Acne is one of the most common skin disorders, affecting nearly 85 percent of Americans. Most people consider it kids' stuff - something that people outgrow.
      Statistics say otherwise.
      Over 10 years, the prevalence of adult acne has increased, according to a report in the Journal of the American Academy of Dermatology. The mean age for someone to begin treatment for adult acne has jumped from 20 to 26, according to the journal.
There have always been some adults who suffered from chronic acne beyond the teen years, but today treatment-resistant acne is more common, said Dr. Richard Fried, a Lower Makefield dermatologist who estimates that half his patients are adults with acne troubles.
      There are many theories about what is behind the increase - pollution, hormone-fed meats, bad diets and out-of-balance lifestyle.
      Among the biggest common denominators is stress, according to dermatologists, including Fried, who is considered a leading expert on the connection between skin and emotion, an emerging specialty area called psycho-dermatology.
The mental impact can trigger a never-ending cycle, Fried explained. The stress of living with skin problems leads to more stress and feelings of depression, emotions that have an effect on the body that can initiate or worsen skin problems.

LESS STRESS, FEWER ZITS

       Extensive research also shows incorporating stress management techniques into daily routines can reduce outbreaks of acne and other skin conditions and reduce the need for medical intervention, according to the American Academy of Dermatology.
      The better stress is controlled, the less likely the person will experience inflammation, which contributes to breakouts, Fried said.  For many people, the organ that is most sensitive and reactive to stress is the skin, the body's largest organ.

BLAME BIOLOGY

      Acne doesn't discriminate, but women get the worst of it. About 54 percent of adult women are afflicted with acne, compared to 40 percent of adult men, experts say.
      Blame biology. By nature, women experience greater hormone fluctuations due to oral contraceptives, pregnancy, menstruation or menopause. Women's hair follicles are also more sensitive.
      Add stress to this mix and it's a formula for flare-ups.
      Today women experience more daily stress than they did 20 years ago, but the body's response to anxiety is the same whether a person is being chased or nearing a deadline.
      When a person is stressed out, the heart beats faster. That causes the blood to flow faster and at higher pressure, which makes the organs work harder. The body works similar to a car engine - if the fuel is pumping too fast over a long time, it stresses out the engine parts and something breaks down.
      To add insult to injury, adult womens' skin is drier, more sensitive and less elastic than teenage skin, so it can more easily scar.
      Traditional dermatology, though, has focused on the physical problem - the sore, spot or bump - getting rid of it and controlling future outbreaks. What doctors have neglected is the emotional trauma of living with skin problem. Simply put, your skin can make you depressed, said Fried, who also holds a degree in clinical psychology.
      "If I'm miserable because I look at my face in the mirror, it sucks my energy,' he said. "It sucks my positive outlook on life."
      There is scientific proof and medical evidence backing him up, he added.
      Studies show the profound emotional and functional impact of acne increased levels of depression, anxiety that can affect social interaction and school or job performance.
      The combination of traditional acne treatment and stress-relieving exercises has helped a 60-year-old Lower Makefield woman, one of Frieds's patients. She admitted that at first she was skeptical that stress was the source of her skin problems.
      The occasional pimple resurfaced in her 20s and 30s, but once she reached her mid-40s it was as if she traveled back into her teen years.
      "What was I thinking? I don't know," she said. "Why is it happening? Why am I still dealing with this?"
      Her breakouts today are about the same as they were when she was a teen, usually a few zits on her cheeks and chin. "It's not there al the time," she said.
      The desire to hide those pesky pimples hasn't diminished. The woman recalled one time how she strategically held her hand over her chin during a presentation at work.
      "I think once they're there, they're there," she said. "It's not pleasant. But I probably worry more about the aging than the pimples, and I probably worried more about the pimples when I was 14."