There’s no one specific cause of adult breakouts, as they can be related to several skin conditions such as acne, rosacea and periorificial dermatitis (POD), to name the three most common causes (with adult acne and rosacea leading the way).
Before we talk about these three in a bit more detail, it's firstly very important to acknowledge that the two most common conditions - namely adult acne and rosacea - are chronic skin conditions, not just self-limiting disorders that one has to endure for a short period of time. Recognising the chronicity of adult acne and rosacea also means that maintenance treatment and using the right skincare is integral for the management of these conditions.
Acne and rosacea are very common skin health issues affecting the female face. They can both present as inflamed breakouts of pimples and spots. Because both acne and rosacea can show up with spots, it is not uncommon that they are mixed up by laypeople and general healthcare professionals alike. In addition to these inflamed lesions, we need to look for some other symptoms which are more specific to either acne or rosacea. For acne, blackheads and whiteheads, medically known as comedones (laypeople may call them ‘congestion’) are a typical feature. With rosacea, we look for tiny broken capillaries, known as teleangiectasias and ask about facial flushing, which are all common features in rosacea prone skin (‘vascular rosacea’). However, it’s also possible to suffer with an overlap of both adult acne and rosacea.
Acne is one of the most common skin health issues dermatologists see. And we are increasingly seeing cases of adult acne which can persist into your 30s, 40s and beyond (or only start in your adult years). Sadly, even mild acne can have a significant negative impact on confidence.
You might think to yourself, “oh it’s only a couple of spots, it can’t be acne”. People commonly assume only very severe cases of pimples are considered acne. In fact, acne is merely a medical term for spots, pimples, blackheads and whiteheads, and the term itself has no relationship to the severity of the breakout.
Rosacea is another common facial skin problem in adult women. It’s easy to mistake with acne, both by patients and general healthcare professionals. Rosacea is more common in women than men and those fair-skinned types among us are particularly susceptible, that’s why it’s also known as the ‘curse of the Celts’, but any skin type can develop rosacea.
Rosacea can also show up with vascular changes such as redness, flushing and broken capillaries, either with or without inflamed spots such as papules, pustules, ‘bumps’ and ‘blotches’. Rosacea itself does not come with comedones (blackheads and/or whiteheads), as mentioned, but of course there may be an overlap with acne.
Less commonly, rosacea might also affect the eyes, causing them to become dry and gritty-feeling and the lids may become inflamed. The skin on the nose or other facial skin areas may in rare cases develop into a condition called phymatous, where the skin reddens and thickens, and pores appear enlarged. On the nose, we call this rhinophyma and if you’re familiar with the medical name for a nose job, you’ll understand why (‘rhino’ means nose in Ancient Greek).
Rosacea often appears mid-life, but this is not a given, it can appear earlier or later, too. Even if you never had acne as a teen, rosacea can come up later in life: patients often report being clear-skinned teens yet, now they’re in their forties, they’re seeing not only lines and wrinkles appearing, but also breakouts; not fair!
Coming in at third place for most common skin conditions causing breakouts in adult women is POD. POD was traditionally called perioral dermatitis, which refers to a rash around the mouth (‘oris’ means ‘mouth’ in Latin). But we sometimes also see the condition in other facial skin areas such as around the nose and eyes, so it’s now more accurately called periorificial dermatitis, meaning a rash around facial openings such as mouth and nostrils (‘orificium’ is Latin for ‘opening’).
POD is characterised by groups of tiny red bumps and is often accompanied by flaking. In contrast to acne and rosacea, this rash may feel a little itchy and the skin often feels tender, burning or tight. POD is more common in women than men and usually occurs in adults. POD can be caused by over-using rich skincare, neglecting to wash the face properly or using wet wipes instead of washing with water. Topical, inhaled or nasal corticosteroids can potentially also cause POD.