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We're brought up to believe that acne is just a teenage problem expecting to go away as we grow up.  But the truth is for some it never goes away. Mine never did in fact it actually got worse and turned into cystic acne. Now I'm just hoping to get rid of my acne before I start getting wrinkles! 

My Cystic Acne Story
I had acne as a teenager and used topical treatments, as an adult out of the blue I developed cystic acne. I was given cortisol shots to treat the cysts, and topical cylindamilicin. Later I was given dioxicyclin which I had a SEVERE side effect. I could not eat or drink without pain. I had blood test and an ultra sound but they didn’t know what was wrong. I asked if it was my new medication (that I’d been on for less than a month) and I was told it was not by both my doctor and pharmacist. I stopped taking it anyway to rule out the drug as a possibility. I was fine after words. I remained convinced it was the medication. My friend later on took the same medication and had the same effect (it was an ulcer caused by the pill being lodged in her throat). Needless to say I had not truly given antibiotics a shot at this point. Despite this my Dr aggressively tried to get me on accutane. I was appalled at the fact that he would attempt to put me on a clearly dangerous drug without giving less risky options a try. I went to a new dermatologist who gave me a serious antibiotic that quickly calmed my”angry” acne face and long with it gave me a yeast infection. I was put on a lower dose of antibiotics (ery tab), birth control,and retinol-a and my acne seemed to disappear. I stopped taking birth control because I was nervous about being on it and didn’t know if it was needed along with a lowered dose of antibiotics, my face was still fine.

I decided to stop taking antibiotics for several reasons one I thought I had a fungal infection (the test ended up showing negative), and had been on antibiotics for 1 and half years. I also had an aunt who lost her colon due to a bacterial infection from antibiotic resistant bacteria after being on antibiotics, well that was enough for me to stop taking my antibiotics. I stopped taking antibiotics 6 months ago.  My cystic acne came back a few months after I stopped taking it, and it does not look good. I do not want to go back to antibiotics so I have been trying to see what diet and lifestyle changes I can make that.

About a year ago I started having weird symptoms which lead me to believe I had an hormonal imbalance and lead to much researching on hormones, I started wondering if that was why I developed cystic acne out of the blue as an adult. Was I just treating the symptom of an underlying problem?  Turns out I was, I have PCOS a common hormonal disorder in women that causes you to have too high of androgens (male hormones).  A hormonal imbalance along with many other factors is often the underlying cause of acne in adults according to a few books I've recently read.  

What Causes Acne In Adults
Acne can be caused by temporary lifestyle factors such as a bad reaction to makeup or skin care products, sweat, oil from hair, etc.  I want to make clear this is not the type of acne I'm talking about here.  The acne I'm talking about is not occasional, but rather the constant you never have a clear face kind.  The following list of possible causes of acne are based on the books "The Clear Skin Diet," by Alan Logan and Valori Treloar and "The Clear Skin Prescription," by Dr Nicholas Perricone.

Inflammation
Dr Perricone believes acne to be rooted in inflammation not that inflammation is a by product of a clogged pore.  My take on this is that it certainly can't hurt to try to lower inflammation anyways since nearly all chronic diseases are linked to inflammation.  He suggest eating an anti-inflammatory diet and using supplements that reduce inflammation and antioxidants both orally and topically. 

Stress 
Researchers from the Toyama Medical and Pharmaceutical University in Japan have published a paper in the journal Dermatology (2003), that reported an abundance of nerves that release substance P surround and innervate the sebaceous glands of acne patients.  When released, substance P causes growth of the sebaceous gland and subsequent oil production to help fuel the acne growth and congestion in the follicle, and it also promotes inflammation (Logan page 135). Interestingly zinc is needed for the enzymes used in clearing this up and zinc is often found to be in low levels in acne patients.

• Stress does this by causing increased inflammation and oxidative stress, raising cortisol, and depleting zinc, magnesium, and selenium, which help control acne.
• Stress causes poor dietary choices.

Hormonal Imbalances  
Sensitivities to androgens (male hormones) and high levels of androgens can cause acne in both male and females. According to Livestrong, "When androgens, which include the hormone testosterone, overstimulate the skin's sebaceous glands, those glands can produce too much of the oil known as sebum. Extra sebum can clog your hair follicles and pores, allowing bacteria to take up residence."  In females PCOS (a female disorder where ovaries produce too much androgens) is often the cause, but males can have imbalances in their androgens as well.   According to WebMD an imbalance in both male and female hormones (estrogen) can also cause breakouts. For women, this can happen during pregnancy, perimenopause, and menopause.  Not sure if you have a hormonal imbalance?  Find a doctor who understands hormones and ask your doctor for a hormone test to find out.

Poor Diet 
It has long been established that diet does not effect acne in the medical community based on a few studies, one being the chocolate bar study.  But Nicholas Perricone MD, Alan Logan ND, and Valori Treloar MD disagree with these studies on the basis that they were poorly designed and far from the quality of evidence that would warrant throwing diet having any effect on acne out the window.  I agree with them.  Here is an interesting read from Clinics in Dermatology 2011 Chocolate and Acne How Valid was the Original Study? (pdf) for more specifics on this study.   Does this mean there is a diet acne connection?  No, but I think that it means we should not prematurely dismiss it entirely.   Especially when the diet being advocated is merely what most good doctors would recommend as a good diet.  I mean really what's the risk?  Good overall health?

 Dr Perricone says one should follow an anti-inflammatory diet to decrease acne, which is characterized by low glycemic foods, high in fruits and vegetables, low in animal proteins except for fish, and high in good fats (nuts, olive oil, flax, avocado, chia, fish)  and low in bad fats (vegetable oils, sunflower, safflower, peanut, trans fats, etc).

Logan and Treloar argue in "The Clear Skin Diet" that we should follow the traditional Japanese diet which is low in fat, sugar, flour, and dairy and high in fish, vegetables, sea vegetables, rice, green tea, fruit, and soy foods.  They sound pretty similar to me and they both sound too me like a good diet to have anyways.

Too Little or Too Much Exercise 
I know what your thinking, too much exercise?  Yes exercising too much can cause acne if you are exercising to a point where you are creating too much stress on your body or in other words over training, also some forms of exercise can cause an increase in adrogens (male hormones).  On the other hand too little exercise can be a real big problem too.  The solution is to make sure to be very active every day, do activities you like and make sure to not have too long of workout sessions allow for proper rest and recovery in between work outs.  Having proper rest and recovery between work outs will also ensure you get the most benefit from your workouts with the less effort anyways.

Gut/ Brain/ Axis and Leaky Gut

Learn more about how to heal a leaky gut from Dr. Josh Axe

While mainstream medicine does not recognize a gut acne connection, many doctors such as Chris Kresser, Dr Josh Axe, and Mark Harman M.D, do believe there is a connection between gut health and skin conditions such as acne.  A leaky gut, or intestinal permeability, is a condition in which the walls of the small intestine become inflamed, damaged, and porous, allowing undigested foods, bacteria, yeast, and other pathogens into the bloodstream. Once these pathogens escape the confines of the intestines and hit the bloodstream, they trigger inflammation in the body and brain. This can be caused from medications (NSAIDs such as ibuprofen and aspirin, corticosteroids, chemotherapy, and antibiotics), food allergies (such as gluten), radiation therapy, and stress. If you are not sure if you have a leaky gut or not you can be tested for this by your doctor.  I have not taken this test myself.

• Delayed food allergies are among the most common causes of acne. Foods like gluten, dairy, yeast, and eggs can be problems if you have a leaky gut. 
• Taking probiotics (such as lactobacillus) can improve acne.
• Good bacteria from probiotics also take up residence on the skin, helping with acne.
• Avoiding medications that affect gut health (NASIDs, antibiotics, and corticosteroids).

Whatever the cause of acne, know that it is a symptom of a problem.  It is your bodies way of telling you something is off (assuming your not experiencing the normal teen acne which is due to temporary hormonal changes).  I urge you to try and explore what might be the reason for your adult acne, since finding it will not only help reduce your acne, but also improve your overall health. For example, finding out I have PCOS has helped me to realize potential health risk I might have, and to help avoid them.  I also think it's possible I might have a leaky gut, due to long term use of Ibuprofen (to deal with menstrual cramps from PCOS) and antibiotics (ironically to treat acne).  I base this on the fact that I have psoriasis, and have had long term use of antibiotics and ibuprofen.  Many in the alternative health field believe that psoriasis, an autoimmune disease, is caused by leaky gut.  Mainstream medicine does not recognize any cause yet of psoriasis.

Due to my findings of having PCOS, and possibly leaky gut, I have been able to adjust my lifestyle in ways that could possibly help my overall health.  I have stopped taking antibiotics and NAIDs for several years now.  I eat a low GI diet, and I am using biomimetic progesterone as prescribed by my doctor to treat my PCOS.  I also use 25 mg of zinc daily only when I start to break out until it clears up (zinc can build up in your system so you don't want to take to much).  My acne has gotten better but I still do have it.  I feel like my overall health has improved a lot.

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Disclamer
I am not a doctor, dietitian nor nutritionist. I have ZERO medical training and NO formal nutritional training.  The information provided on this site, such as text, graphics, images, is for informational purposes only. It is not to be construed as medical care or medical advice and is not a replacement for medical care given by physicians or trained medical personnel.  Always seek the advice of your physician or other qualified healthcare provider(s) when experiencing symptoms or health problems, or before starting any new treatment.