How Is Teen Acne Different from Adult Acne?

• What Are the Definitions of Teen and Adult Acne?
• Differences in Symptoms Between Teen and Adult Acne
• Sex Differences Between Teen and Adult Acne
• Differences in Causes of Teen and Adult Acne
• In Conclusion

What Are the Definitions of Teen and Adult Acne?

Acne is classified as either:

1. Adolescent or teen acne, which occurs in people under 25 years of age.
2. Adult acne, which is acne that occurs in people over 25 years of age, and can be either persistent or late-onset.
   • Persistent acne: If teen acne never goes away and sticks around past the age of 25, it becomes adult acne and is called persistent acne.
   • Late-onset acne: If acne shows up spontaneously after the age of 25, it's called late-onset acne. Late-onset acne can be further broken down into either chin acne or sporadic acne.
     • Chin acne: Breakouts occur on the chin and around the mouth.
     • Sporadic acne: Breakouts can show up anywhere on the skin.

In both teens and adults, acne develops the same way. First, skin pores are clogged with dead skin cells. Skin oil (sebum) gets trapped inside the clogged pore, which then causes an overgrowth of acne bacteria (C. acnes). This leads to inflammation, breakouts, and possibly scarring.²

Although teen and adult acne are the same skin disease, teen acne is much more common than adult acne.

Differences in Symptoms Between Teen and Adult Acne

Teen and adult acne differ in type of breakouts, location of breakouts, and presence or absence of scarring.

Teen acne:

1. Type of breakouts: A combination of inflammatory lesions (papules, pustules, nodules, and cysts)⁴ and non-inflammatory lesions (whiteheads and blackheads)
2. Location of breakouts: Usually on the forehead, nose, and chin⁴
3. Scarring: Less common in teen acne than in adult acne⁵

Adult acne:

1. Type of breakouts: Mainly papules and pustules⁵
2. Location of breakouts: Usually on the cheeks and lower part of the face, including the chin and jawline.⁵ More breakouts around the mouth, on the neck, chest, and on the back in adult acne than in teen acne.⁶
3. Scarring: More common in adult acne. Doctors believe that scarring is more common in adult acne because there are more inflammatory breakouts in adult acne, and adult acne is more resistant to treatment and takes longer to heal.⁵

Sex Differences Between Teen and Adult Acne

• Teen acne: More common in males.
• Adult acne: Normally equally common in both sexes, but more common in females if it is late-onset acne.

Differences in Causes of Teen and Adult Acne

Despite the differences in their symptoms, teen and adult acne typically share the same causes:

• Hormonal imbalance
• Family history
• Diet

Smoking and alcohol consumption show a much weaker potential connection.^3,8,9

Let's take a closer look at each potential cause, starting with hormonal imbalance.

Hormonal imbalance

In both teens and adults, an increase in the level of androgens (male hormones present in both males and females) in the body must occur for acne to form. This increase in androgens may be caused by:

• Teen acne: Males and females: Puberty or poor diet. Females only: Poly-cystic ovary syndrome or pregnancy.
• Adult acne: Males and females: Ongoing hormonal imbalance or poor diet. Females only: Pregnancy or poly-cystic ovary syndrome.

The increased androgen levels stimulate the growth of skin oil glands under the skin, resulting in increased production of skin oil (sebum), which can lead to a cascade involving acne bacteria (C. acnes) and inflammation, and ultimately acne.¹⁰

Family history

The following British Journal of Dermatology article sums it up. If acne runs in your family, you are more likely to suffer with it as well.

Similarly, a study that looked at 454 people with adult acne found that a family history of acne was a key risk factor for suffering from acne after age 25.

Several research groups have investigated the role of genetic (hereditary) factors in both teen and adult acne by studying pairs of twins at different ages. Identical twins are exactly the same genetically, whereas non-identical twins are genetically similar as a pair of siblings who are not twins.

Diet

In both teens and adults, diet is the third most frequently implicated factor by scientists in acne development and severity.⁹ However, research is still trickling in, and no firm conclusions can yet be made.

Diet suspect #1: Food with a high glycemic load

• Teen acne: Sugary foods may increase skin oil (sebum) production and teen acne.
• Adult acne: Sugary foods may increase sebum production and adult acne.

For both teens and adults, food that possesses a high glycemic load (cause spikes in blood sugar) may contribute to acne development. Examples of such foods include white bread, white rice, pasta, soda, or candy. Some foods with a low glycemic load include fish/meat, vegetables, nuts, or oils.

Eating high-glycemic load food increases the production of a hormone called insulin in the body. Because insulin is a "master" hormone, which controls other hormones, it increases the amount of male hormones (androgens) in the blood. As discussed above, an increase in androgens possibly leads to increased sebum production and acne.¹⁶

Diet suspect #2: Dairy products

• Teen acne: There might be a weak connection between dairy (milk products) and teen acne, but the science is still not in on this.
• Adult acne: There might be a weak connection between dairy and adult acne, but the science is still not in.

There is still no strong evidence linking any dairy products to teen or adult acne. The studies that we will discuss below are based on questionnaires, which are prone to error. In order to show that dairy products cause acne, researchers will need to conduct a randomized controlled trial. This is a type of experiment in which half of the patients are randomly assigned to a group which consumes dairy products, and half of the patients are assigned to a group which does not. At the end of the experiment, the researchers compare the acne between the two groups. Until such an experiment is performed, the evidence for the role of dairy products in teen and adult acne will remain unconvincing.^16,17

Smoking

• Teen acne: Smoking may be linked to teen acne, but the evidence is contradictory.
• Adult acne: Smoking may be linked to adult acne, but the evidence is contradictory.

For both teens and adults, the link between cigarette smoking and acne remains controversial. Despite studies establishing a positive association between the two,^12,18,19 a few studies have reported no association or even claimed that cigarette smoking offers some sort of protection against acne in both teens and adults.²¹

In the studies which support the view that cigarettes play a role in acne development and severity, there is still no consensus on the mechanism by which this might occur. There are currently two hypotheses, however, regarding how cigarettes may cause acne.

1. Nicotine in cigarettes causes the blood vessels, which supply blood to the sebaceous glands, to narrow. Blood flow is important for the body to be able to fight bacteria which can grow on the sebum. By decreasing blood supply to the sebaceous glands, cigarettes may allow for the bacteria that is associated with acne to grow and multiply.²²
2. Smoking cigarettes may change the chemical makeup of sebum, making acne more severe.²²

Alcohol

• Teen acne: Drinking alcohol might be linked with teen acne, but the evidence is limited.
• Adult acne: Drinking alcohol probably does not cause adult acne.

In Conclusion

In conclusion, teen and adult acne differ in location and type of breakouts and in which sex is more likely to be affected. The causes of teen and adult acne appear to be similar and are still under debate.