Advanced Treatments For Adult Acne

July 01 2021 – Cassandra Hilton

Advanced Treatments For Adult Acne
Advanced Treatments For Adult Acne

The Adult Acne Epidemic: 

How lucky that we get to worry about ageing and acne simultaneously! According to the Journal of American Academy of Dermatology, 54% of women over the age of 25 have some facial acne.

Acne that arises in adulthood is different than that which plagues teenage years—adult acne is more likely to be inflammatory with lesions primarily located around the mouth, chin and jaw line, and with fewer whiteheads.

Virtually all acne formation is linked to hormones, and women have to deal with exacerbations often due to fluctuating hormones. Different periods in their lives, such as puberty, ceasing the oral contraceptive pill, pregnancy, perimenopause and menopause, can turn previously clear skin into a landscape of clogged pores, whiteheads, blackheads and blemishes.

Cassandra Hilton, Naturopath & Ocinium Founder

Cassandra’s typical client presents with persistent acne, predominantly, in twenty to thirty-something women. Many of the clients were additionally stressed by treatments that seemed to be aggravating their problems, often than not, providing short term gain at the price of undesirable long term consequences.

Treating symptoms with mainstream treatments, such as steroid therapy, benzoyl peroxide and antibiotics, not surprisingly ignore the causes and create issues such as rebound inflammation with a vengeance, skin photosensitization and disruption of both the skin and gut microbiome.

Acne and impaired barrier with atopy, especially perioral or seborrheic dermatitis, is increasingly a feature of adult acne.

Cassandra stresses that if you think your acne may be the result of an underlying condition or is not responding appropriately to over-the-counter treatments, you should make an appointment with a board-certified dermatologist. 

Polycystic ovarian syndrome (PCOS)

PCOS is present in 12–21% of women of reproductive age. Up to 70% of women with PCOS remain undiagnosed. There is mounting evidence to suggest that PCOS might be a complex multigenic disorder with strong epigenetic and environmental influences, including diet and other lifestyle issues.

PCOS and fertility

PCOS is associated with reduced fertility with an increased risk of miscarriage, cardiovascular risk factors and diabetes.  Women with PCOS are more likely to suffer from depression, anxiety, poor self-esteem, disordered eating and psychosexual dysfunction.

Women with PCOS may not have cystic formation on the ovaries, they may just have symptoms of the syndrome (acne, oily skin, excess hair growth, irregular cycles, central obesity, insulin resistance, pre-diabetes, hypothyroidism).

Follicles or eggs, which are normal for the ovary, are these so called cysts located on ultrasound. You can have many eggs and still have normal hormones. Generally greater than 10 follicles or enlarged follicles may be suggestive of PCOS. However, an ultrasound test cannot fully diagnose or rule out the hormonal condition of PCOS.

The diagnostic criteria for diagnosis (Rotterdam) of polycystic ovary syndrome requires two of the three criteria:

  • Oligo/anovulation
  • Hyperandrogenism - clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone
  • Polycystic ovaries on ultrasound

Other causes of androgen excess

All other causes including those of androgen excess must be ruled out. These include the masculizing types of hormonal birth control pill, hypothalamic amenorrhea (lack of periods due to undereating or undereating of carbohydrates), congenital adrenal hyperplasia (occurs for 9% of androgen excess) Cushing syndrome, thyroid dysfunction and hyperprolactinaemia.

Reversing androgen excess

In reversing androgen excess, consider using a natural anti-androgen supplement like zinc, DIM, peony & licorice or reishi mushroom, Ganoderma lucidum. Vitex agnus-castus (Vitex) is beneficial in high-prolactin types of androgen excess, but when prolactin is not high, it can worsen most androgen excess PCOS.

PCOS and insulin resistance

There is a 70% chance (some investigators say it occurs in all women with PCOS) that your PCOS is insulin resistance (high insulin). Insulin resistance is a common finding among both normal weight and overweight PCOS patients.

The best way to test for insulin resistance is to measure the hormone insulin, NOT glucose. Insulin is tested either as fasting insulin or an oral glucose tolerance test with insulin.

In reversing insulin resistant PCOS, treatment considers primal style diets, maintaining a healthy circadian rhythm sleep and supplements like magnesium, chromium, zinc, alpha lipoic acid and inositol.

Atopic dermatitis and acne

The International Dermal Institute’s assertion is that atopic dermatitis, especially perioral or seborrheic dermatitis, is increasingly a feature of adult acne leads to the obvious corollary that an increasing numbers of adults are suffering from barrier malfunction.  

The stratum corneum (SC), make up the barrier layer responsible for regulating moisture levels in the skin. Compromised barrier function is governed by a variety of factors: altered microbiome, bacterial overgrowth, aging, daily wear and tear, external skin stressors such as over-exfoliation and use of antimicrobial products, and internal factors such as nutrient-poor diets.

Supplements that supply the SC with the building materials it needs to create and maintain its protective barrier suggest a partial solution to barrier malfunction. In strengthening the skins barrier supplements like collagen, probiotics, centella asiatica (Gotu Kola), zinc, vitamin A, C, E, B5, silica, selenium, vitamin D and essential fatty acids found in fish oils can assist.

Let’s get to the best skincare ingredients to reduce adult acne

Using products that both treat and prevent acne are critical,” Cassandra Hilton, Skin Naturopath & Founder Skincare Brand Ocinium. When it comes to topical skincare solutions for adult acne, ingredients that regulate sebum, keratinisation, reduce bacterial load, clogged pores, inflammation and strengthen the skins barrier are all contenders for healthy skin.

Vitamin A

If you’ve had breakouts for years and still aren’t seeing an improvement, then it might be time to call in the big guns—we’re talking retinol for acne.

Serums containing retinol are great, as they fight both acne and post-acne scarring. Retinol treatment is the ultimate multi-tasker, reducing the appearance of pores and wrinkles while visibly improving the signs of premature ageing fine lines, uneven texture, age spots, dryness, and dullness. 

Unlike salicylic acid, which exfoliates dead skin cells and dissolves clogs, and benzoyl peroxide, which kills acne-causing bacteria, retinoids work from the inside out. The retinoic acid seeps into the cell and binds to nuclear receptors, which oversee big-picture functions like cellular metabolism, proliferation, inflammation, and cell death—ultimately telling these receptors to kickstart their turnover process. 

Not only does increased skin-cell turnover remove a key factor of what causes acne—namely, dead skin cells—but there’s another benefit, they can help to keep pores clear and open so other topical acne treatments can penetrate effectively. 

Retinol is an all-around skin fixer as it works at the skin cell level and makes your skin cells behave in a healthy and normal way. It makes the skin less wrinkled, firmer, smoother and tighter, everything you could want from an anti-aging ingredient.

Not only do they reverse photoaging damage while clearing up acne, retinols regulate sebum production and normalise keratinization meaning that it prevents dead skin cells from sticking together and clogging the pores. Not only that, but it also makes your pores produce less sebum that helps the pores to stay nice and clean and not get clogged up by an excess sebum and dead skin cells. 

Vitamin B3

Although niacinamide does not count as one of the gold standard anti-acne ingredients, if you have problem skin it's totally worth a try. It has sebum regulating and anti-inflammatory properties. A  study that used 4% niacinamide for 8 weeks to treat acne found that 82% of those treated showed some improvement. What's more, the results were slightly better than with a 1% clindamycin gel, an antibiotics often used to treat acne.

When it comes to strengthening the skins barrier, very few ingredients comes as close as niacinamide. Studies have shown that 2% niacinamide can increase the synthesis of free fatty acids, cholesterol, and ceramides that result in healthier and stronger skin barrier, decreased trans-epidermal water loss and better hydrated skin.

Of other notable things studies show that vitamin B3 can help to speed up epidermal cell growth (that slows down with age), it can help with wound healing, it can smooth the structure of the skin and it has also antibacterial and photo protective properties. Plus, it might also be useful for rosacea and atopic dermatitis because of its anti-inflammatory property. 

Vitamin B5

Pantothenic acid regulates epidermal barrier function and keratinocytes differentiation via CoA metabolism. Randomized, Double-Blind, Placebo-Controlled Study of a Novel Pantothenic Acid-Based Dietary Supplement in Subjects with Mild to Moderate Facial Acne showed that there was a greater than 67% reduction in the number of total facial lesions after 12 weeks of supplementation. Its main job in skincare products is to moisturise the skin. It’s a humectant meaning that it can help the skin to attract water and then hold onto it. There is also research showing that panthenol can help our skin to produce more lovely lipids that are important for a strong and healthy skin barrier. 

Another great thing about panthenol is that it has anti-inflammatory and skin protecting abilities. Research also shows that it might be useful for wound healing as it promotes fibroblast (nice type of cells in our skin that produce skin-firming collagen) proliferation. 

Salicylic acid

If you have ever struggled with let’s just call it “problem skin” (you know, acne, blackheads, whiteheads, large pores) then most probably you are familiar with salicylic acid (SA).

Salicylic acid (generally derived from willow bark or other natural sources) is a beta hydroxy acid (BHA) that works from the outside in to dissolve protein, and is very effective at clearing congestion. SA is lipid soluble and it can go right into the pores and shed the stuck, dead skin cells out from there. That’s really good for treating blackheads as well as preventing acne formation. SA is also a potent anti-inflammatory agent, with a chemical structure very similar to aspirin, and it does have similar anti-irritant and anti-inflammatory effect. These effects are both helpful both for acne and rosacea.  

Linoleic acid omega 6 oils

LA is a really important little guy found naturally in our skin. It is the most abundant fatty acid in the epidermis and it serves as a structural precursor for important skin lipids called ceramides. Knowing this, it will not come as a surprise that Linoleic acid has a central role in the structure and function of stratum corneum permeability, aka healthy skin barrier.  LA deficiency leads to an impaired more permeable skin barrier and the topical application of LA-rich sunflower oil can fix this issue rapidly.

LA is not only important for dry, barrier damaged skin types but also for acne-prone skin. Research shows that problem skin has lower levels of linoleic acid (and higher levels of oleic acid) than normal skin. So LA-deficiency in the skin seems to be connected not only to an impaired skin barrier but also to acne, therefore smearing LA all over your face might help with your problem skin. Omega-6 rich oils like safflower and sunflower are ideal; stay away from coconut oil, which can be comedogenic.

Skin identical ingredients

Skin-identical ingredients are really nice ingredients that can be found in the skin or mimic the things that can be found in the skin naturally. They commonly form part of the skins natural moisturising factors (glycerine, hyaluronic acid) or outer stratum corneum (SC) lipids (ceramides, cholesterol and fatty acids such as linoleic acid). Cellular communicators occur within the epidermis and dermal layer with receptor sites to signal to our skin cells to “behave better”, these include skin identical cellular communicators such as niacinamide, retinol, tocopherols, peptides and vitamin C.  


Bifida Ferment is an interesting probiotic with promising properties in barrier function and reducing inflammation. As far as published research goes, applying 10% bacterial extract to sensitive, reactive skin helped with better barrier function and decreased skin sensitivity. Another promising probiotic to keep an eye open for is Lactobacillus ferment. The ingredient has both anti-microbial (at 5%) and anti-inflammatory (at 1%) activity when  tested on individuals with acne lesions, was also shown to work faster than Salicylic Acid at reducing the size of the lesions and the erythema (redness and inflammation). The anti-acne effect is attributed by binding to the bacteria cell and disrupting the bacteria’s membrane. Lactobacillus ferment is helpful in killing harmful bacteria and creating a healthy balanced microflora. Compared to well-known anti-acne and anti-inflammatory salicylic acid the probiotic worked faster at reducing the size and redness of acne lesions. 

While we make every effort to make sure the information in this website is accurate and informative, the information does not take the place of professional or medical advice. The information does not serve to diagnose, treat, cure or prevent any disease for therapeutic purposes or as a substitute for the advice of a health professional.