Your days as an awkward teen may be over, but that doesn’t mean your acne disappeared as you stepped into adulthood.
Adult acne is a common condition with a lot of possible causes and a lot of potential treatment options. According to the Canadian Dermatology Association, 20%–30% of adults between the ages of 20 to 40 experience acne.
Acne isn’t dangerous, but that’s not the point. Body image is an important part of our mental health, and acne that persists into adulthood can disrupt our self-confidence. Keep reading to find out what may be causing your adult acne and what you can do for clearer skin.
Adult acne is caused by a variety of reasons, so we’ll break it down by direct and indirect causes:
When the sebaceous glands of the skin make too much sebum — oil that hydrates the skin — your skin gets oily and you can get clogged pores.
Several factors can cause excess oil production, such as over-cleansing, pollution, certain skincare products, hormonal fluctuations, genetics, etc.
Sometimes oil production stimulates the production of bacteria, which can multiply and cause inflammation (redness and swelling). Whether or not the inflammation is near the surface or deeper inside the skin will determine the kind of acne: for surface-level inflammation, you’ll see a “pustule”, whereas “papules” (pimples) and cysts can develop when the inflammation is deeper.
You’ll see a whitehead when oil starts to break through the surface of the skin. If the oil becomes oxidized, that’s when you’ll see a blackhead.
After ovulation, the body increases its production of progesterone — which also increases your skin’s production of sebum (oil). Male hormones like testosterone, produced in people of all genders, can also increase sebum production.
Changes in hormone levels are also why acne gets worse around your menstrual cycle, during or after pregnancy, during perimenopause and menopause, and when you stop or start using hormonal birth control.
Stress — or the release of stress-related hormones as part of the body’s stress response — doesn’t cause acne alone, but it can make acne worse.
When people experience acute stress, they can scratch or pick at their skin, which exacerbates existing acne. When people experience chronic stress, they may be sleeping poorly, eating poorly, and ignoring skincare — all of which can make acne worse.
Skin and hair products
If you have oily or combination skin, make sure you’re using “noncomedogenic” products that don’t cause pore blockages (comedones). Oil-free, water-based products are best for oily skin.
Hair products may also cause forehead acne, because gels, creams, or sprays may linger on your skin all day after application in the morning. Also make sure you’re rinsing your hair properly after shampooing, as any leftover product can cause the skin to break out.
Medications like lithium, anti-seizure drugs, and corticosteroids can cause acne as a side effect.
Polycystic ovarian syndrome (PCOS)
PCOS is a hormonal condition that causes the ovaries to produce an abnormal amount of androgens, which then cause acne, hair growth, and weight gain. While the cause of PCOS isn’t known, many people with PCOS are insulin-resistant, which is also thought to trigger higher levels of androgens.
Your risk of acne increases if one or more of your parents have also struggled with acne at some point in their life. One twin study of women with acne found that acne is a “highly heritable disease with significant additive genetic effects.”
A note on diet and acne: It’s a myth that greasy foods cause acne, but small studies have found that a low-glycemic index diet may decrease acne severity because it lowers spikes in blood sugar, which are linked to inflammation.
Other studies suggest cow’s milk may also be linked to inflammation, so some people see an improvement in their acne if they avoid dairy-containing cow’s milk.
More research is needed, but you can try eating low-glycemic index foods and eliminating cow’s milk — always under the supervision of a healthcare provider — to see if it works for you.
There are several treatments for adult acne, and they come in three forms: topical medications, oral medications, and therapies.
Retinoids are derived from vitamin A. You can get them as creams, foams, gels, or ointments that you can apply to your skin.
Retinoids boost the production of new skin cells, which then push dead skin cells and excessive oil out of blocked pores. Retinoids also have anti-inflammatory properties.
Salicylic acid (BHA)
Salicylic acid is a beta hydroxy acid (BHA) that breaks the bonds between dead skin cells and reduces the skin’s production of sebum. Best for mild acne, it can take several weeks to work and you may see some dryness as a side effect.
Glycolic acid (AHA)
Glycolic acid is an alpha hydroxy acid (AHA) that works similarly to salicylic acid, but it’s considered more “intense”. Unlike salicylic acid, glycolic acid doesn’t reduce the production of sebum, but people who want to reduce hyperpigmentation and uneven skin tone may find it a better option.
Polyhydroxy acids (PHA)
PHAs are a newer class of AHA that work similarly to glycolic acid but with less irritation to the skin. They’re known for cleaning the surface of the skin without leaving behind much residue.
Benzoyl peroxide kills the bacteria underneath the skin, on top of unclogging pores by getting rid of dead skin cells and excess oil. Benzoyl peroxide works well for inflammatory acne (pustules, papules, cysts) as opposed to whiteheads and blackheads.
Dapsone (Aczone) 5% gel
Dapsone is part of a class of medications called sulfone antibiotics. It’s a topical antibiotic gel that works by slowing or stopping the bacteria growth while also decreasing skin inflammation.
Doxycycline (Doryx, Vibramycin, Oracea, or Adoxa)
Doxycycline is part of the tetracycline family of antibiotics (along with minocycline) that’s used to treat moderate to severe acne.
If you’ve tried to treat your acne with topical treatments and you’re not seeing any results, you can try doxycycline. The antibiotic fights bacteria and can treat severe acne on other areas of the body, such as the chest or back.
Doxycycline is one of the most commonly prescribed oral antibiotics for acne because it’s effective with minimal side effects.
Dermatologists have been prescribing birth control to treat hormonal acne for years.
Birth control pills that contain estrogen and progesterone lower androgens levels in the body, which results in less sebum production and less acne. They do come with side effects, however, so they work best for people who also want to use them for contraception.
Spironolactone is another kind of therapy for hormone-related acne, whether caused by PCOS or other hormonal fluctuations. When other acne treatments fail, people with female hormones can see improvements in deep acne on the lower face, jawline, or neck.
Spironolactone isn’t prescribed to people with male hormones due to possible side effects such as breast development.
It’s also recommended that people take spironolactone with birth control, as the medication can cause birth defects in the fetuses of pregnant women. Taking both pills at the same time can also increase the effectiveness of the medication.
Isotretinoin is used to treat severe nodular acne, and it should be used only after other medications have failed. It’s important that people who are pregnant or trying to get pregnant not use isotretinoin, as it can cause birth defects.
According to a 2009 study in Dermato-Endocrinology, most people who take isotretinoin are acne-free within four to six months, depending on the dose. Researchers found that a dose of 0.5–1.0 mg/kg/day reduced sebum excretion by 90% within six weeks.
For persistent acne, a dermatologist may recommend additional therapies that vary in price, efficacy, and time investment:
You may not be able to avoid adult acne altogether if you’re predisposed to it, but you can definitely improve your skin by following some general principles.
1. Don’t pop pimples. You can increase your risk of infection and scarring.
2. Wash your face no more than twice a day. Use an oil-free, water-based cleanser with a soft washcloth or cleansing brush.
3. Clean your skin after exercise that makes you sweat. Sweat doesn’t cause acne, but it can make it worse because bacteria love sweat’s moisture.
It’s important to remember that acne is a recurrent and relapsing condition that may always need therapy. Treatments can take months to see effects, so sometimes a therapy trial needs three to six months before you start to see changes.
Want to talk to a healthcare practitioner to explore options for taking care of your skin? Start your free assessment with Felix.
The views expressed here are those of the author and, as with the rest of the content on Health Guide, are not a substitute for professional medical advice, diagnosis, or treatment. If you have any medical questions or concerns, please talk to your healthcare practitioner.