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  • Writer's pictureallisonmwills

Adult Acne: A Different Approach

Acne is the most common skin disease, and can persist well beyond puberty in adults. Acne is caused primarily by four direct causes including:

  1. Increased sebum production

  2. Hyperkeratinization

  3. Bacterial colonization

  4. Inflammation

These pathogenic factors thrive in a number of different conditions, with some of the most common being diet, genetics, stress, hygiene, inflammation, and hormone imbalances. For individuals that are adhering to proper hygiene (you can find out the toxicity of your skin care products at, avoiding inflammatory and trigger foods, the next step is to assess hormone levels.

Hormonal acne is typically presented as cystic acne around the cheeks, jawline and chin, compared to inflammatory acne, usually blackheads and whiteheads, found on the forehead, nose and chin or “T-Zone”. It has been seen that more than 50% of adult female patients of persistent acne have at least one abnormal hormonal level (1).

Below are the key hormone imbalances that can contribute to adult acne.


Testosterone is an androgenic hormone produced by the body in both males and females. A certain level of testosterone is needed to promote muscle mass, maintain bone density, energy levels, and much more. However, high testosterone levels can also be problematic, especially for females prone to adult acne.

-Elevated levels of androgen levels, including testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEAS) lead to increased sebum production (2).

-Acne prone skin has been found to have higher androgen receptor density and higher 5a-reductase activity than the skin of individuals without a history of acne. Androgens enzymes and receptors lie on the portion of the follicle where the plugging first begins, stimulate differentiation and proliferation of sebocytes, leading to the initiation of acne lesions. (3)

How to balance:

-If you are a female, get your free and total testosterone levels checked. If they are elevated, it is a good idea to rule out Polycystic Ovarian Syndrome with your doctor.

-Increasing SHBG, or sex hormone binding globulin, can decrease levels of circulating free testosterone. High fiber diets have been shown to help increase SHBG.

-Testosterone levels can be optimized through a low glycemic diet.

-Specific herbals may be beneficial including licorice, peony, and spearmint.


Prolactin is a pituitary hormone that regulates ovulation and the production of estrogen and testosterone.

-One study found a significant correlation between prolactin and severity of acne (4).

-Increased prolactin can decrease estrogen, which has been found to be inversely related to acne severity (3).

How to balance:

-Zinc inhibits prolactin secretion (5). Zinc picolinate is well-absorbed by the body and is required by enzymes necessary for hormone balance.

-Vitex Agnus-Castus (Chasteberry) can be beneficial in women with hyperprolactinemia.

-Limit alcohol intake. Chronic alcohol consumption has been observed to increase prolactin levels in rat studies (6).

Insulin & IGF-1

Insulin increases with conditions like diabetes, or increased blood sugar. IGF-1, or Insulin-like Growth Factor, is a hormone that is closely related to both insulin and growth hormone.

-Insulin resistance increases ovarian androgens in female, and decreases sex hormone binding globulin, leading to higher levels of circulating free testosterone.

-Insulin acting on IGF-1 receptors at the sebaceous glands stimulates the production of sebocytes and keratinocytes as well as promotes the expression of enzymes responsible for androgen biosynthesis, further increasing sebum production. (7)

-A positive correlation between the mean facial sebum excretion rate and serum IGF-1 levels has been demonstrated in post-adolescent acne patients demonstrated that IGF-1 levels correlate with severity of acne in women (8).

-IGF-1 Levels were found to positively correlate with acne, especially in females, as well as influence androgen levels including testosterone, DHEA and DHT. (9)

-Improving insulin sensitivity is also a great way to balance IGF-1 and testosterone levels, as well as to help manage cravings for sugary, high-glycemic foods, all of which contribute to acne.

How to balance:

-Limit intake of sugars and processed carbohydrates.

-Exercise regularly. High-intensity interval training is one of the best ways to improve insulin sensitivity.

-Check your levels of Vitamin D- 50 ng/dl is necessary to prevent deficiencies. Vitamin D has been shown to improve insulin sensitivity (10).


Cortisol is the main hormone released in times of increased physical or mental stress.

-Elevated cortisol levels increases inflammation, and decreases skin barrier function, creating an environment more susceptible to acne (11).

-Cortisol is also a major cause of insulin resistance.

How to balance:

-Limit use of stimulants including caffeine.

-Exercise regularly.

-Get 7-8 hours of quality sleep per night.

-Adaptogens such as ashwagandha and holy basil can help balance stress responses.

There are many factors that can create an environment susceptible to acne. For those who are suffering from persistent adult acne, it is a good idea to check hormone levels and consult with an experienced doctor on the best ways to balance your unique levels. Hormones regulate virtually every process in your body including mood, weight, and mental function. By achieving proper hormone balance, you will not only look your best, but also feel your best.













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