8 common questions about acne, answered by dermatologists

When you think of acne, chances are you picture a young teenager in middle or high school — and you’re not wrong. Acne tends to happen during puberty and is often seen as a rite of passage into adulthood.

But acne doesn’t have an expiration date, and you can still get pimples in your 20s and even in your 50s. “Acne being a young person’s problem is a myth,” Dr. Elaine Kung, founder of Future Bright Dermatology and assistant professor of dermatology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, tells Yahoo Life. “I have seen acne in people as young as 8 to as old as 80.”

Here’s why acne can happen at any age, how certain foods and stress play a role in acne, and the best way to treat it.

No. 1: What causes acne?

Pimples form for several reasons. But the most common culprit is excess oil production that, along with dead skin cells, clogs pores, according to the Mayo Clinic. This can create an ideal environment for acne-causing bacteria to thrive, causing inflammation and infection.

That’s why the standard treatment for mild to moderate acne typically involves a one-two punch: benzoyl peroxide and/or a prescription antibiotic, which kills acne-causing bacteria, and a topical prescription retinoid (such as Retin-A) or salicylic acid (usually in the form of a face wash), which removes oil and dead skin cells to unclog pores.

Hormones play a role in the excess oil production that leads to breakouts. As you move from adolescence to adulthood, Kung explains, excess androgen levels and hormonal fluctuations increase oil secretions, making the hair follicles, aka pores, more prone to clogging and inflammation.

Your genetics can also determine how much oil your body’s sebaceous glands secrete and how easily hair follicles get clogged. In other words, if your parents had acne-prone skin when they were younger, chances are you’ll also have it.

Your skin care habits are another factor. Dr. Melanie Kingsley, associate professor of dermatology at Indiana University School of Medicine and dermatologist at Indiana University Health, tells Yahoo Life that you can significantly lower the risk of breakouts by washing your face twice daily — morning and night.

“Don’t wake up with all those oils on your face from bedtime and go on with your day or put makeup on without washing your face first,” she says. Likewise, before you go to bed, Kingsley says, you want to remove the dirt and oil that could clog pores overnight.

Kung explains that exposure to air pollution and high humidity can cause inflammatory acne breakouts. Even touching external items such as your phone and then your face can be enough to clog your pores if your hands are dirty. With the COVID-19 pandemic, there’s also the issue of “maskne,” as sweat and dirt from face masks touch the bottom of your face for long periods of time, causing acne.

Bottom line: There are multiple factors that can trigger acne. “There is never one singular factor people can eliminate to cure themselves of acne,” notes Kung.

No. 2: How long does it take for a pimple to show up on your skin?

On average, a pimple takes about two to six weeks to rear its head on the skin’s surface. However, “everyone’s unique in how their skin is sensitive to breakouts, oil and dirt,” says Kingsley. “Some people will tell you they never wash their face and are completely fine. Others go one night without washing their face and wake up with a pimple in the morning.”

No. 3: Is adult acne harder to treat than teenage acne?

Acne isn’t only a teenage problem — adults can get acne at any stage of life. In fact, the American Academy of Dermatology reports adult acne is rising and affects 15% of adult women.

Kingsley says some adult patients who see her for their acne say they never had it as a teen. If you’re someone who falls into this category, the most likely reason is because of hormonal changes. For example, some women entering menopause may experience acne because of the drop in estrogen and rise of testosterone levels. “I have a lot of patients in their 30s, 40s, 50s with acne who never thought they’d have to battle acne in their adulthood, but it is an issue throughout life for many people,” says Kingsley.

Coping with acne at any age is frustrating. Whether adult acne is harder to treat, however, is up for debate. On the one hand, both experts say that adults may be more compliant and motivated than teens to follow a daily skin care routine. Additionally, Kingsley says adults with stubborn cystic or hormonal acne can be prescribed medications such as spironolactone, which helps block hormones that cause acne.

However, Kung points out that if a lack of good skin hygiene and lifestyle choices — such as smoking, eating a poor diet, not getting enough sleep — are the reason behind the breakouts, it can be harder to break these habits because adults tend to be more set in their ways.

No. 4: Does pizza or chocolate cause pimples?

Diet’s role in acne has been hotly debated for years. While some can consume fried foods and chocolate without breaking out, others may notice a pattern of developing acne after eating certain foods. In general, Kung says, your skin’s health reflects your overall health. Eating foods that are high in sugar (especially white sugar), processed or greasy can increase the risk of inflammatory acne.

Kingsley says that while eating a lot of pizza or chocolate isn’t ideal for your health in general, one culprit to watch out for is dairy. There’s some evidence that shows dairy products such as cow’s milk and cheese promote inflammation and can influence acne. “Kids drinking a lot of milk or cheese tend to have worse breakouts because the foods are very inflammatory,” Kingsley says.

No. 5: Can stress make acne worse?

It’s not just a coincidence that breakouts appear when you’re under stress. Research suggests stress can trigger acne flares. Kung explains that during stressful events, such as a work deadline or financial problems, the body releases corticotropin-releasing hormone (CRH) and inflammatory cytokines to deal with the stressor. CRH promotes the production of an oily substance called sebum, which can clog pores and cause pimples.

Stress can have an indirect effect on acne as well. When people are stressed, priorities can shift, putting things like their skin care routine and other healthy habits, such as eating a balanced diet and getting a good night’s sleep, on the back burner. “They’re so stressed they’re not washing their face as much or not keeping up with their routine to spend more time on studying or meeting their deadline,” says Kingsley.

No. 6: Does putting toothpaste on a pimple make it go away?

Toothpaste is a popular home remedy for acne. Kung says the appeal stems from the fact that toothpaste has ingredients such as calcium carbonate that dry up the skin and shrink the pimple. However, she warns that toothpaste has plaque-removing abrasive ingredients such as silica that can irritate the skin. Silica can also worsen acne inflammation, making your face redder and more noticeable.

Instead, Kingsley recommends putting on a sulfur or benzoyl peroxide face mask and going to bed with it. The masks will help absorb excess oil and dry out dead skin cells clogging pores.

No. 7: Does tanning help clear up pimples?

Sunshine and drier weather can help with several inflammatory health conditions, so it’s not entirely surprising that it can also help clear up inflammatory acne somewhat, says Kingsley. However, she does not recommend going to a tanning bed or lying in the sun without sun protection to get rid of a few pimples since the risks outweigh the small benefits. “There’s so many melanomas and skin cancers coming from patients going to tanning beds, so I wouldn’t justify using it to treat your acne,” she says.

An alternative to tanning is red light therapy for acne, which is offered in dermatology offices. Red light therapy works underneath the skin to repair tissue. It also has anti-inflammatory effects to reduce redness. Another option Kingsley recommends is Isolaz, an FDA-approved light-based treatment that works like a vacuum to clear pores and then sends broadband light into the pores to shrink the oil glands.

No. 8: Can exfoliating help get rid of pimples?

While chemical exfoliation, such as from acids, can help remove dead skin cells and oils that can clog pores, it’s important not to overdo it. “Exfoliating too much, using too much topical medications or over-the-counter salicylic acid or benzoyl peroxide make your skin so irritated the acne gets worse,” says Kingsley.

The same goes for applying too much prescription retinoid. “A lot of people use Retin-A products and that’s very irritating because while it dries up the pores and shrinks the oil glands, at the same time it dries out the skin, which causes peeling, redness and dermatitis from that medication alone,” says Kingsley.

If you’ve been over-exfoliating or applying too much product, Kingsley says, it’s best to reset and go back to the basics. She suggests starting with a gentle cleanser and not exfoliating more than once a week. For retinoids, you don’t want to use more than a pea-size amount for the entire face, says Kingsley, who adds that you should apply a retinoid every other day or every third night for the first couple of weeks to see if your skin tolerates it. You can also mix it with an oil-free moisturizer to lessen any irritation until your skin gets used to it.

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