Adult Acne: Why You Get It, How to Fight It
Adult acne is more common than you think – and fairly easy to treat.
Adult acne can really put a crimp on your life. Last year, for instance, Christine Janssen considered posting a new photograph of herself on her business web site but ultimately resisted the idea. “With my acne, I just wanted to put a paper bag over my head,” says Janssen, 41, who runs a Manhattan marketing research company.
Skin problems afflict almost everyone growing up, but some never outgrow it, says Jonette Keri, MD, PhD, assistant professor of dermatology at the University of Miami Miller School of Medicine and chief of dermatology at the Miami VA Medical Center. She estimates that nearly 30% of women and 20% of men ages 20 to 60 (and beyond) are troubled by breakouts.
What Causes Adult Acne?
Adult acne is caused by sebum, an oily substance produced by the skin’s sebaceous glands. Sebum clogs pores, which attract bacteria and become inflamed. For some adults, breakouts are a result of hypersensitivity or overproduction of androgens (male hormones). But an imbalance in both male and female hormones (estrogen) can also cause breakouts. For women, this can happen during pregnancy, perimenopause, and menopause. Some medications, such as corticosteroids, and cosmetics can also contribute to the development of acne.
How Is Adult Acne Treated?
Treating adult acne is tricky. Most acne medications are geared to teens' oily skin, a bad choice for drier adult skin. Effective treatment often requires a trial-and-error approach that takes time, Keri says. Her recommendations include:
Cleansers: Cetaphil and Aquanil are the most gentle. Avoid too-strong gels and products containing beads or granules, which are abrasive and can irritate and worsen sensitive skin.
Creams and lotions: Use an over-the-counter retinol product to clean pores and help reduce fine wrinkles. Prevent discoloration and fade acne scars with products that contain salicylic and glycolic acids. And to spot-treat a breakout, use a product with benzoyl peroxide, which helps kill bacteria.
Prescription medications: The topical antibiotic clindamycin helps fight bacteria in the skin; so does tetracycline, another antibiotic, taken orally. Oral contraceptives and spironolactone, a blood pressure drug, can help balance hormones. A gel containing dapsone, an antibiotic, helps fight infection and inflammation involved in acne.
High-tech solutions: Laser and intense pulsed light treatments mainly target scars, but blue light therapy treatments kill acne-causing bacteria. These treatments are costly, though, so explore your other options first.
A Skin-Care Regimen for the Acne Prone
Believe it or not, there’s a trick to skillful face washing. To start, try to keep your face clean during the day. Then wash your face twice daily with the cleanser (if your skin is dry, try using water the second time). Use only warm water (hot water is drying). Wash for just 1-2 minutes (more can irritate your skin). And use your hands instead of a rough washcloth. (If you must wash with a cloth, choose one made for babies, so it’s as soft as possible.)
As for Janssen, she found that a doctor-prescribed regimen of gentle cleansing, oral antibiotics, and a retinol cream did the trick, and her new photo is now proudly posted on her web site. She says, “All my friends comment on how clear my skin looks.”
10 Myths and Facts About Adult Acne
If you lived with acne as a teenager, you probably heard all sorts of advice about why you developed acne and what you should do about it. “You eat too many potato chips!” “You don’t wash your face enough!” “Cut down on the chocolate!”
The fact is that most of what you thought you knew about acne as a teen -- and much of what you may think you know about adult acne -- is probably a myth. Here are some common acne myths.
Acne Myth 1: Adults don’t get acne.
Not true. Surveys have found that significant numbers of adults are still getting acne into their 30s, 40s, and even 50s. Acne may look different when you’re 36 than it did when you were 16 -- it’s more likely to be reddish nodules around your mouth and jaw, rather than whiteheads and blackheads scattered all over your forehead, nose, and cheeks -- but it’s acne all the same.
Acne Myth 2: Eating chocolate and drinking soda gives you acne.
“The diet controversy over acne goes on,” says Amy Derick, MD, FAAD, a dermatologist in Great Barrington, Ill. “The idea that chocolate and caffeine cause acne has never really panned out.” Some studies have suggested that milk products might influence acne, because of the presence of hormones and bacteria in the milk. “But the data isn’t that strong, and I don’t want to recommend that 30-year-old women cut out milk when they need it for their bone health.”
Acne Myth 3: Stress causes acne.
This myth may have some basis in reality, but it’s hard to quantify. “Some studies have found that college students have increased breakouts during finals, but it’s hard to be sure if it’s causative,” Derick says. Not all students with acne have increased breakouts during stressful times. "So maybe stress does play a role, but we haven't seen any good studies showing that stress hormones make acne worse."
Acne Myth 4: Don’t wear sunscreen, it will aggravate your acne.
You just have to pick the right sunscreen. Chemical sunscreens, like Helioplex, dissipate UV light using a chemical reaction, which may cause heat bumps. If you’re prone to acne, use a physical sunscreen like zinc oxide instead.
Acne Myth 5: You have acne because you’re not washing enough.
Unless you’re a slob, that’s probably not true. “Studies in teens show that washing your face twice a day is more effective than just once, but more than that isn’t necessary and can dry out your skin,” Derick says. “Cleansers are only on your skin for five seconds. Leave-on products like retinoid creams are more efficacious.”
Acne Myth 6: You can’t wear makeup if you have a breakout.
Some makeup can definitely exacerbate acne, particularly thicker liquid foundations that can clog pores and stage-type pancake makeup. “But lighter, looser powder foundations, like mineral powder, aren’t nearly as aggravating to your skin,” Derick says. “Of course, people who have acne want to cover it, and coverage is better with thicker liquids, but you have to compromise.”
Acne Myth 7: Acne is just a cosmetic problem.
Acne can have lasting consequences in how you feel about yourself -- and left untreated, or improperly managed, it can leave permanent scars.
Acne Myth 8: You just have to wait and let acne go away with time.
There are many treatments now available for acne, and dermatologists can prescribe the right option for you.
Acne Myth 9: You can “clean up” a pimple by scrubbing at it.
That’s actually the worst thing you can do. “People will spend hours trying to get goop out of skin to heal the acne,” Derick says. “But picking your skin is the number one way of getting a scar. If you have a huge pimple and a big date tonight, you can get a single injection from your dermatologist that will reduce it. Don’t pick!”
Acne Myth 10: If you’re an adult, just go to the cosmetics counter and get a good face cream or cleanser.
“People will go to their department store and get advice from the person behind the counter who’s selling products, but they won’t pay a co-pay to an expert who could give a real prescription for acne,” Derick says. “What dermatologists can do for acne is much more than these over-the-counter products. Especially if you have really problematic skin, our repertoire is much more diverse than just benzoyl peroxide and salicylic acid.”