Many people assume acne is an issue that primarily affects teens. But, plenty of people experience acne well into their adulthood. It tends to be more common for those who had acne during adolescence, says Dr. Anar Mikailov, a board-certified dermatologist and the founder of KP Away. However, even if you didn’t have acne in your formative years, there are plenty of reasons why pimples are starting to pop up as an adult. Understanding what’s causing your breakouts can help keep them at bay. We dive into the science behind adult acne below, plus how to treat it.
Why Adult Acne Happens
Whether the occasional pimple pops up here and there or bumpy, inflamed skin becomes a regular occurrence, adult acne tends to manifest as harder-to-treat pimples because of inflammation, fluctuating hormones, genetics, and stress, amongst other things. But not everyone experiences full-blown cystic acne as an adult. Instead, the skin can experience more mild whiteheads and blackheads to moderate blemishes and papules or more severe, swollen, and inflamed cysts.
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Research shows that one in three women experience acne in their 30s, compared to about 20 percent of men. Women experience more drastic changes in hormone levels than men, which can account for why it’s a more notable occurrence, says Dr. Mikailov.
The Major Acne Triggers
It can be frustrating to think you haven’t ‘escaped’ acne once you’ve reached adulthood, says Dr. Hayley Goldbach, a double board-certified dermatologist and dermatologic surgeon at Brown University. Often, the causes of adult acne are the same as what happens when you’re a teen, but there are a few triggers specific to getting older.
Hormones: It probably comes as no surprise that right around your menstrual cycle is when the skin tends to experience the most amounts of flare-ups. But it’s not just your period that can cause acne — it can also happen due to pregnancy, pre-menopause, menopause from a spike, or a decrease in hormones. Dr. Kim Nichols, a board-certified dermatologist in Stamford, CT, says that much like teens, adult acne directly correlates to fluctuating hormones. “As we age, our bodies produce hormones slower and begin to produce more progesterone.” As a result, adult acne flare-ups are often the result of excess oil production triggered due to shifting hormones. “Women, especially, begin to produce less estrogen, vital for moisture retention. Without that moisture, the pores become dehydrated and crack open, inviting unwanted bacteria into the skin,” she adds.
Overactive sebaceous glands: Oily skin doesn’t stop once you become an adult, especially if the oil glands are genetically programmed to produce and pump out large amounts of sebum. Remember, sebum is one part of the recipe for acne, and an increase of it acts as food for the bacteria that causes acne. However, the plus side of oily skin is that it helps lubricate and hydrate the skin for fewer lines and wrinkles.
Stress: Stress is a significant driver of increased cortisol, which increases oil production. Dr. Goldbach explains that stress can affect the overall balance of hormones and result in breakouts. Stress also escalates the release of a hormone called cortisol, sending oil production into overdrive as a response mechanism.
Diet: What you eat is directly reflected in how your skin looks. “Diet can cause inflammation, primarily if it includes sugar and dairy, as spikes in glucose levels can lead to higher sebum production,” says Dr. Mikailov. “For young adult men, I often see acne related to dietary supplementation from workouts and muscle-building products,” Dr. Goldbach adds.
The wrong skincare products: Skincare is not one-size-fits-all,” says Dr. Nichols. “For example, you can’t borrow a friend’s regimen because your skin type and concerns are different, and that’s where the issue lies.” The introduction of unfamiliar formulas and ingredients can exacerbate and overwhelm the skin.
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How to Prevent Breakouts
While not every case of adult acne is preventable, there are several actionable steps to take which lessen the risk, severity, duration, and incidence of recurring breakouts. “Remember, acne has a large genetic component, so don’t blame yourself if it seems like you are doing everything right and you still break out,” says Dr. Goldbach. The key to thwarting and reducing acne is consistency — in your skincare routine (give the ingredient or product at least four to six weeks, if not longer) and your lifestyle. Your game plan isn’t too dissimilar from how you’d treat teenage acne, so here are some friendly reminders on how to address it:
Load up on a good prebiotic and probiotic: Incorporating a prebiotic and probiotic for adult acne patients can help put the skin on the path to clear since both work to balance the ratio of bad to good bacteria in the gut. But unfortunately, an imbalance of gut flora can also affect the skin’s microbiome, affecting breakouts. “There is exciting research in probiotics, which suggests that they can help treat and prevent acne,” says Dr. Goldbach. “In short, “bad” bacteria, called P. acnes, causes acne, so it’s important to have the proper balance between good and bad bacteria. Probiotics can help with this and have anti-inflammatory effects,” she adds.
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Exfoliate regularly: To get dead skin cells off the surface so they don’t become lodged in the pore and contribute to acne soup, don’t bypass regular exfoliation. However, you don’t need to exfoliate with anything harsh or irritating, and doing it about twice per week should suffice. Professional and at-home chemical peels once every four to six weeks are another option and help give an even deeper level of exfoliation.
Consider lasers: Whether you choose to see your dermatologist for an acne-busting laser or you want to go with the DIY route, blue light works wonders for killing acne-causing bacteria and inflammation fast. It essentially suffocates the bacteria and reduces redness to help clear up acne. On the other hand, red light tackles inflammation.
Stick to all-star ingredients: Get familiar with your product labels. Look for non-comedogenic and oil-free products to reduce your risk of clogging pores. Make sure to focus on hydration (with C.E.O. Afterglow Brightening Vitamin C Moisturizer) as excess sebum can result from your skin making up for lack of lubrication. And incorporate one of these powerful ingredients that prevent and treat breakouts:
Benzoyl peroxide: Works to decrease the number of acne-causing bacteria on the skin. However, benzoyl peroxide can dry out the skin, so make sure not to overuse it.
Salicylic acid: Part of the beta-hydroxy acid (BHA) family, salicylic acid helps break up the contents within the pore to minimize breakouts by getting deep within the pores — down to where it matters — to break up everything. However, if salicylic acid (and benzoyl peroxide or over-the-counter strength adapalene) do not improve acne after two to three weeks, your dermatologist may move you to a prescription-strength retinoid or another mode of therapy.
Retinol and retinoids: Vitamin A-derived retinol and retinoids should be a mainstay of any adult acne regimen since they speed up the rate at which skin cells naturally slough off for less dead skin on the surface and in the pores. Dr. Nichols often suggests prescription products containing tretinoin, a “first generation” retinoid, which is considered the most intense option for adult patients seeking immediate satisfaction. “Tretinoin can work relatively quickly to improve the skin’s tone and texture because it causes the cell turnover process to occur faster. Therefore, we see speedier results,” she explains.
Sulfur: If your skin is sensitive and can’t handle salicylic acid or benzoyl peroxide and you notice the skin getting worse, Dr. Macrene suggests buying an over-the-counter remedy with sulfur (like the Saturn Sulfur Spot Treatment Mask).
Spironolactone. Spironolactone is a blood pressure medication yet is often prescribed off-label to help with hormonal acne. It blocks increased testosterone levels, the male hormone found in females’ bodies that stimulates the oil glands, for marked improvement in adult acne driven by hormones.
Don’t fall into the trap of trends: Not every popular skin fad needs to be part of your routine, as many of them aren’t appropriate for all skin types. “For example, I’ve seen people discuss ‘slugging,’ which can clog pores,” says Dr. Goldbach. Acne-prone skin should avoid trendy skin treatments like this one.
Eat clean: A healthy, balanced diet rich in lean protein, fruits, and vegetables is best. Try and avoid or limit dairy and starchy carbohydrates, which are known to lead to acne breakouts. If a particular food causes your skin to react, it’s best to stay away from it. There are so many dairy-free alternatives than we had five or 10 years ago, making it a little easier to make some tweaks if dairy is the culprit of your acne.
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Stress less: While easier said than done, if stress is a common cause of your breakouts, try and do everything to stay calm and relaxed. Keeping stress levels in check comes down to instilling and practicing stress management, whether your outlet is meditation, working out, journaling, or something else.
And, as an FYI: In the event of a pimple, the best approach is a hands-off one, meaning don’t pop the pimples. All picking and popping do are further irritate the skin, spread the infection, and create long-term hyperpigmentation and scarring. Dr. Mikailov says he sees increased skin sensitivity and a higher frequency of post-inflammatory hyperpigmentation and scarring in adult women.
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