Adult acne is a difficult issue that is often faced in a medical skin care practice.  There are many causes put forth for this condition, but in the end, most adult acne is cosmetic acne. 

The majority of the acne that occurs after adolescence is caused by cosmetic products.  Also, teenage acne and acne rosacea in adults are often made much worse by cosmetics.  Most patients will not have problems with these products, but it seems that about 5-8% of the population will react to certain cosmetic ingredients.  By evaluating the cosmetic products a patient uses and carefully selecting the proper replacements, patients can get the best results from the treatments offered in the medical office. 

The primary culprits in adult acne are cosmetics and hair care products that contain fragrances, plant oils, and plastics.  Fragrances can cause contact reactions, which can lead to the development of acne.  Plastics and plant oils can plug pores, particularly the larger pores in the chin and peri-nasal areas.  Acne is caused by anaerobic bacteria.  These are bacteria that prefer to live in an environment where there is no oxygen.  When pores are plugged, on oxygen-deprived environment is created, and those bacteria flourish causing visible pimples, greasy red areas and cysts. 

Most medical skin care practices have developed their favorite approach and products to help clear up acne in these adult patients.  By evaluating the patient’s choices of cosmetics and eliminating potential offenders, you can enhance the results of your current approach. 

Patients should avoid using products with any fragrance on acne prone areas of the body.  Not all fragrances are a problem, but have the patient eliminate all fragrances until their acne has cleared.  Then, if a fragrance, or a product containing a fragrance, is really important to the patient have them spot test any cosmetic products for a couple of days. 

Plant oils such as aloe, Vitamin E, coconut oil and even baby oil should be avoided.  Pure mineral oil, used sparingly, does not cause acne.  Many products used in medical skin care lines do contain some of these products.  Again, 90+% of patients will do fine with these products, but for patients with acne prone skin, these can be the offending ingredients. 

Lastly, the most overlooked acne causing products are hair care products.  Conditioners, hair sprays and hair gels almost all contain plastics, which can block pores and cause breakouts.  The ingredients to be aware of are PVP, CVP and any copolymer ingredient.  Scalp breakouts and chin acne (it is very common for a person to touch their hair and to touch their chin) are good indications that hair care products are the offenders.  Many waterproof, sweat proof, or smudge proof cosmetics and sunscreens also contain these plastics. 

Try to have a patient eliminate any of these products from their daily routine.  Begin them on a skin care program that includes a good exfoliant, such as glycolic acid, aha’s or afa’s, and perhaps include a topical or oral antibiotic.  If cosmetics are the cause of the patient’s acne, they will usually clear up within 1-2 weeks.  Then having them switch to more appropriate cosmetic products will help prevent future breakouts. 

What cosmetic products can be recommended? 

Shampoos – Standard dandruff shampoos (non-conditioning)
Conditioners – Avoid all containing any plastics
Hair Sprays/Gels – Those containing PVP or CVP esters in my experience seem to be less problematic, but they should be non-aerosol and unscented.
Soaps – standard dermatology recommended soaps for sensitive skin, containing little or no fragrances.
Makeup and Foundations – if possible, avoid until patient is clear.  If not, water based matte or velvet finish products are a little better than others.  Avoid powders and “smudge proof” products.

Products of these types are difficult to find.  Still, for patients where cosmetic acne is the problem, the results can be very dramatic and provide you with very loyal patients.