Acne affects millions of people each year.

Commonly prescribed medications and creams often come with undesirable side effects. Making small changes in diet and adding specific supplements to your daily routine can significantly improve acne.  This article reviews adult acne and highlights the science-based recommendations you can follow to start seeing clearer skin.

Adult Acne Overview

Annoying acne breakouts are no fun, but chronic acne can take a physical, mental, and emotional toll on your health.

Acne is the presence of pimples, usually on the face, due to clogged pores in the skin.

Though typically thought of as a teenage affliction, acne affects millions of adults every year. Acne after age 25 is considered adult acne. Adult acne may have a different disease course and treatment than teenage acne (1). The lesions can persist from adolescence or begin to appear in adulthood.

Acne can present as whiteheads, blackheads, pustules, papules, cysts, or nodules. Adult acne usually presents with more inflammatory type lesions than teenage acne. It is usually found on the lower third of the face and sides of the neck (1).

In 2015, acne affected almost 10% of the population worldwide (2). Acne is more common in people of African American and Hispanic descent (1).

Common Causes of Acne

It is widely accepted that acne is, at least in part, an inherited condition.

Diet, lifestyle, and toxin exposure (like pesticides and herbicides) may all play a role in worsening acne.

While the exact causes of acne are still under investigation, there are four factors at play (1):

  1. Increased oil production by skin glands
  2. Abnormal shedding of skin cells that build up in pores
  3. P. acnes bacteria settling in the duct
  4. Inflammation

For many people, there also appears to be a hormonal component causing acne. Fluctuating levels of testosterone, estrogen, and other hormones throughout a woman’s monthly cycle stimulates sebum production (1). Men naturally have higher amounts of testosterone than women. However, when testosterone levels increase too much, as in the case of steroid use, acne can develop or worsen.

Common Treatment Options

Common treatments for acne include topical retinoids and oral medications.

Medications for acne may include Accutane and broad spectrum antibiotics (3). Certain antibiotics that can treat acne have the potential to cause undesirable side effects. Some of these side effects include antibiotic resistance, inflammation of the large intestine, skin color changes, and liver dysfunction (3). Discuss these options with your dermatologist to find the right fit for your needs.

The Diet-Acne Connection

While it is unclear if diet causes acne, several studies show that diet may influence its severity.

Diet and Acne

A high-calorie, high glycemic diet may worsen acne.

High glycemic foods like white breads and pasta, cakes, cookies, and desserts increase sugar levels in the bloodstream. This increases production of the hormone insulin and insulin-like growth factor-1 (IGF1) (1). IGF1 affects the amount of sebum on the skin and feeds the P.acnes bacteria (1). Higher levels of IGF-1 are found in those with adult acne than without it. Increased IGF-1 levels in the body not only stimulates sebum production, but also leads to the build up of dead skin cells in the follicle, both of which are factors in acne’s course (1).

In one study of 43 males with moderate to severe acne were assigned either a low glycemic load diet or a high glycemic load diet for 12 weeks. After 12 weeks, those in the low glycemic load group had decreased total lesion counts, decreased levels of acne relevant sex hormones, and decreased circulating insulin-like growth factor 1 (4).

Refined sugars and carbohydrates, milk products, and saturated and trans fats have the ability to raise IGF1, raise and lower androgenic sex hormones (like testosterone), and increase sebum production (1). On the other hand, omega-3 fatty acids, like those found in fatty fish (salmon) or nuts and seeds (chia, walnuts, flaxseed) have the ability to decrease sebum production and decrease the inflammation associated with adult acne (5).

Microbiome and Acne

Gut health is a factor in the course of many conditions, including acne.

Bacteria in the gut performs numerous roles like building immunity and creating intestinal lining integrity. In a normal gut, there is a balance of good and bad bacteria. However, many disease states like depression and rheumatoid arthritis, have links to bacterial imbalances. Achieving balance can be achieved through dietary change.

The gut microbiome and skin health are intricately related. One study showed that supplementing with the probiotic Lactobacillus rhamnosus resulted in an improvement of acne. In a 12-week randomized, double blinded, placebo controlled study, participants were given either a probiotic supplement with Lactobacillus rhamnosus at a dose of 3×109 cfu/day or a placebo supplement without probiotics. The probiotic group showed a greater improvement in acne after 12 weeks than did the placebo group. This was likely due to the probiotic’s effect on expression of genes involved in the development of acne (7).

A prospective, randomized, open-label study of 45 females studied the impact of taking probiotics and antibiotics on acne. Those who took the antibiotic for acne with the probiotics Lactobacillus acidophilus and Bifidobacterium bifidum experienced a greater decrease in number of acne lesions and less side effects than the group taking antibiotics alone (8).

Supplements for Acne

Green tea and fatty acid supplements may help decrease inflammatory lesions in adult acne.

One component of green tea called EGCG can decrease the number of inflammatory acne lesions. In a randomized, controlled study, participants with moderate to severe acne got either a placebo pill or a 1500 mg decaf green tea supplement containing 856 mg of EGCG . After 4 weeks, the group receiving the green tea extract showed significantly less inflammatory acne lesions than did the placebo group (3). The extract decreased lesion counts on the nose, mouth, and chin of adult women.

A randomized, controlled trial showed that a high quality fish oil supplement or GLA (gamma-Linoleic acid) supplement helps decrease acne lesions in mild to moderate adult acne. When compared to a placebo group, a twice-daily capsule of 1,000 mg of fish oil containing 500 mg of EPA and 500 mg of DHA improved acne. A twice-daily capsule of 1,000 mg borage oil and 200 mg GLA resulted in overall acne improvement similar to the that of the fish oil (9).

An observational study looked at 5 people taking an omega-3 supplement containing EPA, green tea extract, zinc, selenium, and chromium. 4 out of 5 people saw a reduction in the total number of acne lesions. All participants in the study saw a decrease in inflammatory lesions after two months (6). Though small and not placebo-controlled, these reports suggest the power of certain nutrients on acne. More research is necessary to confirm these findings.

Key Takeaways

Choosing to increase specific foods/nutrients while decreasing others may help improve adult acne.

Foods to Decrease/Avoid:

  1. Avoid added sugars and highly processed carbohydrates like white breads and pasta, cookies, cakes, and desserts
  2. Avoid foods high in saturated fats and trans fats found in candy bars, chips, and pastries
  3. Reduce cow’s milk intake due to its ability to increase sebum production

Foods to Increase:

  1. Increase your intake of omega 3 fatty acids. These foods include salmon, mackerel, herring, trout, tuna, walnuts, ground flaxseed, flaxseed oil, hemp seeds, hemp oil, chia seeds, pumpkin seeds, and sesame seeds.
  2. Choose low glycemic carbohydrate foods like whole grains, legumes, nuts, seeds, and non-starchy vegetables.
  3. Increase intake of fruits and vegetables. Aim to “eat the rainbow” everyday to get a variety of nutrients good for skin health. These include vitamins A, C, D, E, Zinc, Selenium, and Chromium. Eating a range of colors from green to red to yellow provides the widest range of anti-inflammatory plant nutrients.  

While acne can cause physical, mental, and emotional pain, there are daily habits that can make a difference in acne severity. Eating an overall anti-inflammatory diet, improving gut health, and avoiding inflammatory foods may help improve adult acne.