“Adult acne is often hormonal and tends to be cystic — so it’s the hard red bumps,” says Rebecca Baxt, MD, a dermatologist at Baxt CosMedical in New York City and Paramus, New Jersey, and a member of the American Academy of Dermatology (AAD). “It’s very frustrating, especially for women who didn’t have acne as a teenager or just had a little and wonder, Why am I getting pimples now?” RELATED: The Skin-Care Glossary Every Woman Needs to Have
Why Do We Get Adult Acne, Even if We Didn’t Get It as a Teen?
From genetics to lifestyle habits, a number of factors can trigger a breakout. “For both teenage acne and adult acne, there is strong evidence that the tendency for acne has been encrypted in our genes,” says Yoram Harth, MD, a board-certified dermatologist and the medical director of MDacne in San Francisco. Still, the type of acne you get as an adolescent is different from adult acne. “While adolescent acne will usually appear on the forehead and cheeks, the typical areas for adult acne are the lower jaws around the mouth and on the chin,” Dr. Harth says. If you have frequent acne breakouts as an adult, you’re not alone. According to the AAD, as many as 50 million Americans are dealing with acne at any given time. Here are some of the most common culprits: Hormones Fluctuating hormones around the time of your menstrual period or during pregnancy — or even during menopause — can lead to zits, according to the AAD. Androgens in men and women may contribute to acne breakouts. The AAD notes that these hormones send the oil glands into overdrive, changing those skin cells that surround your hair follicles. Stress When we’re stressed, our bodies produce more androgens. “I always joke with people: ‘I’ll give you a prescription for no stress,’” Dr. Baxt says. As a July 2017 review published in Acta Dermatovenerologica Croatica notes, emotional stress can set off a cascade of neurological effects that may trigger and worsen acne. In particular, the stress hormone cortisol may trigger sebum production, leading to breakouts, per an article published in June 2014 in Inflammation & Allergy Drug Targets. Family History If one of your parents or siblings has acne, you may have a genetic predisposition for it. “Severe acne with scarring definitely runs in families,” Baxt says. RELATED: 6 Common Misconceptions About Managing Acne According to an article published online in February 2018 in Clinical, Cosmetic, and Investigational Dermatology, having acne during adolescence increases the risk of adult acne, especially in women. While genetics can play a role in teen acne, your risk of getting acne as an adult is amplified if one or both of your parents had it, too. The same article cites past research suggesting that 53 percent of adult women with acne had first-degree family members who also had adult acne, as evidenced in one study. Other data, published in a January 2017 review in the Journal of Clinical and Aesthetic Dermatology, points to a greater connection, noting that as many as two-thirds of all adult acne cases are attributed to genes. Diet and Lifestyle An unhealthy diet with a lot of sugar and alcohol may make your acne worse, Baxt says. “I’m not going to say that they cause it 100 percent, but I do see a lot of people who improve their diet and their acne gets better,” she says. The American Heart Association (AHA) recommends a maximum daily intake of 6 teaspoons (tsp) of added sugars a day for women and 9 tsp per day for men. Keep in mind that sugar can be sneaky in food labels. Be on the lookout for these other names for sugar:
Corn syrupFruit juice concentrateHoneyMalt sugarSugar molecules, such as glucose, sucrose, maltose, and lactose
Your skin also doesn’t like other foods that can increase your blood sugar. An article published in April 2016 in Advances in Dermatology and Allergology suggests that the link between acne and foods higher on the glycemic index — meaning those most likely to spike blood sugar levels — may be strong. Foods high on the glycemic index include white bread, white rice, and white pasta, along with chips, cookies, and cake. The review published in the Journal of Clinical and Aesthetic Dermatology cites prior research that cow’s milk, especially skim milk, may be associated with a higher risk of acne lesions in adults. That may be because low-fat dairy products generally have more sugar than their whole-fat counterparts, says Harth. Lactose is another form of sugar. The authors suggested substituting nut milk, like almond milk, for cow’s milk if you think milk may be triggering your acne. Yet another dietary consideration is your daily sodium intake. “Some doctors suspect that sodium has consequences for skin because of iodine,” says Harth. The Advances in Dermatology and Allergology article notes there may be a link, though more research is needed. Still, limiting your sodium intake is part of a following a healthy diet and can help reduce your risk for high blood pressure, notes the AHA, which recommends no more than 2,300 milligrams (mg) of sodium per day and ideally a maximum of 1,500 mg of sodium per day. “To reduce iodine-rich salt, it is best to stick to low-sodium versions of packaged foods,” says Harth. RELATED: 10 High-Sodium Foods to Avoid
What’s the Best Way to Treat Adult Acne?
It goes without saying that managing stress, along with following a healthy diet and lifestyle, are among the controllable factors that can trigger acne. Trading in processed, high-carb, and high-sugar foods for whole plant-based ones can help get your skin on the right track. Aside from diet, it’s important to keep your stress level under control. Meditation, reading, and other relaxing activities can help. The AAD also recommends the following:
Wash your face twice a day. Also, be sure to use a cleanser after working out or after any activity where you’re working up a sweat.Avoid skin-care products that contain alcohol. These can be too trying for the skin and end up doing more harm than good.Shampoo regularly. If you have oily skin and hair, do so daily.Avoid direct sunlight and tanning beds. Too much sun can have a drying effect on the skin.Limit touching your face during the day. This action can spread oil from your hands to your face.
If you’re looking for a quick fix, beware. “People try all kinds of home remedies, and it’s only after a year or more that they then see a dermatologist," Baxt says. “That’s unfortunate because for adult female cystic acne, you need a doctor and a prescription — you can’t really treat it on your own.” Hath agrees. “Home remedies and natural products sound appealing but unfortunately have minimal value in acne treatment,” he says. “These natural products can irritate the skin or be just ineffective. If your goal is to get clear skin, you should be using topical medical-grade acne medications that are tested and proven to be effective. For people looking for natural treatments, the best alternative will be one of the new products that combine medical-grade anti-acne medications with natural boosters, such as aloe and witch hazel, to help clear your skin faster with less irritation than with regular anti-acne medications.” RELATED: The Best Natural Remedies to Add to (but Not Replace) Your Acne Treatment Plan A dermatologist may recommend birth control pills or prescribe spironolactone, a blood pressure medication also prescribed for acne, to help reduce breakouts, according to the AAD’s 2016 guidelines for treating acne. Or you may be a candidate for isotretinoin, a prescription medication for severe acne. There are also other options, like injections, oral or topical antibiotic treatments, laser and light treatments, and chemical peels, Baxt says. If you want to try over-the-counter acne medication options first, Baxt recommends this regimen: Use a 5 to 10 percent benzoyl peroxide wash once a day and a 2 percent salicylic acid wash once a day. Then alternate applying a benzoyl peroxide gel or adapalene gel — a prescription-strength retinoid treatment that’s now available over the counter — every other night. Keep in mind that benzoyl peroxide can bleach your pillowcase, and adapalene may make your skin sensitive to waxing and the sun, so sunscreen is a must, Baxt says. It may take two to three months of following any acne treatment program to see the full effects, she adds, so be patient. Oral contraceptives may also offer more long-term solutions to regular acne breakouts, thanks to the added hormones estrogen and progestin, which may help tame hormonal fluctuations that could contribute to your acne, according to the AAD. Be aware, however, that oral contraceptives can cause side effects, such as nausea and bloating, especially when you first start taking them, per the Mayo Clinic. Women over age 35 who smoke should also ask their doctors about the risk of blood clots when taking birth control pills, notes the AHA. More severe acne breakouts that don’t respond to the aforementioned methods may require a prescription from your dermatologist. The AAD notes that your dermatologist may prescribe prednisone to treat acne fulminans, a severe type of acne. For stubborn cysts or nodules, your derm may inject a corticosteroid into the affected area. For blackhead or whiteheads that aren’t responding to medication, your derm can use acne extraction to clear the blemishes. RELATED: 10 Things Your Skin Is Trying to Tell You — and How to Respond
The Key Takeaways on Preventing and Treating Adult Acne
While you can’t control your genes, you can control the diet and lifestyle habits that may contribute to adult acne breakouts. If you’re not seeing results, though, it may be time to see a dermatologist. “Treatment for adult acne should start with a medical-grade topical skin-care routine that is personalized for the skin type and acne severity,” says Harth. Additional reporting by Lisa Haney
