Adult Acne: A Dermatologist’s Guide to Beating Breakouts

Adult acne is a thing. You are not alone if you are still fighting spots. Some adults continue to get acne well into their 30s, 40s, and even 50s. It is even possible to get acne for the first time as an adult.

In the same way that men bald in a certain pattern, adult-onset acne tends to affect the lower third of the face with red angry bumps and painful pus pimples along the jawline, chin, and neck. Hair follicles and oil-producing glands in this area are more sensitive to hormones, sending oil production into overdrive. Sound familiar?

Say “Hello” to your skin’s new puberty

But having a name for it and being part of a statistic is not helpful. You want to know: how do I get rid of it!

Clean up your diet

Ditch the dairy especially fat-free milk. It is sad but true that milk is not only pro-inflammatory, but also contains breakout triggers such as testosterone and Insulin-like Growth Factors. Skimmed milk interestingly is the worst culprit as it contains less skin-clearing estrogen than whole milk.

Plus, the lactose in milk is a sugar that stimulates insulin, the catalyst for a whole hormonal cascade resulting in more inflammation and oil production. High glycemic foods such as refined flour, sweets, and processed carbohydrates cause breakouts in the same way.

Work on your gut

Acne is often a red flag that there is an imbalance in your gut bacteria (we call this the gut microbiome). It is critical to reverse the overgrowth of ‘bad’ bacteria in the gut by avoiding inflammatory foods and replacing digestive enzymes while repairing your gut lining and upping your gut-loving fiber intake to feed the ‘good’ bacteria.

Reinoculating your gut with probiotics and fermented foods is important, but if introduced too early, it can worsen symptoms. Working with an integrative nutritionist is highly recommended.

Simplify your skincare regimen (and stick to it!)

The sheer number of products women (and increasingly men!) pile on may be to blame for “pomade acne”. This was originally described as pimple-causing hair ointments, but now refers to breakouts from any occlusive product which blocks your pores.

Too many active products can cause inflammation, which then leads to acne flares. By the time my patients reach me, they usually have a staggering list of products they have tried out of desperation. 

Work on stress management 

Stress and the cortisol spikes it causes can make your oil glands go haywire. Since stress is unavoidable, dependable stress management techniques are very important: whether meditation, working with a therapist, exercising, or just taking a long, hot bath with lavender-scented bath salts at the end of the day is what works for you. That ‘tired yet wired’ feeling is a warning sign that your cortisol levels are too high.

Check what medication you are taking

One of my first questions to my adult acne female patients is always: what contraception are you on? Are you using the Mirena – a progestogen-releasing IUD? Let’s be clear: Your skin does not like progesterone. That’s why your skin can freak out when you’re pregnant. Treating acne while still on the Mirena is like swimming upstream. Other culprits in adult-onset acne are antidepressants and anti-epileptic medications. 

Check your hormones

New-onset acne in adults can be a sign of excess androgens (think testosterone) produced by the ovaries and adrenals in women.

Hormone tests are important to check for hormonal imbalances found in Polycystic ovarian syndrome and menopause for example which could be triggering your acne.

Try over-the-counter solutions

Start slowly with an acne wash or topical gel containing salicylic acid or glycolic acid to help remove dead skin cells and clear out pores. If your skin can tolerate it, an over-the-counter benzoyl peroxide gel or wash can also be helpful for its anti-bacterial properties. 

See a dermatologist

If nothing clears your acne, see a dermatologist. Effective treatment is available. Often we will use combination therapy using prescription topicals with oral medication and in-house treatments such as peels and Forever Clear BBL light therapy.  With a dermatologist’s help and a bit of patience, virtually every case of acne can be controlled.