumes, it nourishes beneficial gut bacteria, supporting a balanced microbiome. These bacteria produce short-chain fatty acids (SCFAs), which strengthen the gut lining, reduce inflammation, and help prevent leaky gut. Fiber also supports overall health by aiding digestion, lowering cholesterol, and regulating blood sugar.

External & Lifestyle Triggers of Adult Acne

• Skincare & Barrier Health

  • Over-exfoliation, using harsh products, and reliance on stripping treatments like benzoyl peroxide can weaken the skin barrier, making acne worse.

  • Instead, a hydration-focused, barrier supportive and anti-inflammatory skincare routine can improve skin health.

• Comedogenic & inflammatory Ingredients

  • Most skincare and makeup products contain pore-clogging and/or irritating ingredients that can lead to persistent breakouts.

  • Many problematic ingredients are still used in significant concentrations, even in products claiming to aid with acne.

  • It is important to recognize that the problem lies not in physical pore-clogging but in the potential of specific molecules to trigger inflammation and intense hyperkeratinization.

• Environmental & Lifestyle Factors

  • Lifestyle factors like poor sleep, pollution and smoking can exacerbate acne.

  • Adopting a clean lifestyle by practicing stress management techniques (yoga, meditation), and prioritizing sleep can have a significant impact on skin health.

A Comprehensive Approach to Treating Adult Acne

Because adult acne stems from both internal and external factors, treatment should be multifaceted, addressing the person as a whole rather than just symptoms.

Final Thoughts

A holistic approach, combining internal support with external care, creates a sustainable foundation for clearer, healthier skin.

If you struggle with persistent adult acne, working with an integrative practitioner can help you develop a personalized approach that addresses both internal and external triggers—leading to long-term, radiant skin health.