Original Article By Amy Marturana
There’s nothing more disappointing than waiting until your 20s to finally have clear skin, and then learning the hard way that bad breakouts don’t necessarily end when your teenage years do. Coming to terms with adult acne is difficult—best rest assured, you’re not the only grown woman dealing with zits.
“Put it this way: it is so common that pimples are meeting wrinkles,” dermatologist Neal Schultz, M.D., creator of Beauty Rx Skincare, tells SELF. “For the last 10-20 years, adult acne has been increasing. It can even go into your 50s, right to menopause.” If you had acne as a teen, chances are you’ve got oily skin that’s prone to breakouts. But even if you didn’t, it’s still possible you’ll end up with adult acne.
Even though the outlook seems dreary (acne and wrinkles sounds like some sort of sick joke, right?), knowing what’s causing your complexion woes can help you clear up your skin and keep breakouts at bay.
Your hormones may be to blame.
“Fluctuation in hormones, such as before one’s menstrual cycle, is the main cause,” explains dermatologist Julia Tzu, M.D., of Wall Street Dermatology. Specifically, androgens (male hormones) like testosterone. This usually rears its ugly head in the form of deep (painful) cystic acne around the chin, neck, and back, says dermatologist Rebecca Kazin, M.D., F.A.A.D., of the Washington Institute of Dermatologic Laser Surgery and the Johns Hopkins Department of Dermatology.
Stress can be an extra (and very influential) driving force.
Another source of hormonal changes: stress. Whether you work full-time, are a full-time mom, or juggle both, chances are your stress levels are high. “When you’re stressed, you have an organ called the adrenal gland that makes the stress hormone cortisol, and puts it out into the body to help the body deal with stress,” Dr. Schultz explains. Unfortunately, a tiny bit of testosterone leaks out with it. For a woman, this male hormone can drive the oil glands to produce more oil—the root cause of breakouts. (Thanks a lot hormones!)
Pollution isn’t helping your case either.
“Air pollution just puts this layer of crap on your face,” Schultz says. Especially if you live in a city. Go walk around outside for a half hour, he suggests. When you come home, wipe your face with a toner pad or face wipe, and see what color it is. Warning: You’re not going to like what you see.
You may be using the wrong products.
If you have oily or combination skin and are prone to breakouts, you should be using skincare products labeled “oil-free,” “non-comedogenic,” or “water-based,” Schultz says. Just one of these will ensure that the lotion you’re slathering on isn’t going to clog your pores and make matters worse. Try a gel-based moisturizer like Belif The True Cream Aqua Bomb; for an SPF option, we like PCA Skin Weightless Protection Broad Spectrum SPF.
You’re cleansing too frequently and intensely.
“Over-washing your face can make acne worse,” Kazin explains. Cleansing more than twice a day is too much, and can just dry out skin, “which can cause [it] to produce more oil to overcompensate.” Your Clarisonic addiction may not be helping either. “It helps remove all makeup and helps your cleanser work better, but I worry about the coarse ones. It’s almost like giving yourself microdermabrasion twice a day, which can cause a breakout,” says Kazin. Schultz seconds that: “Anything that rubs skin will, to a small extent, promote acne.” That includes a grainy or gritty cleanser, too. Try these two gentle face washes instead: Phace Bioactive Detoxifying Gel Cleanser or Frank Body Creamy Face Cleanser.
Specific foods may or may not have an effect—the evidence is all super fuzzy.
We’ve all heard the foods that allegedly cause acne—chocolate, fried foods, pizza, caffeine, nuts. But Schultz reminds us that in large statistically significant studies, these have not been proven to cause zits, but there are always exceptions. “If you break out when you eat chocolate, don’t eat chocolate.” Same with dairy, which again, has been shown in some cases to have an effect but no concrete cause-and-effect relationship exists.
The one food Schultz does recommend to avoid is iodine. “Iodine causes acne in everyone if you eat enough,” he says. You can find it in shellfish, like lobster, shrimp, crab, and some greens like kelp and spinach. The different between iodine and those other “acne-causing foods” is that iodine builds up over weeks and months before it starts to affect skin.
Your sweet tooth is causing a skin problem.
Another potential skin saboteur is sugar because it raises your insulin level. More and more evidence shows that insulin may boost those oil-triggering male hormones, Schultz explains. Stick to low-glycemic foods—ones that have complex carbs like whole grains, which break down slower in the body and cause less of an insulin spike. Your health will be better for it, too.
The ingredients to look for:
- Salicylic acid is the gold standard of acne treatment. It’s also called a beta-hydroxy acid. Salicylic works by exfoliating gently to unclog pores. It’s in a ton of OTC cleansers and spot treatments, and it’s gentle enough to use on your whole face.
- Benzoyl peroxide works by actually killing the acne bacteria, while exfoliating the pores at the same time. It’s not so gentle, and can make skin really dry and irritated if you use too much. Stick to spot-treating with this one.
- Sulfur draws oil out of skin and has a drying effect, making it another great spot treatment. You’ll also find it as the active ingredient in some face masks, like Cosmedix Clear Clarifying Mask.
- Glycolic Acid is an alpha-hydroxy acid, and an exfoliating ingredient that targets both acne and wrinkles at the same time. “The same way it helps acne, it helps wrinkles—by removing dead cells on surface. If you have effective exfoliation, you’re stimulating collagen and hyaluronic acid,” Schultz explains. This will help improve skin’s texture and reduce fine lines and wrinkles while also clearing up breakouts.
- Retinol is a vitamin A derivative, which the skin absorbs and converts to retinoic acid. Retin-A is the prescription form. “Topical retinoids are fortunately one of the most effective treatments for acne, and also happens to be a highly effective anti-aging ingredient, because of its collagen-building properties,” Tzu notes. The biggest downside is they’re harsh, and can sometimes be too much for sensitive skin.
Exfoliation is key, and something you should do more regularly.
This is Schultz’s number-one piece of advice. “Exfoliation is the most important thing you can do on a regular basis to be fighting acne both in terms of preventing it and treating it.” His go-to ingredient? Glycolic acid. While a glycolic cleanser will help, a treatment that really soaks into your skin is what will give you the results you want.
Always keep a spot treatment handy.
Spot treatments are key for treating a pimple ASAP. Benzoyl peroxide is often vilified for being harsh, but when it comes to really zapping a zit, it should be your best friend. Just dab it on the trouble spot to dry it out and kill bacteria.
Look for products that also fight inflammation.
Inflammation is always involved when you have a breakout, causing that swelling and redness we all work hard to cover up with our best concealer. We like Groh Ergo Boost Skin Repair Treatment—it’s rich in antioxidants that help calm down irritation, and ergothioneine, a compound naturally occurring in mushrooms, helps repair damaged skin cells.
You may need more than just topical treatments.
Hormones are ruthless, and all the topical treatments in the world won’t make a difference if yours are seriously out of whack. In that case, you need to fix things internally first. “Medications that manipulate hormonal levels, such as oral contraceptives and spironolactone are helpful in curbing hormonal chin and lower face outbreaks,” Tzu says. Ask your derm about what might work for you.
Never try to extract cysts on your own.
Those big, painful zits will leave a scar if you pick and prod at them—”the only way to reduce it quickly is to drain it, and that’s not a DIY deal,” Schultz warns. The reason they’re painful is because quick expansion stretches the nerves. “Drinking good red wine is often helpful [to numb the pain],” he jokes. Take Advil, apply a warm or cold compress (whichever feels better to you), and go see your derm. “Cortisone shots are the true ‘spot treatments’ for painful cystic acne lesions,” Tzu says.
There’s a difference between scars and hyperpigmentation.
Scars that are indented aren’t going to go away on their own, and most likely need professional treatment. Talk to your derm about laser options, as well as subcision and microneedling—all proven methods to get rid of scarring. But those brown spots left behind once a zit goes away? You can treat them at home if you’re diligent. Schultz says you have to stick to a regimen of daily sunscreen use, exfoliation, and application of a bleaching product that will help remove the excess pigmentation in the skin.