Despite what you see in popular culture, acne isn't just a problem for adolescents and young adults. Whether it's caused by hormones, stress or lifestyle choices, acne breakouts are just as much of a frustration for adults. Dr. Luzheng Liu, NorthShore Dermatologist, offered tips and insight into the different causes and possible solutions for various forms of acne in an online chat. Below, she answers some more common questions and further explains how your diet can impact your skin.  

Is it common to have more acne as an adult than during childhood/adolescence? What are some causes in adults?
Yes, common. Most common causes in adults are monthly hormonal fluctuation in females, polycystic ovarian syndrome patients, or rosacea (which appears similar to acne but not identical, less common in teens compared to adults)

Does the location of the acne tell you about the cause?
If acne mostly occurs on lower cheeks, along jaw line, chin – this is most likely hormonal in female, and related to shaving in male.

How does a dermatologist determine the right regimen for treating acne?
By examination of patients at the clinic. Based on the history, morphology, distribution, age, other medical problem, dermatologist will discuss right regimen with patients and make a treatment plan together with patients.

Is hyperpigmentation the same as acne scars? What makes it different?
No, many different types, based on the causes, color, distribution. Patients needs to see dermatologist for evaluation if it’s not from acne.

Do dermatologists ever recommend medical spa treatments (peel, microdermabrasion, etc)?
I do, but some dermatologists may have different view for medical spa.

Are there any foods or diets that are particularly good or bad for adult acne?
Yes, please see below:

The Role of Diet in Acne

Although initially considered controversial, recent studies have prompted dermatologists to revisit the link between diet and acne. The strongest evidence to date suggests the following:

High glycemic index (GI) diets appear to exacerbate acne

• Glycemic index has to do with a food’s potential to increase blood glucose and insulin
• Ingestion of high GI foods triggers a cascade of endocrine responses that may promote acne through androgens, growth hormones and cell signaling pathways
• Foods with a GI < 55 are low – consider adding these foods to your diet
• Low GI foods include peanuts, low-fat yogurt, apples, kidney beans, most vegetables, multi-grain brain, cherries and sweet potato
• Foods with a GI >70 are high—try to avoid these foods when possible
• High GI foods include white bread, white potatoes, watermelon, doughnuts, dates, chips, cornflakes

• Certain dairy products may make acne worse, especially skim milk
• Although the mechanism remains unclear, hormones and/or growth factors in dairy products might be the culprit 
• Try some dairy-free alternatives that also have a low GI: Almond milk has a low GI (30), and is low calorie and cholesterol-free
• If you eliminate dairy altogether, make sure to supplement with calcium and vitamin D

Weaker evidence suggests the following factors might play a role in acne:

• Acne patients might have an increased burden of systemic oxidative stress, and thereby antioxidants (vitamin C, green tea) might be helpful in acne. The relative intake of omega-6 to omega-3 polyunsaturated fatty acids appears to be an important modulator of inflammation. Eating foods rich in omega-3 fatty acids, or taking fish oil supplements with 1000-2000 mg/day of EPA or DHA (important omega-3 fatty acids) might benefit both acne and mood.
• There exists a gut-brain-skin unifying theory suggesting that intestinal microflora might influence the skin and the brain. Eating yogurt with “live cultures” or taking a daily probiotic supplement containing Lactobacilli and/or Bifidobacterium might have a positive influence on the skin and the mind.