Have you ever heard of AFA, or Adult Female Acne? You may be wondering why women have an acne condition named after them. Well, it’s because adult women suffer from acne more than adult men. You can probably guess why, right? Yep—Hormones.
Aside from genetics, hormones are the biggest culprit when it comes to acne. When we’re adolescents, when we’re pregnant, if we have polycystic ovarian syndrome (PCOS), when we’re going through menopause... we’re subject to a slew of hormonal symptoms, which can often include acne.
So how can women manage AFA if it’s caused by a hormonal imbalance? In this article, I’m going to shed some light on AFA, and show you some safe and natural ways to manage and hopefully reduce AFA.
What Causes AFA
If you’ve been paying attention to my blog articles over the past couple of weeks, you may have noticed they’ve all been focused around the theme of acne. Acne is a condition that many of us struggle with—50 million Americans, in fact (5)—and because there are so many different facets when it comes to acne, one article just won’t cut it.
In this article, we’re focusing on AFA (Adult Female Acne). AFA is defined as one that affects women over the age of 25 and may persist continuously or intermittently from adolescence or manifest for the first time in this period (1). So let's dive in and first talk about the causes of AFA.
As mentioned in many of my previous blog articles, acne is caused predominantly by genetics and hormones, with stress and medications—and even other factors like diet and environment—often playing a part.
If your mother and/or father had, or have acne, this will more than likely be the reason why you also get to experience the joys of acne, particularly during adolescence. If acne is not genetic, but you’re now experiencing outbreaks as an adult, it’s more than likely the result of a hormonal imbalance.
There are three classifications for adult acne (1,2):
- Persistent Acne
- Late Acne
- Recurrent Acne
Persistent acne is when acne begins during adolescence, and continues on into adulthood with no break in between. This is often a result of either genetics or hormones—or both.
Late acne is when acne presents itself in adulthood with no previous existence, not even during adolescence. This is more likely to be caused by hormones.
Recurrent acne is a newer classification for adult acne, where it is present during adolescence, improves for a period of time, and then reappears later in life. Again, this could be either genetic, hormonal—or both.
While there has not yet been extensive study done on AFA, studies do show that exposure to ultraviolet radiation, stress, obesity, diet, smoking, sleep disorders, cosmetics, medications, excessive skin washing, possible resistance to P. acnes, and endocrine deficiency diseases can all contribute to adult acne (1).
Another factor that can increase likelihood of acne developing as an adult is when there is a deficiency of the epidermal barrier function (1). The epidermal barrier serves as a mechanism to stop transepidermal water loss (TEWL) from occurring in the skin. When this barrier is damaged—through over-exfoliation, using harsh soaps or sulfates, sun exposure, and cold or hot temperatures, for example—it becomes weakened, and the skin’s moisture content becomes depleted more rapidly.
Once the skin starts to lose vital moisture, it can become inflamed. Acne is considered an immune-mediated chronic inflammatory disease (3). So if there is a build-up of inflammation within the skin, it can create a haven for acne to flourish.
How Do Hormones Cause Acne?
Our hormones have such an important role in regulating our bodies. Humans have over 50 different hormones, many of them are produced in very small amounts (8).
The hormones that can affect our skin in adulthood are the ones that are more prevalent during hormonal events, such as PCOS and menopause. Testosterone—the major androgen hormone produced in the testes, ovaries, adrenal glands, and fat cells—is responsible for growth and reproduction. This hormone is more dominant in men, and found in smaller amounts in women. When women have a hormonal imbalance, testosterone can spike, causing them to get male-like symptoms, like excess hair and acne breakouts (7).
If estrogen—a female-dominant hormone produced in the ovaries, corpus luteum, and placenta—drops down too low, even if testosterone levels are normal, you may experience acne. The same goes for progesterone—a hormone produced by the ovaries, placenta, and adrenal glands (7).
Other hormones that can cause acne breakouts when imbalanced are insulin and insulin-like growth factor-1, adrenocorticotropic hormone (ACTH), melanocortins, glucocorticoids, growth hormone (GH), and corticotrophin-releasing hormone (CRH), which I’ll talk about in the next section (7). These hormones work around the clock to keep our bodies regulated and healthy. Unfortunately women are more often susceptible to hormonal imbalances than men are, which is why women suffer from adult acne more than men. This is why they’ve named it Adult Female Acne, not Adult Human or Male Acne.
How Stress Affects Our Skin
When we are stressed, our cortisol levels can spike. When cortisol spikes, it sends a signal to our hypothalamus, which then produces the hormone corticotrophin-releasing hormone (CRH). CRH then stimulates the oil and sebum production in our body (6).
When our skin produces excess oil and sebum, our follicles become congested more rapidly. So our skin becomes oilier, or our pores become visibly clogged. This is when we may begin to notice more blackheads, whiteheads, pustules, and other blemishes.
As mentioned earlier, if you’re also overexposing your skin to UV rays, over-cleansing, or taking certain medications, for example, these can all damage your skin’s protective barrier. Add in a hormonal imbalance—like menopause—and you have the perfect environment for acne and inflammation to harbor and grow.
So, as you can see, adult acne is often caused by a cascade of events. It doesn’t just show up one day for no reason.
Lifestyle and Acne
Something else to point out that can contribute to acne is our lifestyle. A poor diet and sedentary lifestyle can cause a plethora of issues down the line. Poor diet can cause gut inflammation, and contribute to an unhealthy immune system. Being sedentary, or immobile for most of your day—like sitting at a computer all day, then switching to the couch at night—can affect all of our bodily systems, as well as our mental health. So of course this is also going to affect our skin.
A typical diet in America is high in processed foods, refined sugars, and saturated fats, while also being low in fresh fruit, vegetables, fish, and fiber (9). This is a recipe for disease and hormonal imbalances. So one thing I always advised my clients to do is to clean their diet up.
Reducing and eliminating as many foods from your diet that doesn’t grow in nature is half the battle. Replace refined sugars with natural sweeteners like honey. Replace processed snacks with fruit and vegetables or lightly salted popcorn. Eat whole foods, not processed foods. Foods that are lightly baked or steamed to retain their nutrients—not coated in calories and deep fried in saturated oils.
Meal prep to save money and eliminate the temptation of being lazy and going for the quick and easy option. Convenient foods are usually the most detrimental to our health—unless it’s a piece of fruit.
Stop drinking anything that has additives, like soda. Quit smoking tobacco and cut down on alcohol. Do something active everyday, even if it’s just walking for 20 minutes.
Not only will a healthier lifestyle help with your physical health, but it will also improve your mental health. All of which can help with acne.
If you’re suffering from AFA, but don’t know the exact cause, the best way to figure it out is to use the process of elimination. Start by following the lifestyle steps in the previous section. Do one thing at a time so it isn’t overwhelming, and you can form habits gradually over time.
If you’re taking medications, ask yourself if you need to be on them. Studies show that many adults are taking medication for conditions that can be healed through improving their diet and lifestyle, such as switching to a plant-based diet (10), lowering your BMI, maintaining physical activity everyday, and limiting television time (11).
Hormonal imbalances caused by menopause or PCOS are a little trickier to navigate. I’m not going to pretend to know the best avenue to take here. I read tons of articles on each of these topics. They are extensive and complex, and they really deserve their own article. So I won’t dive into them in this article.
But what I will say is that making lifestyle changes that are better for you are only going to help any conditions that you’re currently experiencing. Even if it doesn’t heal or stop the conditions, it will give you a better quality of life.
It’s important to look at your life as a whole. One of my good friends is a doctor and he says that in medical school they are taught to treat symptoms. So when doctors have patients who are clearly obese, but have high blood pressure, doctors will medicate the patient for their high blood pressure. They aren’t really taught to treat the condition that is causing the symptoms. There are some doctors who may do both, but it’s not common practice.
In a perfect world, all doctors would prescribe a lifestyle plan, not just medication. This plan could include diet, exercise, and even a mental health plan. But because doctors are medical experts, not lifestyle experts, it’s really up to us to look after our own health as a whole.
Sometimes our lifestyle is too difficult, or too overwhelming to change. If you suffer from anxiety or depression for example, seeking help from a therapist or psychologist could be the best starting point for you. If you’re ready to make changes, but don’t know where to begin, working with dieticians and physical therapists might be the answer.
You may need to try a few different things to see what works for you. For me, chiropractic treatment doesn't work, but give me a deep tissue massage any day. Yet, my husband swears by a Chiropractor, and doesn’t like deep tissue massage.
Some people like to see a therapist every month to hash out their issues; and some people prefer a silent Reiki session. Your body might respond well to power walking seven miles every other day; but your sister’s body may only respond to weight training. A low-carb diet may work for your husband; but your body might be better with a Mediterranean diet and intermittent fasting. Different strokes for different folks—find what works for you.
Natural Treatment for Acne
I am a huge advocate for using what mother nature gave us. I truly believe that for most conditions humans face, we can find the answer in nature. I’m not talking diseases like polio, coronavirus, or HIV, or even the invention of antibiotics—although we have a culture of overusing antibiotics (12). These are all medical breakthroughs that we needed for our species to survive.
But for things like skin conditions—acne, hyperpigmentation, psoriasis, etc— and other conditions, like IBS (15), IBD (14), and psoriasis (13), the answer is often found in nature.
Some known natural ingredients for treating acne and inflammation are (16,17):
Our range of skincare that contains calendula can be found here.
Our range of skincare that contains aloe can be found here.
Our range of skincare that contains chamomile can be found here.
Our range of skincare that contains marshmallow can be found here.
Our range of skincare that contains green tea can be found here.
Our range of skincare that contains azadirachta indica can be found here.
Our range of skincare that contains cannabis can be found here.
Our range of skincare that contains rosemary can be found here.
Our range of skincare that contains eucalyptus can be found here.
Having hormonal acne can be incredibly disheartening and difficult to manage. But if you start from the basics, and manage the symptoms holistically by changing your lifestyle, and implementing natural ingredients into your skincare ritual, it will not only improve the symptoms of acne, but it can change your entire outlook on life.
Emma Masotti is an Australian now living in Austin, TX, and has been a trained esthetician for over 15 years. She is a sustainable skincare writer, educating and building awareness around proper skin health that doesn’t cost the earth.
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