If you struggled with acne as a teenager, you probably remember the relief you felt when your complexion was finally pimple-free. Unfortunately, men and women in their late twenties and thirties often notice breakouts cropping up again. Roughly 20 percent of men and 30 to 50 percent of women will experience acne after age twenty. Are you stuck with spots forever? Where does acne come from and what can you do about it?
“Excess oil can clog hair follicles, which can then get infected with bacteria and create the inflammation that we see as a pimple,” says Alicea Wu, a primary care physician with One Medical Group in San Francisco. During adolescence, there’s a rise in androgen hormones that increases sebum (oil) production and leads to teenage acne. As puberty hormones balance out in your early twenties, you may find that your skin clears up.
While the cause of adult acne isn’t completely understood, hormones may still be part of the problem. Women often experience hormone-related premenstrual flares. Pregnancy and medical conditions such as polycystic ovary syndrome can also cause hormonal changes that affect the skin. In addition, other factors such as cosmetics, stress, medications, and diet may contribute to breakouts.
Eventually, adult acne will go away on its own, Wu says. Almost all acne clears up by age 50. But if you want to treat the condition, your doctor can help. And you probably don’t need a dermatologist. Your primary care doctor should be able to handle it. Unfortunately, there’s no quick fix. For chronic acne, a methodical approach works best.
Here’s what you need to know about treating adult acne:
- Be gentle. When you break out, your first instinct may be to pick at pimples and to scrub your face clean. That just makes matters worse, Wu says. Picking can cause scarring, and repetitive trauma to the face from over-cleaning aggravates acne. Instead, Wu recommends washing your face gently twice a day, using just the fingertips, with lukewarm water and a liquid cleanser such as Cetaphil. Also, avoid oil-based products, like liquid foundation, which can clog pores. Instead look for products labeled “oil-free” or “noncomedogenic.”
- Try a topical retinoid. Retin A is a derivative of vitamin A and may be one of the first treatments your provider prescribes. Retin A encourages new skin cells to regenerate. It also helps prevent the formation of blackheads and whiteheads. But it doesn’t work overnight. It may take weeks, or even months, to reap the benefits of Retin A, and during this time you may experience redness and peeling. The waiting period can be disconcerting, but hang in there. A secondary benefit of Retin A is its ability to reduce fine lines, which makes it a popular “anti-aging” skin treatment.
- Fight the infection. To address the bacterial element of acne, your provider might suggest using benzoyl peroxide or a topical or oral antibiotic in addition to a retinoid. These help treat the current infection and may prevent the bacteria from coming back.
- Manage your hormones. Many health care providers will recommend birth control for women to reduce acne. By balancing hormones (more specifically, by suppressing progesterone), oral contraceptives can prevent the overproduction of sebum that leads to clogged pores and pimples.
- Reduce stress. During times of stress, including lack of sleep, your adrenal glands kick up their stress hormone output, which can lead to increased production of sebum. Yoga, meditation, and exercise help reduce your overall stress levels so your body can maintain a healthy hormonal balance.
- Watch your diet. Theories abound about foods such as chocolate, wheat, coffee, and dairy causing acne. To date, there’s been no scientific proof that any one food causes acne. That said, many people have food sensitivities that can affect their skin. If you notice that you’re prone to pimples when you eat a lot of a particular food, eliminate it from your diet and see what happens. By closely observing your habits and your body’s response, you can help your provider treat your condition more effectively.