Adult Acne: Your One-Stop-Shop Guide
I had the utmost pleasure of dealing with pretty severe acne circa middle school. Really, truly, the most fun. Fast forward through a little hormone regulation, some acne scar treatments, and the realization that throwing the kitchen sink at my face was not the solution, and my skin cleared up. Well, kind of, sort of. It’s more manageable, but, in my mid-20s, I’m still blessed with cysts along my jawline and inflamed, pus-filled pimples. It’s adult acne at its finest—a condition that approximately 15 to 50 percent of people over the age of 25 have to deal with. While my breakouts never really went away, it’s just as common to experience your first bout of full-fledged acne during adulthood.
It can be tricky to nail down exactly what prompted adult acne to come to fruition, but dermatologists agree that it’s typically rooted in hormonal fluctuations (read: pregnancy, stress, changes in medication). “Adult acne is similar to other types of acne in that it is caused by the clogging of pores and the overproduction of oil, but it's mainly hormonal and linked to changes at different stages in your life,” says Dr. Shereene Idriss, Board-certified Dermatologist, Founder of Idriss Dermatology in NYC, and creator of the #PillowtalkDerm series on Instagram. As such, getting flares under control is going to have a little less to do with reducing oil production and a little more to do with medications and lifestyle changes. To get allll the info, I tapped a handful of top dermatologists. Here, they’re running through what causes adult acne, how to treat it, and more.
What Is Adult Acne?
Contrary to popular belief, you don’t always just outgrow your acne once you graduate high school. Your breakouts can be persistent and follow you well into your adult years, or your journey with acne can have a delayed start. “Late-onset acne appears after the age of 25 with no history of adolescent acne,” says Dr. Robyn Gmyrek, a board-certified dermatologist at Union Square Dermatology.
Regardless of whether your acne never left or spontaneously arrived, you’re not alone. It’s actually pretty common—especially in women. “It’s estimated to affect 51 percent of women in their 20s, 35 percent of women in their 30s, and 26 percent of women in their 40s,” explains board-certified dermatologist Dr. Joshua Zeichner.
What Does Adult Acne Look Like?
“Adult acne tends to be generally mild to moderate in severity and to present with more inflammatory, red papules and fewer blackheads or whiteheads compared to adolescent acne,” explains Dr. Gmyrek. The location in which adult acne pops up is also going to be fairly distinctive—it’s primarily located in places that have less oil glands and, interestingly enough, are more prone to dryness. “It generally affects the lower face, particularly the jaw, the zone below the jawline, the neck, and sometimes the chest.”
What Causes Adult Acne?
Well, it’s complicated. And to be honest, there’s no hard and fast answer. “The pathogenesis of adult acne is very complex and remains incompletely elucidated,” says Dr. Gmyrek. “Genetics, the usage of occlusive cosmetics, oral or topical medications, diet, smoking, and chronic stress all have been noted as possible causes or triggers for adult acne.” Here, we’re breaking down a handful of possible causes, but please consult with your dermatologist if you’re looking for a personalized diagnosis.
Hormones
This is by and large the most common adult acne trigger. “Changing hormone levels due to menstruation, pregnancy, menopause, or discontinuing or starting birth control pills can cause adult acne,” explains Dr. Idriss. Reason being, these life events switch up the level of androgen and estrogen flowing through your body. All of these changes can have an impact on the way your skin functions. “Androgen hormones like testosterone, have a significant impact on oil glands,” explains Dr. Zeichner. With more oil, you’ll consequently have more inflammation—both which can lead to the development of acne.
Genetics
You’re going to hate this answer, but your adult acne could just be in your blood. “Those with adolescent acne and a strong family history are more likely to have adult acne,” explains Dr. Gmyrek. Why is this the case? There’s not too much research to explain the ins and outs (le sigh), but a connection has been established.
Heavy Creams
When sudden acne occurs, it’s time to take a close look at any new products that have made their way into your routine—one of them could be the culprit. “Hair products, skincare products, and makeup which are comedogenic can clog pores and cause acne,” says Dr. Gmyrek. Be on the lookout for products containing oils, like coconut oil, olive oil, mineral oil, or jojoba oil, vitamin E, petrolatum, and silicones.
Medications
Do a status check on any new medication in your routine. “Oral medications, including corticosteroids, anabolic steroids, and lithium, can also cause acne,” says Dr. Gmyrek.
Diet
I like sugar and sweets as much as the next person, but unfortunately all those brownies and cookies and sugary fruits could be the source of your cystic breakouts. “Diet, which can influence inflammation throughout the body, can cause acne. Studies have shown that sugary products, sugary beverages, high-glycemic-index foods and milk (particularly skimmed milk) was consistently found to be associated with the presence of acne,” says Gmyrek. Dr. Zeichner adds that whey protein and vitamin B12 have also been linked to breakouts.
Stress
Run a bath and turn on your Calm app—a highly stressful time or situation could cause your skin to go haywire. “Physical and mental stress increase cortisol and androgen hormone production. These hormones stimulate the oil glands and hair follicles in the skin, which can lead to acne. Stress also activates the immune system, which can promote inflammation,” says Dr. Gmyrek.
How to Treat Adult Acne
Treatment, in large part, is going to depend on what’s causing your adult acne. For some, simply switching out a comedogenic moisturizer might do the trick, while others will need a prescription from a dermatologist. For the best course of action, consult with your doctor.
Pick Oil-Free Products
Controlling teenage acne is typically all about controlling oil production with topicals—that’s not necessarily the case with adult acne. “Adult acne should be approached less aggressively with topical products in adulthood, versus adolescence, as the skin tends to be less oily overall,” says Dr. Gmyrek. That said, you'll still want a lineup of products that are non-comedogenic and oil-free. Steer clear of facial oils and heavy creams.
Choose Skincare With Acne-Fighting Ingredients
More mature skin is still going to need a hefty dose of hydration—skin gets drier with age. But if you run on the oily side or find yourself dealing with whiteheads or blackheads, acne-fighting ingredients can be a saving grace. “Benzoyl peroxide, salicylic acid, and retinol are three ingredients you should definitely incorporate into your routine if you have acne,” says Dr. Idriss. “Benzoyl peroxide works by killing the bacteria that can contribute to the development of acne and by reducing inflammation. Salicylic acid is a beta hydroxy acid (BHA) that works by exfoliating the top layer of skin and by breaking down the bonds that hold dead skin cells together—this helps to unclog pores and prevent the formation of acne. Retinol is a vitamin A derivative with powerful skin-renewing properties. By increasing the turnover of skin cells, it helps to unclog your pores and clear your skin.” All sounds pretty good, right?
Aside from the big three, you can also look for products with niacinamide, which can control oil and decrease inflammation, as well as sulfur, which will likely be non-irritating for those with sensitive skin.
CeraVe Acne Control Cleanser
Differin Gel Adapalene Gel 0.1%
DWD Beauty Exfoliation Night
Jori Daily Leave On Acne Treatment Mask
Eat a Low-Sugar Diet
Because sugary foods can cause breakouts, it’s best to limit them on your journey towards clear skin. “It is thought that sugary foods and milk raise levels of a hormone called Insulin Like Growth Factor (IGF) which leads to inflammation in the body and stimulates the production of androgen hormones, which are associated with the production of oil and the development of acne,” explains Dr. Gmyrek. As such, eating a low inflammatory, sugar-free diet can help keep your hormones in check and your breakouts at bay.
See a Dermatologist
Under no circumstances can you go wrong seeing a dermatologist. They’ll always know best and be able to give you accurate and personalized recommendations. But if you’ve been self-treating with over-the-counter products for a little more than a month and see zero progress, it’s 100 percent time to make an appointment—you may need something stronger. “Prescription, topical or oral medications might be needed to help get the skin under control,” says Dr. Zeichner.
There’s also the possibility that there’s an underlying systemic issue causing your acne, and as such, a doctor’s diagnosis is imperative. “If you note hair loss on your scalp, excess hair growth on the face or chest, irregular menstrual cycles, or rapid weight gain or loss in addition to persistent acne, you should seek medical consultation and be evaluated for polycystic ovarian syndrome, or other endocrine disorders,” says Dr. Gmyrek.
Try a Prescription Topical
The products you scoop up at the store may just do the acne-fighting trick, but it’s also possible you need the heavy duty stuff. Your dermatologist can write a prescription for a serum, gel, cream, or pad that comes at higher, stronger concentration than you can buy on your own. Dr. Gmyrek explains that she might consider giving an adult acne patient a stronger retinoid, a topical antibiotic lotion or pad, prescription strength azelaic acid (it unclogs pore and decreases post-inflammatory pigmentation), topical dapsone (which is anti-bacterial and decreases inflammation), or something called Winlevi. “It’s a one percent topical androgen inhibitor that targets the acne hormones in the skin, decreases sebum production and reduces inflammation. It can help treat your acne, but the exact way it works is unknown.”
Try an Oral Prescription
If your breakouts fall more into the cystic or inflammatory papule category (think: deep and painful) and are hormonal in natural, an oral prescription might be the solution. Dr. Gmyrek explains that options run the gamut and the right medication will be decided by your dermatologist. For some, a short-term antibiotic like doxycycline or seysara, which are used to kill bacteria and decrease inflammation, can be useful to get breakouts under control in a short amount of time.
But in the long run, your doctor might want you on a different form of hormonal regulator, like oral contraceptives, aka birth control, or Spironolactone. “Spironolactone is an effective treatment for women suffering with adult hormonal acne,” explains Dr. Idriss. “It works by blocking the effects of androgens, the hormones that contribute to the development of acne.”
An additional option is to go on Accutane, or oral isotretinoin. “This is an oral retinoid which can decrease oil gland production. It can give a longer-term remission of acne but requires a five to six month course and monthly monitoring for side effects,” adds Dr. Gmyrek. For more information on Accutane, read our comprehensive guide.
Consider a Laser
Historically, lasers were reserved for treating post-inflammatory hyperpigmentation (the dark marks left behind by acne), but thanks to new advancements, there is now a laser that actually targets active acne. It’s called Aviclear and it “targets the sebaceous glands with laser light,” says Dr. Gmyrek. It requires three treatments, three weeks apart—and the results are promising. “80 percent saw 50 percent of acne clear at three months and 87 percent had 50 percent of acne cleared at six months,” she adds. Plus, it can be used on all skin types and tones.
Spontaneous Recovery
I wouldn’t recommend just sitting and waiting until your adult acne poofs and disappears—but it does happen. “Some people can eventually snap out of it,” says Dr. Idriss. While you can get clear skin out of left field, it’s still important to have a solid routine or you’ll be left with residual marks, scarring, and post-inflammatory hyperpigmentation. “A targeted skincare routine is important to help control and minimize unwanted effects.”
On the flip side, if medication has your acne under control, don’t take that as a sign to go cold turkey. “The biggest mistake you can make is to stop using your medications after your face clears. If you stop using your medications, your skin will go back to do what it is genetically programmed to do, leading to breakouts,” says Dr. Zeichner.
