1 00:00:04,405 --> 00:00:07,385 Jen Oliver: Welcome to the So That's Why podcast where we unpack the 2 00:00:07,385 --> 00:00:09,455 science behind everyday questions. 3 00:00:09,515 --> 00:00:10,175 I'm Jen. 4 00:00:10,505 --> 00:00:11,075 Chris Smith: I'm Chris. 5 00:00:11,465 --> 00:00:12,095 Matt Edmundson: And I'm Matt. 6 00:00:12,568 --> 00:00:16,138 Jen Oliver: So today's question is one that captures a lot of people 7 00:00:16,138 --> 00:00:20,728 off guard because most of us assumed we'd left this behind in our teens. 8 00:00:21,148 --> 00:00:23,968 Why do adults still get acne? 9 00:00:24,508 --> 00:00:27,418 Matt Edmundson: Now we're talking about acne because apparently the 10 00:00:27,418 --> 00:00:32,458 universe has decided that mortgages back pain and reading glasses are just 11 00:00:32,458 --> 00:00:34,378 not enough of a package deal for us. 12 00:00:35,393 --> 00:00:38,003 Chris Smith: And the frustrating thing is that when it does reappear, there's 13 00:00:38,003 --> 00:00:39,533 often a sense of shame around it. 14 00:00:39,713 --> 00:00:41,483 Like it shouldn't still be happening. 15 00:00:41,483 --> 00:00:44,303 Surely, which can get in the way of people actually treating it effectively. 16 00:00:45,023 --> 00:00:45,323 Jen Oliver: Yeah. 17 00:00:45,323 --> 00:00:49,343 So today we are gonna answer why adult acne is so common. 18 00:00:49,853 --> 00:00:53,753 What's happening under the skin when a breakout appears, and what the 19 00:00:53,753 --> 00:00:58,973 evidence actually says works for treating it when you are no longer 16. 20 00:00:59,873 --> 00:01:00,203 Matt Edmundson: Yeah. 21 00:01:00,203 --> 00:01:01,493 And I'm gonna be straight with you. 22 00:01:01,493 --> 00:01:03,503 I assume this was just a hormone thing. 23 00:01:04,183 --> 00:01:06,943 And we'd be done in this episode in about four minutes time. 24 00:01:06,943 --> 00:01:10,483 But a spoiler alert, apparently it's not just a hormone thing and the episode will 25 00:01:10,483 --> 00:01:12,283 be slightly longer than four minutes. 26 00:01:12,553 --> 00:01:14,893 Chris Smith: Well, hormones are certainly evolved, but you are right. 27 00:01:14,923 --> 00:01:16,723 There's a lot more to it than just hormones. 28 00:01:17,473 --> 00:01:21,283 Jen Oliver: But before we dig into the adult specific picture, it's worth 29 00:01:21,283 --> 00:01:25,213 us being clear, isn't it, about what acne actually is, because most people 30 00:01:25,213 --> 00:01:27,613 think of it as just spots without. 31 00:01:27,988 --> 00:01:29,728 Understanding what's driving them. 32 00:01:30,238 --> 00:01:33,478 Chris Smith: Yeah, so acne or acne vulgaris to give its full name 33 00:01:33,508 --> 00:01:37,048 is an inflammatory condition that affects the hair follicles and 34 00:01:37,048 --> 00:01:38,663 their attached sebaceous clans. 35 00:01:39,343 --> 00:01:41,683 These are the oil glands in your skin. 36 00:01:41,893 --> 00:01:43,273 So it's not a surface issue. 37 00:01:43,423 --> 00:01:45,253 It starts inside that hair follicle. 38 00:01:45,853 --> 00:01:47,563 Jen Oliver: And it's quite complex, isn't it? 39 00:01:47,593 --> 00:01:51,703 Would you believe four specific processors all have to align 40 00:01:51,703 --> 00:01:53,113 for a breakout to develop? 41 00:01:53,533 --> 00:01:58,903 So the first is excess seran production, so your oil glands over overproduce 42 00:01:58,963 --> 00:02:03,433 under the influence of androgens, which are hormones like testosterone 43 00:02:03,433 --> 00:02:05,173 that both men and women have. 44 00:02:05,593 --> 00:02:05,863 Chris Smith: Yep. 45 00:02:05,863 --> 00:02:09,813 And the second is what we would consider to be a. Abnormal skin 46 00:02:09,813 --> 00:02:11,853 cell shedding inside that follicle. 47 00:02:11,853 --> 00:02:16,203 So our skin does shed naturally, uh, but something's going wrong here. 48 00:02:16,203 --> 00:02:19,683 And crucially, those cells we're trying to, shed become more sticky 49 00:02:19,953 --> 00:02:22,803 and rather than clearing out, normally they accumulate and block the pore. 50 00:02:23,673 --> 00:02:26,283 Matt Edmundson: So the follicle gets blocked from the inside, not 51 00:02:26,283 --> 00:02:30,568 the outside, which would explain why just washing your face, uh. 52 00:02:31,018 --> 00:02:32,668 It doesn't really sort of fix it. 53 00:02:32,878 --> 00:02:33,688 Jen Oliver: Exactly. 54 00:02:33,688 --> 00:02:37,978 And once that blockage forms, which it's called a comedone, the 55 00:02:37,978 --> 00:02:42,988 third factor kicks in, and that's a bacterium called cutie bacteria acnes. 56 00:02:42,988 --> 00:02:43,918 It's probably not cute. 57 00:02:44,008 --> 00:02:46,528 Matt Edmundson: I was gonna say it's cutie bacteria, 58 00:02:46,738 --> 00:02:48,388 Jen Oliver: probably the bane of most people's lives. 59 00:02:48,388 --> 00:02:50,728 But anyway, or C acnes for sure. 60 00:02:50,728 --> 00:02:55,398 And that grows rapidly in that oxygen pore oily environment of the pore. 61 00:02:56,218 --> 00:02:58,168 Chris Smith: Um, and as if that wasn't enough, there's a fourth 62 00:02:58,168 --> 00:03:01,468 piece, which is your immune system responded to that blockage and to 63 00:03:01,468 --> 00:03:03,118 the bacteria with inflammation. 64 00:03:03,448 --> 00:03:07,228 And that inflammatory response is what creates the redness, the swelling, 65 00:03:07,408 --> 00:03:09,238 and the pain of that visible spot. 66 00:03:09,778 --> 00:03:12,658 Matt Edmundson: So like you say, four separate things going wrong at once. 67 00:03:12,658 --> 00:03:14,098 Like the stars have aligned. 68 00:03:14,488 --> 00:03:15,808 I guess it's like a project, isn't it? 69 00:03:15,808 --> 00:03:19,018 Without a project manager, everyone's doing their own thing and the outcome 70 00:03:19,018 --> 00:03:20,713 just seems to be mayhem and chaos. 71 00:03:21,688 --> 00:03:24,748 Jen Oliver: Which it is actually, that's actually a pretty good summary of it. 72 00:03:24,808 --> 00:03:26,758 And the reason it's so common. 73 00:03:27,088 --> 00:03:31,708 So studies suggest that up to 50% of women in their twenties experience 74 00:03:31,708 --> 00:03:35,998 acne with significant numbers climbing into their thirties and forties. 75 00:03:36,576 --> 00:03:38,831 Chris Smith: Now something for our fact fans. 76 00:03:39,131 --> 00:03:40,541 Jen Oliver: You mean you're gonna bust a myth? 77 00:03:41,141 --> 00:03:44,501 Matt Edmundson: Oh, here he comes, captain MythBuster again. 78 00:03:44,801 --> 00:03:45,551 Chris Smith: Absolutely. 79 00:03:45,581 --> 00:03:48,971 So I mentioned earlier about sticky dead cells blocking 80 00:03:48,971 --> 00:03:50,246 the pores, but did you know. 81 00:03:50,906 --> 00:03:53,786 The concept of pores, opening and closing is one of the 82 00:03:53,816 --> 00:03:57,026 biggest myths in skin science, or should I say skincare marketing. 83 00:03:57,296 --> 00:04:02,606 So pores do not open and close what I know, they aren't like little 84 00:04:02,606 --> 00:04:05,606 trap doors with muscles that make them open and close on demand. 85 00:04:06,116 --> 00:04:06,686 Matt Edmundson: Are you sure? 86 00:04:07,016 --> 00:04:11,636 So all the times like I've seen skincare products or treatments claim 87 00:04:11,636 --> 00:04:16,706 to open pores or said to myself that even exercise may be opens, pores. 88 00:04:16,961 --> 00:04:18,371 It's just not true. 89 00:04:18,731 --> 00:04:21,281 So how come then if that is true, Mr. Chris? 90 00:04:21,281 --> 00:04:22,961 And I'm not denying that that is true. 91 00:04:23,441 --> 00:04:26,681 Uh, how come pores are sometimes more visible than other times? 92 00:04:27,131 --> 00:04:30,701 Um, I thought that's because they were sometimes more open. 93 00:04:31,451 --> 00:04:36,731 Jen Oliver: So now it's because instead of opening and closing, they dilate contract. 94 00:04:36,731 --> 00:04:38,771 So the dilated pores. 95 00:04:38,786 --> 00:04:39,836 Are more visible. 96 00:04:40,376 --> 00:04:41,156 Chris Smith: Exactly that. 97 00:04:41,216 --> 00:04:44,876 And dilated pores can be caused by them being clogged. 98 00:04:44,966 --> 00:04:50,006 Uh, being inflamed or by a loss of skin elasticity or just through age. 99 00:04:50,666 --> 00:04:53,996 Matt Edmundson: And so cleaner and clearer pores look tighter then. 100 00:04:53,996 --> 00:04:54,206 Right. 101 00:04:54,206 --> 00:04:56,576 It doesn't just mean that they're somehow slammed shut. 102 00:04:57,386 --> 00:04:57,806 Chris Smith: Exactly. 103 00:04:57,806 --> 00:04:58,106 That. 104 00:04:58,406 --> 00:05:01,346 So we want pores to contract and be tight and clean. 105 00:05:01,946 --> 00:05:03,326 Um, 'cause Yeah. 106 00:05:03,416 --> 00:05:04,256 Looks far better. 107 00:05:04,376 --> 00:05:04,586 Matt Edmundson: Mm-hmm. 108 00:05:05,216 --> 00:05:05,966 Chris Smith: I do apologize. 109 00:05:05,966 --> 00:05:07,946 I kind of took us off on a bit of a, a tangent there 110 00:05:07,996 --> 00:05:08,841 Matt Edmundson: that's unlike you Chris. 111 00:05:08,841 --> 00:05:10,676 Chris Smith: I, I know I'm, yeah, apologies. 112 00:05:11,036 --> 00:05:13,556 Um, so we were talking about, I think we were talking about the four 113 00:05:13,736 --> 00:05:15,386 processes that contribute to acne. 114 00:05:15,476 --> 00:05:20,726 So there was excess sebum production, uh, the skin not shedding 115 00:05:21,026 --> 00:05:23,426 properly and clogging those pores. 116 00:05:23,726 --> 00:05:28,586 Um, the commo formation, as Jen mentioned, and then the skin's inflammatory response. 117 00:05:29,036 --> 00:05:31,136 The important thing to point out here is that. 118 00:05:31,736 --> 00:05:35,336 Those processes are identical in teenagers or adults. 119 00:05:35,396 --> 00:05:38,846 So the difference is what triggers them in adult life, because the driving 120 00:05:38,846 --> 00:05:40,946 forces shift considerably beyond puberty. 121 00:05:41,996 --> 00:05:45,536 Jen Oliver: So the biggest adult specific trigger is changes in hormones. 122 00:05:45,596 --> 00:05:50,096 And even though changes in hormones are often behind teenage acne in adults, 123 00:05:50,276 --> 00:05:54,176 it's the irregular shifts that cause the problems, particularly the drops 124 00:05:54,176 --> 00:05:58,496 and the spikes, rather than like the steady high that's seen in puberty. 125 00:05:59,411 --> 00:05:59,681 Chris Smith: Yeah. 126 00:05:59,681 --> 00:06:03,641 And for women, um, the most common pattern is cyclical. 127 00:06:04,346 --> 00:06:04,856 Acne. 128 00:06:04,856 --> 00:06:06,356 So it's tied to the menstrual cycle. 129 00:06:06,356 --> 00:06:10,826 So specifically the days before menstruation when progesterone 130 00:06:11,036 --> 00:06:14,996 falls, but androgen activity, those sex hormones such as testosterone, 131 00:06:15,326 --> 00:06:16,796 they remain relatively elevated, 132 00:06:17,396 --> 00:06:21,116 Jen Oliver: and that shift alone can boost the sebum and production and cause 133 00:06:21,116 --> 00:06:26,276 the skin cells in the follicle to shed faster, which is why so many women see 134 00:06:26,276 --> 00:06:31,196 breakouts popping up in the same place at roughly the same point in their cycle. 135 00:06:31,791 --> 00:06:36,291 Matt Edmundson: And by same place you mean specifically the jawline and lower face? 136 00:06:36,531 --> 00:06:36,891 Chris Smith: Yeah. 137 00:06:36,891 --> 00:06:40,761 Almost always because, um, that pattern is so, in fact, that pattern is so 138 00:06:40,761 --> 00:06:45,141 consistently recognized that persistent lower face acne in adult women is 139 00:06:45,141 --> 00:06:49,191 now treated as a hormonal flag in dermatology, not just a skin issue. 140 00:06:49,941 --> 00:06:51,861 Jen Oliver: And it's just delightful being a woman. 141 00:06:51,861 --> 00:06:54,141 Perimenopause is another window where. 142 00:06:54,476 --> 00:06:58,556 It becomes significant 'cause estrogen levels drop, but the androgen 143 00:06:58,826 --> 00:07:00,836 activity that still remains high. 144 00:07:00,836 --> 00:07:04,826 And so that shifts the hormonal balance in a way that reactivates 145 00:07:05,126 --> 00:07:07,016 those sebaceous gland activity. 146 00:07:07,106 --> 00:07:11,426 Um, and that might have been, your skin might have been clear for years. 147 00:07:11,906 --> 00:07:15,026 Matt Edmundson: So you spend your twenties then dealing with hormonal acne, your 148 00:07:15,026 --> 00:07:16,696 thirties finally getting on top of it. 149 00:07:17,456 --> 00:07:20,456 And then perimenopause seemed to say, why not so fast? 150 00:07:20,606 --> 00:07:20,846 Jen Oliver: Yeah, 151 00:07:21,146 --> 00:07:21,386 Chris Smith: I know. 152 00:07:21,386 --> 00:07:22,316 It's just not fair, is it? 153 00:07:22,466 --> 00:07:22,916 Let's be honest. 154 00:07:23,096 --> 00:07:23,491 Yeah, no, I agree. 155 00:07:23,726 --> 00:07:25,166 It genuinely is quite common. 156 00:07:25,436 --> 00:07:28,766 Um, and then the stress on top of everything else, which operates through 157 00:07:28,766 --> 00:07:32,906 a completely separate pathway, but is a massive contributor to adult acne. 158 00:07:33,431 --> 00:07:37,091 Jen Oliver: Yeah, cortisol, which is your primary stress hormone, and 159 00:07:37,091 --> 00:07:41,201 that's getting a lot of press lately, that directly stimulates the sebaceous 160 00:07:41,201 --> 00:07:43,061 glands to increase sebum production. 161 00:07:43,421 --> 00:07:47,621 But research has shown that by itself, it drives inflammation in the skin. 162 00:07:47,621 --> 00:07:49,631 So the effect is actually two pronged. 163 00:07:50,411 --> 00:07:53,501 Chris Smith: Yeah, and I suppose you can think of it of less of a case of, 164 00:07:53,531 --> 00:07:56,141 um, stress creating acne from nothing. 165 00:07:56,411 --> 00:08:00,641 A more like stress lowering the threshold at which everything that was already 166 00:08:00,671 --> 00:08:04,451 kind of quietly ticking over tips over the edge into a full on breakout. 167 00:08:05,396 --> 00:08:06,086 Jen Oliver: It's just great. 168 00:08:07,016 --> 00:08:10,526 But research, it's also shown that psychological stress ramps up the 169 00:08:10,886 --> 00:08:15,656 pro-inflammatory cytokine activity in the skin, even without changes in sebum. 170 00:08:15,656 --> 00:08:19,736 So it's not just about oiliness, it's how your immune system reacts, 171 00:08:19,998 --> 00:08:21,796 Matt Edmundson: Which probably explains the timing then, doesn't it? 172 00:08:21,796 --> 00:08:25,456 The spot that appears the morning before something important 173 00:08:25,636 --> 00:08:28,966 has been in the pipeline, uh, longer than we seem to think. 174 00:08:29,026 --> 00:08:29,116 Jen Oliver: Mm-hmm. 175 00:08:29,536 --> 00:08:30,136 Chris Smith: Absolutely. 176 00:08:30,406 --> 00:08:31,546 And then we've got diet. 177 00:08:31,696 --> 00:08:35,506 So diet is the third major adult driver and the mechanism 178 00:08:35,506 --> 00:08:36,886 here runs through blood sugar. 179 00:08:37,306 --> 00:08:41,236 So high glycemic foods being white bread, sugary drinks. 180 00:08:41,501 --> 00:08:42,551 Refined carbohydrates. 181 00:08:42,551 --> 00:08:43,871 You know, the things we all kinda like. 182 00:08:44,471 --> 00:08:49,671 They cause this rapid insulin spike, which in turn elevates a hormone called IGF one. 183 00:08:49,991 --> 00:08:50,831 Matt Edmundson: IGF one. 184 00:08:50,831 --> 00:08:52,151 Sounds like mission impossible 185 00:08:52,151 --> 00:08:52,571 Jen Oliver: for us. 186 00:08:52,571 --> 00:08:52,781 It does. 187 00:08:52,781 --> 00:08:53,621 It does. 188 00:08:54,131 --> 00:08:55,656 It's definitely a weapon of the MythBuster. 189 00:08:58,766 --> 00:09:00,616 Matt Edmundson: Done, should pun done. 190 00:09:00,686 --> 00:09:00,976 Done. 191 00:09:00,976 --> 00:09:01,096 10. 192 00:09:01,446 --> 00:09:03,336 Jen Oliver: So I'll help you out here, Chris. 193 00:09:03,456 --> 00:09:09,156 IGF one is insulin growth factor one, and that directly stimulates the sebaceous 194 00:09:09,156 --> 00:09:14,046 glands and speeds up the abnormal shedding of the cells in the skin follicle. 195 00:09:14,376 --> 00:09:14,436 Um. 196 00:09:15,106 --> 00:09:19,636 There was a review in 2023 and they found a consistent link between 197 00:09:19,636 --> 00:09:24,076 high glycemic diets and acne severity, especially in adult women. 198 00:09:24,616 --> 00:09:24,886 Chris Smith: Yeah. 199 00:09:24,886 --> 00:09:29,326 And um, dairy is worth mention here too, so the association is less consistent 200 00:09:29,326 --> 00:09:33,826 across studies, but some research points to the insulin and growth 201 00:09:33,826 --> 00:09:38,026 factor content of milk as a potential contributor for certain individuals. 202 00:09:38,486 --> 00:09:42,266 Matt Edmundson: So a, a meal deal then with your white bread, your sugary drink. 203 00:09:42,446 --> 00:09:47,096 A yogurt is not just, it seems a nutritional compromise, but also 204 00:09:47,096 --> 00:09:50,156 potentially having a conversation with your sebaceous glands that 205 00:09:50,156 --> 00:09:51,686 you didn't really ask it to have. 206 00:09:52,136 --> 00:09:52,496 Jen Oliver: Yep. 207 00:09:52,836 --> 00:09:56,496 And that's, we're not even counting what you put on your skin. 208 00:09:56,796 --> 00:09:59,016 So that's just what you put in you, in your body. 209 00:09:59,346 --> 00:10:02,826 Um, acne cosmetica is actually a real thing. 210 00:10:03,126 --> 00:10:06,756 So breakouts that are triggered or worsened by skincare and makeup, 211 00:10:06,756 --> 00:10:12,066 and that's things like heavy creams, sun, sun, cream formulas, and certain 212 00:10:12,066 --> 00:10:16,356 foundations can actually block the follicles and lead to comedones. 213 00:10:16,681 --> 00:10:16,951 Chris Smith: Yeah. 214 00:10:16,951 --> 00:10:20,071 And of course that could be particularly frustrating because people often 215 00:10:20,071 --> 00:10:23,731 reach for more skincare in response to acne without checking whether 216 00:10:23,731 --> 00:10:26,431 the products they're actually using are already part of the problem. 217 00:10:26,701 --> 00:10:26,971 Jen Oliver: Mm-hmm. 218 00:10:27,391 --> 00:10:27,751 Matt Edmundson: Yeah. 219 00:10:27,751 --> 00:10:30,571 So who does this actually affect then? 220 00:10:30,691 --> 00:10:33,751 Um, and does it look the same across different people? 221 00:10:34,346 --> 00:10:35,840 Jen Oliver: So it's definitely not uniform. 222 00:10:35,840 --> 00:10:39,680 There was a large epidemiological study across multiple countries, 223 00:10:39,680 --> 00:10:43,610 and they found that adult acne affects women at a significantly 224 00:10:43,610 --> 00:10:45,740 higher rate than men overall. 225 00:10:46,100 --> 00:10:50,060 Um, and adult onset acne, meaning like new breakouts that 226 00:10:50,060 --> 00:10:51,500 started after the age of 25. 227 00:10:52,670 --> 00:10:57,140 With no teenage history is considerably more common in women than in men. 228 00:10:57,290 --> 00:10:58,340 Great news for us women 229 00:10:58,760 --> 00:11:01,880 Chris Smith: I know, and in by contrast, when it comes to men, men are more likely 230 00:11:01,880 --> 00:11:05,870 to have persistent acne that's continue from adolescents without fully clearing. 231 00:11:06,230 --> 00:11:11,330 So it's driven by constantly higher androgen levels, and it tends to persist 232 00:11:11,540 --> 00:11:13,340 as more severe when it does persist. 233 00:11:13,835 --> 00:11:17,285 Matt Edmundson: So men, fewer acne episodes, but going for maximum 234 00:11:17,285 --> 00:11:22,535 impact when they do occur seems to be the, seems to be the consensus. 235 00:11:22,565 --> 00:11:22,625 Jen Oliver: Yeah. 236 00:11:23,900 --> 00:11:25,100 Essentially, yes. 237 00:11:25,190 --> 00:11:29,780 And for women, it's just another joy for women, there's a specific condition that 238 00:11:29,780 --> 00:11:34,370 amplifies that pattern significantly, and that's polycystic ovary syndrome, 239 00:11:34,370 --> 00:11:36,170 which is actually quite common, POS. 240 00:11:36,410 --> 00:11:40,010 And that involves chronically elevated androgen levels that 241 00:11:40,010 --> 00:11:41,960 drive acne, that's persistent. 242 00:11:42,140 --> 00:11:46,310 It's often more cystic, and it frequently doesn't really respond 243 00:11:46,310 --> 00:11:49,610 to like your standard topical treatments without addressing. 244 00:11:49,940 --> 00:11:51,620 The hormonal picture underneath. 245 00:11:52,190 --> 00:11:52,520 Chris Smith: Yeah. 246 00:11:52,520 --> 00:11:55,430 And that's so important because you know, if you are experiencing a series 247 00:11:55,430 --> 00:11:59,720 of breakouts that don't shift even after several months of consistent treatment, 248 00:11:59,990 --> 00:12:02,750 it's well worth the conversation with your doctor to investigate whether 249 00:12:02,750 --> 00:12:04,010 something systemic is going on. 250 00:12:04,790 --> 00:12:09,800 Matt Edmundson: So what about the idea then that acne means your skin is dirty? 251 00:12:10,010 --> 00:12:10,970 'cause I, this one. 252 00:12:11,060 --> 00:12:13,220 It still makes a rounds for me. 253 00:12:13,580 --> 00:12:16,640 Jen Oliver: I feel like, I feel like Captain MythBuster should join 254 00:12:16,640 --> 00:12:19,370 in now, but I'll be a sidekick. 255 00:12:19,370 --> 00:12:20,930 We need a name for that, but it's, 256 00:12:21,440 --> 00:12:22,190 Matt Edmundson: he could be Madam 257 00:12:22,190 --> 00:12:22,670 Jen Oliver: MythBuster. 258 00:12:22,725 --> 00:12:23,745 Be Madam MythBuster 259 00:12:25,760 --> 00:12:27,380 doesn't sound quite as heroic, 260 00:12:27,530 --> 00:12:27,860 Chris Smith: does it? 261 00:12:27,920 --> 00:12:29,360 Pen like an alternate Penfold, 262 00:12:31,730 --> 00:12:32,390 the younger viewers? 263 00:12:32,690 --> 00:12:33,260 No idea. 264 00:12:33,260 --> 00:12:33,470 No 265 00:12:33,470 --> 00:12:34,700 Matt Edmundson: idea what we're talking about. 266 00:12:35,415 --> 00:12:37,755 Jen Oliver: Well actually your skin being that dirty, that's 267 00:12:37,755 --> 00:12:39,825 completely without biological basis. 268 00:12:39,825 --> 00:12:43,755 So the four processes we described are all happening inside the follicle, 269 00:12:43,755 --> 00:12:48,885 the excess oil, the sticky cells, the bacteria, the immune response, none 270 00:12:48,885 --> 00:12:51,315 of which are driven by surface dirt. 271 00:12:51,645 --> 00:12:52,365 Chris Smith: Absolutely right. 272 00:12:52,365 --> 00:12:55,210 And in fact, over washing and harsh scrubbing of the 273 00:12:55,215 --> 00:12:56,955 skin strips away its barrier. 274 00:12:57,405 --> 00:13:01,365 It also increases inflammation, um, and it can worsen the very condition 275 00:13:01,365 --> 00:13:02,325 that people are trying to treat. 276 00:13:02,645 --> 00:13:06,515 So the evidence consistently points to gentle kind of twice 277 00:13:06,515 --> 00:13:07,865 daily cleansing as the best route. 278 00:13:08,105 --> 00:13:11,225 Matt Edmundson: Okay, so the person in scrubbing their face three or 279 00:13:11,225 --> 00:13:13,625 four times a day, which is what I did when I was a teenager. 280 00:13:14,135 --> 00:13:14,555 Um. 281 00:13:15,830 --> 00:13:19,550 They're making their skin worse, and if they are, they're not imagining it, right? 282 00:13:19,580 --> 00:13:22,400 Jen Oliver: No, they're generally make, genuinely making it harder 283 00:13:22,400 --> 00:13:24,110 for their skin to regulate itself. 284 00:13:24,410 --> 00:13:28,070 So once the skin barrier is compromised by like the excessive 285 00:13:28,070 --> 00:13:32,000 washing, the inflammatory response can become more pronounced, not less. 286 00:13:33,290 --> 00:13:33,800 Chris Smith: That's right. 287 00:13:34,370 --> 00:13:38,870 So if we look at beyond standard skincare, what does treatment actually look like? 288 00:13:38,930 --> 00:13:43,190 Um, for mild to moderate adult acne, there are three over the counter 289 00:13:43,190 --> 00:13:46,640 actives with genuinely solid, uh, evidence behind them aren't there? 290 00:13:46,700 --> 00:13:47,030 Jen Oliver: Yeah. 291 00:13:47,030 --> 00:13:49,710 So there's benzoyl peroxide and that targets that. 292 00:13:50,185 --> 00:13:54,025 C Acnes, we talked about targets that The cutie one. 293 00:13:54,025 --> 00:13:54,295 The cutie one, yeah. 294 00:13:54,295 --> 00:13:54,305 Yeah. 295 00:13:54,385 --> 00:13:55,045 Not so cute. 296 00:13:55,045 --> 00:13:59,545 In this state, in this case, the cutie one, it targets that directly 297 00:13:59,875 --> 00:14:01,915 and has an anti-inflammatory action. 298 00:14:01,915 --> 00:14:06,415 And then salicylic acid, you often see that in skincare products that dissolves 299 00:14:06,415 --> 00:14:11,365 the bonds between the abnormal sticky skin cells in the follicle, helping to 300 00:14:11,365 --> 00:14:13,255 break down the blockage and clear it. 301 00:14:13,615 --> 00:14:17,635 And then there's also, um, a retinoid now available without 302 00:14:17,635 --> 00:14:19,465 prescription in many countries. 303 00:14:19,770 --> 00:14:24,030 And that normalizes follicle cell turnover at the source 304 00:14:24,510 --> 00:14:25,290 Matt Edmundson: and, okay. 305 00:14:25,410 --> 00:14:26,250 That's all very helpful. 306 00:14:26,250 --> 00:14:29,460 But is there any particular order or priority there, or is 307 00:14:29,460 --> 00:14:31,020 it just pick one and see Chris? 308 00:14:31,230 --> 00:14:34,140 Chris Smith: Well, I'd say as a general rule, starting with one at a time is 309 00:14:34,140 --> 00:14:37,800 really important because introducing multiple active simultaneously makes 310 00:14:37,800 --> 00:14:39,960 it impossible to know which is working. 311 00:14:40,020 --> 00:14:44,400 And the combination can cause significant irritation to already very 312 00:14:44,400 --> 00:14:47,640 inflamed skin, especially if you've got a kind of sensitive skin type. 313 00:14:48,410 --> 00:14:51,200 Jen Oliver: And I think the single most important thing to understand about 314 00:14:51,200 --> 00:14:53,450 topical treatments is the timeline. 315 00:14:53,660 --> 00:14:58,730 So most of them require a minimum of about six to eight weeks for any noticeable 316 00:14:58,730 --> 00:15:03,590 improvement, and three months really to properly evaluate its effectiveness. 317 00:15:03,920 --> 00:15:05,070 Matt Edmundson: Six to eight weeks, which is. 318 00:15:06,005 --> 00:15:10,415 Roughly four times longer than I. Most people, including me, give 319 00:15:10,415 --> 00:15:13,415 anything before declaring this thing doesn't work in ordering three new 320 00:15:13,415 --> 00:15:15,395 products at midnight on Amazon, right? 321 00:15:15,395 --> 00:15:15,635 Jen Oliver: Yeah. 322 00:15:15,635 --> 00:15:16,325 We've all been there. 323 00:15:16,505 --> 00:15:17,255 Chris Smith: Uh, totally. 324 00:15:17,255 --> 00:15:20,165 And of course that, I mean, that is the single biggest reason, isn't it, that, 325 00:15:20,165 --> 00:15:23,405 uh, treatments get abandoned because before they've had a chance to work, 326 00:15:23,495 --> 00:15:25,205 people are kind of moving on already. 327 00:15:25,715 --> 00:15:28,805 And the thing to remember here is there are multiple things at play, 328 00:15:29,045 --> 00:15:32,675 including calming your own skin, your skin's own inflammatory responses. 329 00:15:32,675 --> 00:15:32,885 So. 330 00:15:33,215 --> 00:15:35,375 Treatments are never gonna be a quick fix. 331 00:15:35,915 --> 00:15:38,585 Um, it's really important to keep in mind though, that for those who have 332 00:15:38,585 --> 00:15:41,705 stuck with it and tried products for long periods of time, you know the 333 00:15:41,765 --> 00:15:43,325 the time they're recommended for. 334 00:15:43,835 --> 00:15:47,645 If you're not seeing successful changes, then prescription options are available 335 00:15:47,705 --> 00:15:49,065 and it may be time to talk to your doctor. 336 00:15:49,910 --> 00:15:53,300 Jen Oliver: Yeah, in some prescriptions they include like stronger topical 337 00:15:53,300 --> 00:16:00,020 retinoids or antibiotic combinations to reduce bacterial resistance and systemic 338 00:16:00,020 --> 00:16:04,460 treatments like certain birth control pills that try to address the issue added 339 00:16:04,460 --> 00:16:07,340 source rather than just on the surface. 340 00:16:07,820 --> 00:16:12,380 Matt Edmundson: Okay, so when, so when should uh, someone stop 341 00:16:12,380 --> 00:16:15,205 managing this themselves and actually search out, say a dermatologist? 342 00:16:16,100 --> 00:16:20,450 Chris Smith: So I think if that acne is leaving, um, scarring or dark 343 00:16:20,450 --> 00:16:26,360 marks, which is technically post, um, inflammatory hyperpigmentation, that's 344 00:16:26,360 --> 00:16:28,220 a reason to escalate rather than weight. 345 00:16:28,370 --> 00:16:31,790 And the same applies if consistent, like over the counter product use 346 00:16:31,790 --> 00:16:34,240 for two to three months hasn't made a dent in the problem at all. 347 00:16:35,285 --> 00:16:38,555 Jen Oliver: And actually as well don't underestimate the psychological impact. 348 00:16:38,555 --> 00:16:43,445 So research has shown that acne in adults significantly affects people's 349 00:16:43,445 --> 00:16:45,635 quality of life, their self-esteem. 350 00:16:46,085 --> 00:16:50,735 And you know, that alone is a legitimate reason to seek proper support and not just 351 00:16:50,735 --> 00:16:52,505 to push so through something on your own. 352 00:16:52,625 --> 00:16:53,555 Matt Edmundson: Yeah, absolutely. 353 00:16:53,885 --> 00:16:58,385 And something here that strikes me having worked through all of this is acne. 354 00:16:58,715 --> 00:17:01,805 I guess it doesn't feel like a, a skin condition as such. 355 00:17:01,805 --> 00:17:04,205 Once you understand it, it's more like a skin symptom. 356 00:17:04,550 --> 00:17:06,320 Of things happening elsewhere. 357 00:17:06,530 --> 00:17:06,590 Jen Oliver: Mm. 358 00:17:06,800 --> 00:17:08,510 Chris Smith: That's actually a really useful framing. 359 00:17:08,750 --> 00:17:09,290 Matt Edmundson: Thanks, Chris. 360 00:17:09,320 --> 00:17:10,895 Chris Smith: Um, I shouldn't sound surprised by the way. 361 00:17:12,525 --> 00:17:13,415 Jen Oliver: Well done Matt. 362 00:17:13,855 --> 00:17:14,015 Chris Smith: Absolutely. 363 00:17:14,195 --> 00:17:14,775 Pat on the back. 364 00:17:14,775 --> 00:17:14,785 Yeah. 365 00:17:15,260 --> 00:17:16,430 And that point for a Tuesday. 366 00:17:17,420 --> 00:17:21,260 Um, but yeah, the skin is a visible output. 367 00:17:21,260 --> 00:17:24,020 The visible output, but the inputs, the hormones, the 368 00:17:24,080 --> 00:17:25,700 cortisol that Jen mentioned, the. 369 00:17:26,285 --> 00:17:29,795 Blood sugar, the inflammation, they are whole body processes. 370 00:17:29,945 --> 00:17:32,615 And the skin is of course the body's largest organ, but 371 00:17:32,615 --> 00:17:33,785 it's also the one we can see. 372 00:17:34,145 --> 00:17:36,935 So it can reflect things going on elsewhere in the body. 373 00:17:36,965 --> 00:17:38,675 It's basically the visible thing. 374 00:17:38,680 --> 00:17:38,690 Mm-hmm. 375 00:17:40,265 --> 00:17:42,515 Jen Oliver: And those are the threads that run through a lot of what we've 376 00:17:42,515 --> 00:17:44,555 discussed in other episodes, isn't it? 377 00:17:44,555 --> 00:17:49,325 Cortisol dysregulation, blood sugar spikes, systemic inflammation. 378 00:17:49,595 --> 00:17:52,685 They've all, they've all downstream effects across 379 00:17:52,685 --> 00:17:55,235 multiple systems and the skin is. 380 00:17:55,805 --> 00:17:58,535 One of the more visible places that registers them. 381 00:17:58,865 --> 00:17:59,465 Chris Smith: Absolutely. 382 00:17:59,465 --> 00:18:02,285 And ski, uh, sleep is a really good example. 383 00:18:02,285 --> 00:18:03,815 I know we always talk about sleep 384 00:18:04,985 --> 00:18:05,075 Jen Oliver: with 385 00:18:05,075 --> 00:18:05,825 sleep champions. 386 00:18:05,825 --> 00:18:05,835 Chris Smith: Absolutely. 387 00:18:06,185 --> 00:18:10,955 Um, but poor sleep elevates cortisol directly and that cortisol then 388 00:18:10,955 --> 00:18:14,705 feeds into both sebum production and cellular inflammation. 389 00:18:15,185 --> 00:18:18,485 Um, it's another area where sleep quality has a knock on effects that 390 00:18:18,485 --> 00:18:20,135 people don't necessarily expect. 391 00:18:20,195 --> 00:18:20,465 Mm, 392 00:18:20,765 --> 00:18:21,005 Matt Edmundson: yeah. 393 00:18:21,005 --> 00:18:23,075 We do like to talk about sleep on this podcast. 394 00:18:23,285 --> 00:18:25,775 Um, and it's interesting, isn't it, because poor sleep then is 395 00:18:25,775 --> 00:18:30,005 quietly implicated it seems in, in everything, and at some point. 396 00:18:30,320 --> 00:18:33,320 We're gonna have to accept maybe that get more sleep as a lifestyle 397 00:18:33,320 --> 00:18:37,610 tip and a more fundamental, uh, biological requirements that we're 398 00:18:37,610 --> 00:18:38,840 all maybe collectively ignoring. 399 00:18:38,865 --> 00:18:39,185 I don't know. 400 00:18:39,185 --> 00:18:39,465 Mm-hmm. 401 00:18:39,695 --> 00:18:39,985 Jen Oliver: Yeah. 402 00:18:40,605 --> 00:18:41,660 No, I like sleep. 403 00:18:42,560 --> 00:18:43,250 Matt Edmundson: Sleep is good. 404 00:18:43,760 --> 00:18:45,170 We should change the name of the podcast. 405 00:18:45,860 --> 00:18:47,180 Sleep is Good podcast. 406 00:18:47,180 --> 00:18:47,930 Jen Oliver: Yeah, I know. 407 00:18:47,930 --> 00:18:53,120 'cause it, it fits into everything we chat about, but we talked about diet before. 408 00:18:53,260 --> 00:18:55,570 And the diet piece connects back to that too. 409 00:18:55,990 --> 00:18:59,170 You know, blood sugar and insulin response pathway that affects acne 410 00:18:59,170 --> 00:19:02,800 is the same pathway talked about on the food cravings episode. 411 00:19:03,160 --> 00:19:06,100 And these mechanisms, they don't operate in isolation. 412 00:19:06,250 --> 00:19:08,200 They're part of the same metabolic picture. 413 00:19:08,710 --> 00:19:11,140 Chris Smith: Yeah, which is actually good news, right? 414 00:19:11,140 --> 00:19:15,250 Because the lifestyle factors that support skin health are largely the same ones that 415 00:19:15,250 --> 00:19:16,750 support a lot of other health outcomes. 416 00:19:17,080 --> 00:19:19,840 So there's nothing niche or complicated being required here. 417 00:19:20,590 --> 00:19:21,040 Jen Oliver: Okay. 418 00:19:21,040 --> 00:19:23,770 So why do adults still get acne? 419 00:19:24,660 --> 00:19:27,720 Chris Smith: So adults still get acne because the four biological 420 00:19:27,720 --> 00:19:31,770 processes behind acne being excess, sebum production, um, 421 00:19:31,800 --> 00:19:35,670 abnormal skin cell, shedding in the follicle, bacterial overgrowth, 422 00:19:35,730 --> 00:19:37,740 and immune driven inflammation. 423 00:19:38,370 --> 00:19:41,880 Don't stop being possible just because puberty ends, they get 424 00:19:41,880 --> 00:19:46,290 reactivate throughout adult life by things like, um, hormonal shifts, 425 00:19:46,560 --> 00:19:50,880 uh, cortisol levels, blood sugar fluctuations and environmental triggers. 426 00:19:51,240 --> 00:19:54,060 Matt Edmundson: And the gap between you should have grown out of this. 427 00:19:54,330 --> 00:19:58,800 And this is a real well understood physiological process with effective 428 00:19:58,800 --> 00:20:03,985 treatments is exactly the kind of gap this show, uh, exists to close. 429 00:20:05,310 --> 00:20:10,170 Jen Oliver: So that's why adult acne is so common, why it has nothing to do 430 00:20:10,170 --> 00:20:14,910 with hygiene or effort and why matching your treatment to what's actually 431 00:20:14,910 --> 00:20:17,490 driving it makes such a difference. 432 00:20:17,640 --> 00:20:17,940 Chris Smith: Yeah. 433 00:20:18,000 --> 00:20:20,640 And that knowing the mechanism puts you in a much better position 434 00:20:20,640 --> 00:20:21,810 to do something useful about it. 435 00:20:21,870 --> 00:20:21,930 Yeah, 436 00:20:22,560 --> 00:20:22,770 Matt Edmundson: yeah. 437 00:20:22,770 --> 00:20:27,450 No longer at the mercy of your sebaceous glands and their terrible sense of timing. 438 00:20:28,770 --> 00:20:30,180 Jen Oliver: So that's it for this week. 439 00:20:30,270 --> 00:20:32,460 Make sure you hit that subscribe button. 440 00:20:32,700 --> 00:20:36,330 We're unpacking the science behind everyday questions every week. 441 00:20:36,900 --> 00:20:39,930 Tell us in the comments what you'd like us to explore next. 442 00:20:40,140 --> 00:20:43,440 Thanks for geeking out with us, but for now, that's it from me. 443 00:20:43,860 --> 00:20:44,790 Matt Edmundson: That's it from me, 444 00:20:45,015 --> 00:20:46,050 Chris Smith: and that's it from me. 445 00:20:46,500 --> 00:20:47,130 Jen Oliver: Bye for now.