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Spot of Bother

While most women in their 30s and 40s are concerned about the first signs of ageing, for many women – and men – fine lines and wrinkles are the least of their worries. Unexpected midlife breakouts and acne can still be a problem for those who thought they’d left their days of bad skin behind them.

“Acne is not a teenage problem,” says dermatologist Dr Nicholas Birchall. “Men and women can get acne for the first time in their 20s and 30s; it can persist for some people into their late 40s and even beyond that. It’s not solely a teenage issue.” According to Birchall it’s not only those who were plagued with pimples as a teen who are affected by adult acne: those blessed with a blemish-free complexion as teenagers won’t necessarily move through adulthood spot free. “Unfortunately teenage acne doesn’t seem to be a predictor at all,” explains Birchall. “Some people will have acne in their teenage years and grow out of it; for others it will be a persistent problem that moves from their teenage years into their adult years; for some people it may appear suddenly in their 20s or 30s.”

Although adult acne has steadily garnered attention over the past year or so with some claiming the skin condition has reached epidemic proportions globally, Birchall – a Yale-trained dermatologist who frequently speaks at international conferences on the topic – is reluctant to agree and explains that adult acne has always been a problem. Birchall believes the difference is that now we’re starting to talk about acne and break down the stigma that comes with it. “More people are talking about acne. People are less likely to tolerate it.”

Outside Influence

With more of us talking about adult acne, more of us are looking for explanations as to why unwanted blemishes are plaguing us mid-life. Our hectic eating habits frequently take the rap for a plethora of health concerns, including acne, but according to Birchall, we shouldn’t be so fast to point the finger.

Although a diet laden with processed foods, sugars and unhealthy fats is unlikely to be doing our complexions any favours, tackling acne isn’t as simple as cleaning up your eating habits; Birchall says most studies that have been undertaken in the area have revealed there aren’t strong links between the two. Birchall encourages anyone plagued with adult acne to normalise their diet if their habits are particularly unbalanced, but adds, “There’s really no strong evidence for people to have to change their diet dramatically or that a healthy diet alone will clear up acne.”

As for stress, which often comes hand in hand with our hectic modern lifestyles, various studies have been conducted in attempt to unearth the link it has with acne. Birchall believes that while stress can certainly play a role in skin health, it’s not the key driving factor when it comes to acne.
“If you have a tendency for skin problems and then are placed under a lot of stress, then it may aggravate the problem,” Birchall explains, adding that we’re more likely to manipulate our skin more when stressed, which can impact on pre-existing skin problems.

Angela Frazer, senior skincare nurse consultant at Prescription Skincare, agrees and says that increases in cortisol levels during stressful times can lead to an increase in sebum and inflammation. “Stress exacerbates acne but it’s not the cause as such,” Frazer says. “There are a lot of people who lead very stressful, busy lives and have never had a pimple, but if someone is prone to acne then stress could be a trigger.”

The truth of the matter is that lifestyle alone isn’t able to predict who will be afflicted by adult acne; Birchall believes that genetics are the only true indicator. “Genetic factors obviously play a key role due to the amount of oils being produced by the skin. If your family suffers from acne you’ve got a greater chance of suffering from acne yourself,” he says.

Less is More

The misconception that a quick acne fix might be as simple as reducing stress levels and cutting out processed foods can quickly lead to frustration. Although a growing number of those suffering from adult acne are quick to seek professional help, both Birchall and Frazer frequently see patients who are at the end of their tether after trying almost anything to get rid of their acne. “A lot of women often come in after trying every avenue of skincare,” says Birchall.

But, skincare is only part of a larger picture. “There’s a misconception that cosmetics and skincare will solve acne and people end up spending thousands before talking to a dermatologist,” he adds.

It’s not uncommon for women to turn to their beauty cabinet in attempt to cover blemishes, but Birchall explains that excessive skincare and make-up can spur a damaging cycle. “It’s natural to want to use make-up to cover up acne but by covering it up you’re adding to the problem and potentially making it worse,” he says.
Severe acne leads to more emotional distress and acne scarring, which, despite advances in technology, remains incredibly difficult to treat. Facing the world with minimal make-up when plagued with acne might seem like a tough ask but Birchall believes it’s an essential step in combating adult acne. “It’s a matter of simplifying your skincare regime: wearing less make-up, avoiding soaps, and opting for light preparations that won’t block the pores.”

While there’s no click-of-the-fingers solution where acne is concerned, Birchall is enthusiastic about solutions that are currently available. “There’s been a paradigm shift in the way we treat acne,” Birchall says. “The major change we’ve seen in treatments over the past few years is the move towards low-dose Isotretinoin and a move away from the use of antibiotics.”

Isotretinoin – also known by its former brand name Roaccutane – which Birchall says is by far the most effective medicine for treating acne, has received negative attention in the past due to side effects that can occur with the retinoid-based medication. But, as Birchall explains, the side-effect profile has changed dramatically since Isotretinoin was first being prescribed for acne. “The dosages that we prescribe on a daily basis have been reduced. We know we don’t have to use anything like these original doses and we can get the same results.”

Moving Forward

As for what the future might hold for acne treatments, Birchall admits the standard Isotretinoin sets is hard to beat yet is hopeful that a more effective treatment with little to no side effects will come along.

Dispelling the misconceptions often associated with acne – from eating too much junk food to uncleanliness – and removing the taboo of talking about acne is important: at the end of the day, for Birchall and his fellow dermatologists to be able to help women and men who are suffering from adult acne, they have to actively seek help.

“Everyone responds to imperfections in different ways. Some people will have moderate acne and tolerate it. Others will feel like it’s impacting on them a lot more and it knocks their confidence.”

Birchall say that some people seek help straight away, while other people leave it in the hope that they will grow out of it and are then frustrated that they hadn’t dealt with the problem earlier.

“You have to ask yourself: is this affecting your confidence? And if the answer is yes, then seek help because you don’t have to put up with acne.”

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No sad link

A long, dark winter can be mentally and physically exhausting, but recent research challenges the idea that it makes people depressed.

Seasonal affective disorder (SAD) is commonly believed to affect a significant portion of people during the darker winter months, but research published in the journal Clinical Psychological Science could not prove a link.

SAD is based on the theory that some depressions occur in response to reduced sunlight. Steven LoBello, a psychology professor at Auburn University at Montgomery in the US, says his team examined the relationship between depression and latitude. Data was taken across the four seasons “to see if there was an association with sunlight. We simply didn’t find a direct relationship with [depression] and sunlight, the seasons or latitude,” Lobello says.

Depression is episodic and people do have depressive episodes in autumn or winter. But, researchers argue, “being depressed during winter is not evidence that one is depressed because of winter”.

Whatever the cause, visit your GP if you have concerns about how you are feeling. Visit beyondblue.org.au for support or more information.

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