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Understanding and beating breakouts

Nearly 85% of us experience acne at some point-it’s s the most common skin condition in the world. But if you’ve left high school behind-maybe way, way behind-you probably think your pimply days are over. Unfortunately, many adults, mostly women, have acne well into their 20s and 30s and beyond, and most soon realize that the zit creams and potions that once worked well aren’t helping any more.

Adult acne typically involves deep, painful pimples and nodules (inflamed, hard lesions beneath the skin) that form on the lower face (most often around the mouth and along the jawline and chin), chest and upper back.

What’s behind adult acne

In adults as well as teens, acne occurs when excess oil (sebum), dead skin cells and bacteria are allowed to accumulate. In adults, it can be triggered by a few things:


  • Shifts in hormones around menstrual cycles, pregnancy and menopause
  • Medications, including some birth control pills as well as anticonvulsants and corticosteroids
  • Family history (roughly half of adult acne patients have a first-degree relative who had the same problem)
  • Stress


In addition, adult acne can be a sign of a more serious underlying condition: For example, acne accompanied by thinning hair and irregular periods might indicate polycystic ovaries, adrenal hyperplasia (a type of adrenal gland disorder), or even a tumor. If your acne is accompanied by these symptoms, talk to your doctor.

Some adults develop pimples as part of another skin condition called rosacea, which is characterized by persistent, patchy redness and inflammation on the nose and cheeks that typically shows up in your 30s or 40s. Rosacea is not the same as acne vulgaris, and should not be treated the same way. If you think you’ve got it, see a dermatologist.

Proper cleansing/skincare

Skip the scouring

Dermatologists universally discourage scrubbing (with gritty washes, pads, or other mechanical means, which only irritates skin and exacerbates inflammation. Instead, wash gently with a mild cleanser, twice a day (and anytime you’ve been sweating).

Be gentle.

Stick to gentle, alcohol-free products (skip the harsh astringents), as a dry, red face will only make pimples look worse. Address breakouts with targeted treatments from your dermatologist or the drugstore (see below).

Don’t be a picker.

Never (never never) squeeze or pick at pimples, as it leads to more inflammation (and scarring). Treat pimples as they arise, then let your skin heal naturally.

Lifestyle tips

Be careful with cosmetics

Certain beauty products can trap oil and bacteria against the skin and trigger breakouts. Look for oil-free lotions and cosmetics, and be sure to keep your hairspray and other styling products on your hair (and off your face).

Be smart with the smartphone

More and more dermatologists are reporting cases of acne on the cheeks, chin and temples (the ‘œphone zone’). Keep yours clean with window cleaner or disposable wipes (and use the same strategy with the land line).

Hands off!

Absentmindedly touching or rubbing your face can spread oil and bacteria-and definitely make acne worse.

Keep it clean

Wash your pillowcase regularly (every two or three days). If you use a washcloth or another cleansing device, be sure to clean it thoroughly after every use (that means using a freshly laundered washcloth every time).

Stay out of the sun.

Don’t buy into the myth that sunlight is good for acne-it’s not, and it’s really bad for the skin on your face as well as the rest of your body. Be especially careful if you’re using acne medications that can increase your sensitivity to UV light.

OTC treatments

Over-the-counter cleansers and spot treatments work in a few ways: by killing bacteria, eradicating excess oils or speeding cell turnover (the removal of old cells and the growth of new ones-or a combination of these things.

Benzoyl peroxide kills bacteria and removes excess oils and dead skin cells.

Salicylic acid slows shedding of skin cells to keep pores from clogging.

Alpha hydroxy acids (including glycolic and lactic acids) help to remove dead skin cells and reduce inflammation; they also stimulate the growth of new cells.

Prescription options

Topical treatments

Dermatologists often prescribe topicals that combine an antimicrobial (clindamycin, erythromycin) with benzoyl peroxide (which helps clear the pores) or a retinoid, which also speeds cell turnover.

Oral medications

Because hormonal swings are often a culprit in adult acne, many dermatologists prescribe contraceptives. Some doctors recommend combining a short course of oral antibiotics with a topical retinoid, then continuing with the retinoid after the acne is under control. If your acne is severe or resistant to treatment, oral isotretinoin (Accutane) can help; after an initial treatment, some adults can take the drug intermittently to keep their skin clear.

In-office procedures

Active breakouts

Dermatologists can treat active cases of acne with in-office laser and other light therapy treatments (such as photodynamic therapy, or PDT), which zap bacteria, plus chemical peels (to eradicate blackheads and pimples).

Acne scars

If your acne has left you with scars-depressions or raised spots-a dermatologist can treat them with chemical peels, dermabrasion, fillers and treatments such as intense pulsed light (IPL).

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