Q: I’m experiencing an unusual amount of stress in my life, and my skin has never felt so irritated. I haven’t broken out like this since high school. What’s happening?
Dr. Schaffran: If you find yourself dealing with irritated skin and acne again (or still) in your 30s and 40s, first know that you’re definitely not alone. One of the most common questions I get asked by women is, “Why am I dealing with breakouts at this age?” Whether you had it as a teenager and are seeing it persist or recur in adulthood, or are tackling it for the first time, there are likely two main culprits: hormones and stress.
Hormones change and cycle in different ways at different times in your life, and some of those shifts can impact your skin in adulthood — just like they did during puberty.
“In your adult years, the potential for experiencing long periods of hormonal swings is larger than you might think.”
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To understand what’s happening, we need to start at ground zero: your pores.
Pores are like little channels in your skin that are connected to your oil glands. The glands deliver oil up to the pores, which have built-in mechanisms — I like to think of them as tiny brooms — that sweep the oil to the surface of the skin so your pores don’t become clogged. When people have acne, that process has gone awry. The brooms aren’t working as they should.
Hormonal changes can have a big impact on that process. And in your adult years, the potential for experiencing long periods of hormonal swings is larger than you might think. When women stop taking hormonal birth control, for instance, they might discover the pill they’ve been on for 10 years was keeping their skin under control. Pregnancy also brings on new and different hormonal shifts.
Stress — which is pretty much unavoidable during the “midlife crunch” years — can also wreak havoc on hormones. It’s a huge driver of adult acne, especially in women. Factor in the changes to estrogen levels that begin during perimenopause, and you get hit with a double whammy.
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So how does all of this relate to what’s happening with your skin? The main effect of these hormonal shifts is that oil gland activity increases, which means your skin is producing more oil, and pores can’t work as efficiently, which means it’s much more challenging to eliminate that excess oil. That’s how pores get clogged, resulting in deep-seated bumps that get inflamed. People experience acne in different ways, but adult acne tends to be more cystic, deeper and concentrated around the jawline — especially in women.
Similarly, in times of stress, the endocrine system secretes hormones — androgens and cortisol — and those hormones in turn increase oil-gland production. Bacteria that normally live on the skin feed off the excess oil, and this often leads to an inflammatory response, as well as clogging of the pores, and ultimately, an increase in the frequency and severity of acne.
Sometimes, there’s a hormonal abnormality to blame, such as polycystic-ovarian syndrome, or an adrenal gland issue, but those cases are rarer. External factors, like exposure to extreme pollution and the use of overly oily products, can also play a role. But more often than not, it’s run-of-the-mill hormone changes behind that super special feeling that you’re back in high school, and not in a good way.
Dr. Robin Schaffran is chief dermatologist at BalmLabs.