“Doctor, I have been having these painful red bumps on my face. They are worse on my lower jaw and neck, and they just will not go away!” a frustrated female executive complained to me. I told her that she is having an acne breakout. She appeared surprised and exclaimed, “But I am no longer a teenager!”

Acne is usually associated with teenagers and young adults. However, adult acne is more common than you think. It is estimated that one in five adults above age 25 suffers from some form of acne. Acne is frustrating at any age, but maybe even more so during adulthood. Society seems to be less sympathetic to individuals with adult acne. The condition causes even more emotional and physical scars in the adult years and is harder to cope with. “It’s just so unfair!” my patients often complain, “I escaped the teen years without acne and now, I have it! How can that be?”

So what is causing adult acne? In one word: STRESS! People are experiencing more stress than ever before, and all that stress causes our adrenal glands to go into overdrive, increasing the production of stress hormone. When we are under long-term stress (which is common in our busy, modern lives), our stress hormone levels are constantly elevated and acne becomes a constant problem.

What makes adult acne different? Teens tend to get acne on their foreheads and noses. Adults tend to get acne more on the lower half of their faces, like their chins and jawline. In fact, Chinese face mapping correlates this part of the face to the adrenal glands. Bear in mind that the adrenal glands respond to stress. In severe cases, acne can affect the entire face in both teens or adults. Other areas that can be affected are the neck, chest, back, shoulders, arms and even the buttocks.

Beside stress, female hormones can also play a role in adult acne. If your hormone fluctuates, you may get adult acne, especially during menstruation, PMS, and menopause. Dermatologists are not sure why, but the oil glands seem to be more sensitive to hormonal shifts during your 20s, 30s and 40s. Adult acne can therefore worsen when you are under stress and when you are having your period or both!

Management:

* Manage your stress. Do at least 30 minutes of exercise daily. Take 5-10 minutes to practise yoga/ meditation whenever stressful situation arises. Get enough sleep to de-stress and rejuvenate.

* Review facial products that you are using. Your old make-up or daily facial moisturiser may contribute to clogging of pores and infection.

* Limit processed sugars in your diet because some studies have found they do have a negative effect on skin. Eat a healthy balanced diet and drink at least 8 glasses of water daily.

* Use an over-the-counter cleanser that can kill germs and exfoliate the dead skin cells, thus preventing the pores from clogging such as ariSulfur bar or bars with salicylic acid (Aveeno).

* See a doctor/ dermatologist if your acne gets worse. We can prescribe oral contraceptive pills (Diane 35) which contain an anti-androgen that can prevent breakouts with regular on-time usage.

* If oral contraceptive is not an option, then a topical antibiotic and/or retinoids (retin-A, clindoxyl, deriva, differin, epiduo) may be given with/ without an internal antibiotic to eliminate the acne.

* For patients who have engagements (eg public speech, job interview, presentation etc), a quick in-office treatment — a cortisone injection directly into the acne cysts — can result in the rapid reduction of the swelling and redness.

* In-office salicylic acid peel also helps to “dry” the bumps quickly and a prescribed special compounded cream is given after to remove the unsightly dark spots.

* The idea of letting your adult acne outgrow itself is not endorsed. Untreated acne can leave physical and emotional scars, which are even harder to treat.