Adult Acne

(RxWiki News) Here’s what you need to know and what to do if you are prone to adult acne.

If you thought that when you bid adieu to your teenage years, you also said adios to acne, think again. Acne afflicts many adults, particularly women—some into their fifties.

  • In some cases, acne just doesn’t go away after adolescence (“persistent acne”).
  • In others, it appears for the first time in adulthood (“late-onset acne”).

Adult acne can affect self-confidence and quality of life. So, if you’re prone to pimples, here’s what to know and do.

Can you blame your hormones?


  • Acne begins when glands at the base of hair follicles secrete too much sebum, an oily substance that lubricates the skin.
  • The problem is not the oil itself (which simply gives you oily skin), but rather that excess amounts, along with dead skin cells, can clog the follicles, causing whiteheads or blackheads.
  • If bacteria on the skin invade the clogged follicles, the follicle wall can rupture, resulting in redness and inflammation—that is, a pimple.

The flood of androgen hormones that occurs in both teen girls and boys causes these oil glands to go wild, thus increasing the risk of clogged pores and acne.

Hormones play a role in acne development in adults, too.

  • This explains why many women have acne flare-ups prior to their periods and during pregnancy.
  • Fluctuating hormone levels during perimenopause (the several years leading up to menopause) can also exacerbate acne—or cause it for the first time. If it’s any consolation, outbreaks tend to ease with menopause.

Other factors may contribute to acne, including:

  • Genetics
  • Climate (both very dry and humid conditions)
  • Cosmetics and skin care products
  • Certain medications
  • Emotional stress
  • Lack of sleep

Smokers tend to have more breakouts than nonsmokers. Researchers have also been looking at the possible role that intestinal microbes and oxidative stress may play in acne.

Can you blame what you eat?

The literature is rife with inconsistencies about the role of diet in acne. Some research implicates carbohydrate-rich foods with a high glycemic index, such as white rice, white bread, and pretzels. These are quickly broken down into sugar in the blood and thus raise insulin levels, which in turn may increase production of hormones implicated in acne.

  • A study found that young men who ate lower-glycemic foods (such as whole-grain bread and certain fruits) had less acne after 12 weeks than men who ate a lot of refined grains and sugary foods1.
  • According to a review of studies2, the evidence to date “suggests an association between diet and acne,” though it doesn’t prove that diet causes acne, but rather may simply influence it. Leading culprits, the paper cited, are:
    • Diets with a high glycemic load
    • Frequent dairy consumption (milk in particular)
  • Some limited evidence showed that omega-3 fats were protective.

What about chocolate? After all these years, its role in acne is still debatable.

  • In a study3, young men with mild acne took capsules of pure cocoa, gelatin, or a combination of varying amounts of each.
  • Acne worsened over the next week, roughly corresponding to the amount of cocoa consumed.
  • But before you toss your chocolate, keep in mind that the study was small (13 men completed it), did not include women, used only one brand of cocoa, and had other design problems.

More research is needed.

Prescribing patience

Achieving clear skin can take time and may require a combination of strategies. If self-help steps don’t help enough, see a dermatologist. Depending on the cause and severity of the condition, treatment might consist of some combination of:

  • Topical retinoids
  • Topical benzoyl peroxide
  • Topical and oral antibiotics
  • Photodynamic (light) therapy

Topical dapsone (Aczone) is both anti-inflammatory and has antimicrobial properties. It is promoted specifically for women in their late twenties and older.

Hormonal therapy (oral contraceptives and anti-androgens) are other possible options in hard-to-treat cases. Oral isotretinoin (Accutane) is also effective but is used less often because of adverse reactions.

It’s also good to get a proper medical evaluation before starting treatment since adult acne is sometimes a sign of an underlying medical condition, such as polycystic ovary syndrome. And another condition, rosacea, may look like acne but requires different treatment.

On pimple patrol

  • Keep your face clean.
    • Wash gently (don’t scrub) using a mild cleanser and a soft pad (not a rough wash cloth) or your hands; then rinse and blot dry.
    • Remove makeup thoroughly before going to bed.
    • Avoid “exfoliating” skin care products—their gritty texture can further irritate skin.
  • Use “non­comedogenic” or “non­acnegenic” skin products (though such terms are not regulated). Oil­-based products can block sebum from naturally reaching the skin’s surface, but some research has cleared mineral oil.
  • Don’t squeeze, pick, or pop. This increases skin irritation, as well as the risk of infection and pitting or scarring.
  • Over-­the-­counter topical acne medications can be worth a try, but because skin tends to get drier with age, they may cause excess drying and irritation. Some acne products are designed specifically for adults and claim to be less irritating, but you may have to shop around to find one that works best for you—or ask your dermatologist for a recommendation.
  • Eat a healthful diet that’s low in refined grains and sugary foods. You might also see if moderating your dairy intake and getting more omega-­3 fatty acids (from fatty fish and flaxseeds) help reduce outbreaks. If you cut back on dairy, though, be sure to get enough calcium from other sources.
  • Limit sun exposure. It might have some antibacterial effects, and a tan may help camouflage the lesions. However, the long­-term damage from sunning outweighs any short-­term benefits.



  1. R. Smith. American Journal of Clinical Nutrition, July, 2007.
  2. Jennifer Burris. Journal of the American Academy of Nutrition and Dietetics, March, 2013.
  3. Caroline Caperton. Journal of Clinical and Aesthetic Dermatology, May, 2014.