Written by Elizabeth Millard

Actress Keke Palmer, 27, [1] recently revealed to her Instagram followers that she suffers from persistent cystic acne[2] — a condition most of us might associate with hormonal teenagers. For someone who’s well past that awkward phase, getting acne can seem baffling.

But Palmer explained that she also suffers from polycystic ovary syndrome (PCOS), a condition defined by a hormonal imbalance. PCOS affects roughly 5 million American women.[3]

Knowing that her struggle with acne was tied to a medical condition, Palmer wrote, made her feel more committed to improving her overall health.[3] That’s because acne isn’t the only side effect of the disorder. PCOS can also impact fertility and is associated with weight gain as well as an increased risk of diabetes, high blood pressure, and high cholesterol. [3] Check your fertility from home now.

While PCOS is one potential cause of an adult breakout, there are a handful of others. Here are four of the most common culprits — and how to get the help you need.

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Unexplained Acne Culprit #1: PCOS

Considered common among women of reproductive age, [4]PCOS involves hormone fluctuations that cause such issues as prolonged or infrequent menstrual periods, weight gain, excess facial and body hair, and sometimes severe acne.[4] It can occur anytime between adolescence and menopause, and unless the hormonal imbalance is addressed, cosmetic treatments — like acne creams and medications — will give only temporary relief.[5; 6]

“When it comes to hormone changes that can affect the skin, people often think about either end of the age spectrum, like being a teenager or going through a shift due to menopause. But it’s important to know that women [can] have hormone fluctuations at any age,”[6] says Chesahna Kindred, M.D., a dermatologist at Kindred Hair & Skin Center in Columbia, Md.[6; 7] “Your skin is an indication of your underlying health, so knowing if hormones are the issue is important.”[6]

An at-home test, which provides a broad picture of your hormonal health in just five days, is a critical point for determining whether you have a hormone imbalance that needs to be addressed. Knowing your levels can help indicate any issues, which you can then follow up with an appointment with your healthcare provider for a full diagnosis. And while PCOS has no cure,[8] your provider can prescribe effective treatment paths, including weight loss and hormone therapy.[3; 4] For acne specifically, the medications there are many effective treatment options[5] Birth control pills can also help.[5]

Unexplained Acne Culprit #2: Stress

When you’re feeling overwhelmed, frazzled, or anxious for extended periods of time, your body — including your skin — can pay the price.[9; 10]

That’s because cortisol often called “the stress hormone” is produced in higher amounts when you’re feeling like you need to face down a threat. For our ancestors, that threat might’ve been an actual predator. But in modern times, particularly during this challenging pandemic era, your body responds to modern stresses — like looming work deadlines or money trouble—in the same way, it would if your immediate survival were being threatened.[9]

Fight-or-flight response aside, cortisol can also help you function more efficiently on a day-to-day basis.[9] For example, cortisol surges in the morning help energize you for the day,[11] explains David Cutler, M.D., a family medicine physician at Providence Saint John’s Health Center in Santa Monica, Calif.[11; 12]

But if cortisol levels remain high, your body enters a chronic stress phase, which can be coupled with headaches, insomnia, irritability, and, of course, acne surges. That’s because chronic stress causes you to produce more cortisol, which in turn prompts your skin to produce more sebum or oil.[9; 10; 11] Check your cortisol levels at home now.

Unexplained Acne Culprit #3: Thyroid Issues

When your thyroid gland is underactive, it can cause hypothyroidism. The Mayo Clinic notes that this condition can lead to fatigue, increased sensitivity to cold, constipation, weight gain, muscle weakness, and more. It can also contribute to dry skin,[17] which in turn may kick off an overproduction of oils to combat the problem, resulting in acne.[18]

If you’re dealing with persistent breakouts or any other symptom of a thyroid imbalance (such as those mentioned above), a test can measure key hormones and antibodies, letting you identify the presence of hypothyroidism or hyperthyroidism. Check your thyroid from home now.

Unexplained Acne Culprit #4: Micronutrient Deficiency

Although there is a connection between a high-fat, high-sugar diet and adult acne, [21]it’s not a causal relationship. If your diet is relatively clean and you can rule out the other conditions described in this article, a missing critical vitamin or mineral may be to blame for your breakout.

A test can highlight a range of potential micronutrient gaps, including minerals like magnesium, copper, selenium, and zinc, along with vitamins that help with skin health like vitamins E, D, and B12.[23; 24] Check for vitamin and mineral deficiencies from home now.

As Dr. Kindred notes, your skin is often an indicator of your overall health,[6] and it can offer warning signs when something deeper might be at play. If you’re struggling with acne, thinking about any additional symptoms, talking to your healthcare provider, and getting a relevant at-home test can be a safe, private, empowering step toward taking control of your health.

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  1. Instagram
    Keke Palmer
    Acne Post

  2. IMDB
    Keke Palmer

  3. Centers for Disease Control and Prevention
    PCOS (Polycystic Ovary Syndrome) and Diabetes
    https://www.cdc.gov/diabetes/basics/pcos.html#:~:text=PCOS is one of the,beyond the child-bearing years.

  4. Mayo Clinic
    Polycystic ovary syndrome (PCOS)

  5. Gainder S, Sharma B.
    Update on Management of Polycystic Ovarian Syndrome for Dermatologists.
    Indian Dermatology Online Journal 2019 Mar-Apr;10(2):97-105

  6. Chesahna Kindred, M.D.

  7. Kindred Hair and Skin Center
    Meet Dr. Chesahna Kindred

  8. PCOS Awareness Association
    Is there a Cure for PCOS

  9. Mayo Clinic
    Chronic stress puts your health at risk
    https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037#:~:text=The long-term activation of,Depression

  10. Cleveland Clinic

  11. David Cutler

  12. Providence St. John’s Health Center
    David Cutler MD

  13. Mayo Clinic

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  15. Centers for Disease Control and Prevention

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  17. Mayo Clinic

  18. American Academy of Dermatology

  19. MyThyroid.com

  20. American Academy of Dermatology

  21. Penso L, Touvier M, Deschasaux M, Szabo de Edelenyi F, Hercberg S, Ezzedine K, Sbidian E. Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study.
    JAMA Dermatology 2020 Aug 1;156(8):854-862

  22. Lim SK, Ha JM, Lee YH, Lee Y, Seo YJ, Kim CD, Lee JH, Im M.
    Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control Study Combined with a Randomized Controlled Trial.
    PLoS One 2016 Aug 25;11(8):e0161162

  23. Schagen SK, Zampeli VA, Makrantonaki E, Zouboulis CC.
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    Dermatoendocrinology 2012 Jul 1;4(3):298-307. DOI: 10.4161/derm.22876

  24. Harvard Medical School
    Harvard Health Publishing
    Vitamin B12 Deficiency

  25. Mayo Clinic
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  26. Pappas A.
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    Dermatoendocrinology 2009 Sep;1(5):262-7.