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When it comes to finding an effective adult acne treatment, you’ve likely tried every lotion, potion, and serum out there. But it also helps to get to the root of the problem. In other words, to really treat your adult acne, you may need to understand what causes it in the first place.
Because, honestly, 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—but rest assured, you’re not the only adult dealing with zits.
Knowing what’s causing your pimples can help you clear up your skin and keep breakouts at bay. Keep reading to learn some of the most common adult acne causes—and the best ways to treat these stubborn breakouts.
Remind me, what causes breakouts?
At the root of all acne is a clogged pore. Your pores, which are the opening that surrounds each hair follicle, are an important part of your skin because they also house your sebaceous glands.
These glands secrete sebum (oil) through the pore opening, which helps keep your skin soft and protected. But if the pore gets clogged by dirt, dead skin cells, excess oil, and possibly bacteria, you’ve got a recipe for a pimple.
Sometimes, just taking better care of your skin by cleansing or exfoliating regularly can be enough to prevent acne. For many others, though, the situation is more complicated. And, especially when you’re an adult, trying to figure out what’s causing your acne can get pretty frustrating.
Common adult acne causes:
“Fluctuation in hormones, such as before one’s menstrual cycle, is the main cause,” dermatologist Julia Tzu, M.D., of Wall Street Dermatology, tells SELF.
For instance, we know that an increase in the production of progesterone (which happens after ovulation) can be related to acne because it ramps up your skin’s production of sebum. Androgens (male hormones) like testosterone can also increase sebum production and, therefore, play a role in hormonal acne in people of all genders.
This issue usually rears its ugly head in the form of deep (painful) cystic acne around the chin, neck, and back, dermatologist Rebecca Kazin, M.D., of the Washington Institute of Dermatologic Laser Surgery and the Johns Hopkins Department of Dermatology, tells SELF.
Cysts are pockets of pus that form deep in the skin, SELF explained previously. They’re notoriously stubborn to treat because topical treatments don’t usually have much of an effect. And because they’re so deep, they are more likely to cause scarring if popped.
Because your hormones naturally fluctuate at certain points in your life, the American Academy of Dermatology (AAD) explains, hormone-related acne is most likely to pop up:
- Around the time of your period.
- During or after pregnancy.
- During perimenopause and menopause.
- When you start or stop using hormonal birth control.
We know that chronic stress can play a huge role in skin issues like acne, and it’s strongly suspected that the hormone cortisol may be responsible for the link.
When you’re stressed, your adrenal gland releases cortisol, Neal Schultz, M.D. a New York City–based dermatologist, tells SELF, and recent research also suggests that it’s produced locally in hair follicles and different types of skin cells. Although it’s commonly referred to as the “stress hormone,” cortisol is actually an important compound that helps regulate a ton of different bodily processes, including the immune system, digestive system, and neurological systems affecting your mood. Its levels naturally fluctuate over time (even within a single day).
But when you experience stress—especially chronic stress—cortisol can start working overtime, causing issues with those bodily processes, including messing with your skin. Research suggests it may contribute to acne by creating a favorable environment for bacteria-driven inflammatory acne.
You may not have considered the effect that your environment has on your skin—especially the dirt and UV radiation outside. “Air pollution just puts this layer of crap on your face,” Dr. Schultz says, especially if you live in a city.
However, experts still don’t totally understand how pollution can contribute to acne. Obviously, having excess dirt and grime on your face can increase your chances of getting clogged pores, so removing that stuff via a consistent cleansing routine is definitely helpful. But can exposure to UV rays or chemicals in the air actually damage your skin? Or cause acne?
Well, we know that UV exposure increases your risk for skin cancer and premature signs of aging, like fine lines and dark spots. And it’s possible for sun exposure to cause acne because it dries out the skin, leading to excess oil production in an effort to compensate. That’s why it’s always important to wear a broad-spectrum sunscreen with at least 30 SPF basically every day. It’ll help prevent adult acne and help protect your face in general.
If you have oily or combination skin and are prone to breakouts, you should be using skin-care products labeled “oil-free,” “noncomedogenic,” or “water-based,” Dr. Schultz says. Products like these are less likely to clog your pores.
Try a light or gel-based moisturizer like Simple Light Hydrating Moisturizer, $9; CeraVe Facial Moisturizing Lotion, $20; or Tatcha the Water Cream, $70.
“Overwashing your face can make acne worse,” Dr. Kazin explains. Although some people with especially dry or sensitive skin find that they only need to cleanse once a day, most of us should be cleansing twice a day with a gentle cleanser. Cleansing any more than that is usually too much and can just dry out skin, “which can cause [it] to produce more oil to overcompensate,” Dr. Kazin says.
Gentle cleansers like Cetaphil Gentle Skin Cleanser, $14; SkinCeuticals Gentle Cleanser, $36; or Dermalogica Ultracalming Cleanser, $68, won’t aggravate your skin. Additionally, some people find that cleansing balms or oils like Biore Makeup Remover Cleansing Oil, $20; DHC Deep Cleansing Oil, $31; Boscia MakeUp-BreakUp Cool Cleansing Oil, $37; or Then I Met You Living Cleansing Balm, $38, remove makeup more effectively and help their skin feel more moisturized than traditional cleansers.
Additionally, exfoliating too often or with products that are too harsh can damage skin and exacerbate acne. The type of exfoliating you should be doing and how frequently you should be doing it (if at all) depends on your skin type and your major skin concerns. But in general, experts recommend going with the gentler chemical exfoliants (products containing ingredients like lactic acid, glycolic acid, or salicylic acid) over scrubs or brushes, which are considered manual or physical exfoliants.
Experts also recommend exfoliating no more than three times per week for most people. If you have more dry or sensitive skin, just exfoliating once a week or every other week may be plenty for you.
For gentle exfoliating products, check out Paula’s Choice the Unscrub, $35; Tatcha the Rice Polish, $68; or Benton Aloe BHA Toner, $19.
We’ve all heard that some ridiculously long list of foods like chocolate, fried foods, pizza, caffeine, or dairy can cause acne. But, Dr. Schultz says, there’s no conclusive proof that our dietary choices make a huge difference in the severity of acne.
Still, everyone’s skin is different and some people really do notice that their skin reacts badly after they eat certain foods. So the guiding rule here is to pay attention to your skin, and if you feel like it helps to avoid certain foods, you can try to cut them out. That said, planning out any major dietary changes—especially ones involving eliminating foods—is something that’s best done with the guidance of your doctor or an R.D., so consider chatting with your derm before swearing off dairy.
In some cases, adult acne could be a symptom of another health condition, the AAD says.
For instance, one common hormone-related condition that results in acne is polycystic ovary syndrome (PCOS), a condition that causes symptoms such as irregular periods, facial hair, and weight gain. But PCOS is also known to cause hormonal acne thanks to the abnormal hormonal fluctuations it can cause.
Additionally, medications such as corticosteroids, lithium, or androgens can cause acne as a side effect, the Mayo Clinic says. So if you have any conditions that are being managed with those drugs, you’re more likely to get acne.
If you think your acne might be due to an underlying health issue or medication, it’s especially important to check in with a dermatologist to figure out what’s actually going on.
If a close relative has dealt with adult acne, you may be predisposed to having it too, according to the AAD. Part of that is because some things about your skin have genetic factors, like the size and visibility of your pores.
These genetic factors may be out of your control, but you *can* change your skin-care regimen to make sure you’re giving your skin the best chance. That means knowing your skin type and using products and steps that work with your skin, possibly with the help of a dermatologist and prescription acne treatments.
The best adult acne treatment strategies:
The first and most important thing to to do when tackling acne is to make sure you have an arsenal of products with science-backed ingredients at your disposal. Remember that not every product or ingredient is going to work for everyone, and many of these products need to be used consistently for a few weeks before there’s any noticeable change in your skin. So take it slow—but be persistent. And if you’re not seeing any results or you can’t find products that don’t irritate your skin, talk to a dermatologist for some guidance and, maybe, a prescription treatment.
Here are the ingredients to look for:
Salicylic acid is a beta-hydroxy-acid (BHA), a kind of chemical exfoliant. It works by dissolving the bonds between dead skin cells. Salicylic acid is also particularly helpful when treating acne because it’s oil-soluble, which allows it to work its unclogging magic deeper in your oily pores than other chemical exfoliants.
Find it in: A ton of over-the-counter cleansers, spot treatments, and masks. For most people, it’s gentle enough to use on your whole face—possibly even daily. To start with, try a salicylic acid–containing cleanser like Neutrogena Oil-Free Acne Wash, $8, or Dermalogica Breakout Clearing Foaming Wash, $20. When you’re ready for toners and serums, check out La Roche-Posay Effaclar Clarifying Solution Acne Toner With Salicylic Acid, $17; Paula’s Choice 2% Skin Perfecting BHA Liquid Exfoliant, $34; or SkinCeuticals Blemish and Age Defense Serum $106.
Glycolic acid is an alpha-hydroxy acid (AHA), another type of chemical exfoliant.
Find it in: Cleansers, serums, and peels. Pay attention to the concentration of glycolic acid in a given product as this will clue you in to how strong it will be. As the concentration gets higher, the product will be more powerful, but also more sensitizing. So if you’re a beginner, start at the lower end of the spectrum with products like Pixi Glow Tonic, $29; Mario Badescu Glycolic Acid Toner, $18; or First Aid Beauty Facial Radiance Pads, $36. If you want something stronger, check out The Ordinary Glycolic Acid 7% Toning Solution, $13, or Juice Beauty Green Apple Peel, $49.
Lactic acid is yet another chemical exfoliant, an AHA. But lactic acid is known to be gentler than other types of chemical exfoliants, so it’s a good place to start if you’re new to exfoliating treatments.
Find it in: Lactic acid is often paired with other acids in serums, toners, and peels, which means you could still be exposed to a more intense acid without realizing. But you can find lactic acid on its own in The Ordinary Lactic Acid 5% + HA 2% Superficial Peeling Formulation, $7; PCA Skin Facial Wash, $38; and the cult-favorite Sunday Riley Good Genes All-in-One Lactic Acid Treatment, $122.
Polyhydroxy acids (PHAs), which includes gluconolactone and lactobionic acid, are another class of chemical exfoliants and are generally considered to be the most gentle. If you have very dry or sensitive skin, or you’ve had bad reactions to other chemical exfoliants in the past, you should consider using a PHA.
Find it in: Lots of exfoliating peels, masks, and creams, such as Dr. Jart Dermaclear Micro Milk Peel, $42; Glow Recipe Avocado Melt Sleeping Mask, $42; and Cosrx PHA Moisture Renewal Power Cream, $24.
Benzoyl peroxide works by actually killing the acne bacteria while exfoliating the pores at the same time. It’s not as gentle as the chemical exfoliants, so be careful when using it and make sure to moisturize.
Find it in: A classic derm recommendation, PanOxyl facial wash, comes in both lower-strength and higher-strength versions. But benzoyl peroxide is also found in many lotions and spot treatments, often paired with a chemical exfoliant like salicylic acid. Check out SkinMedica Acne Treatment Lotion, $56; Glo Skin Beauty Clear Skin Spot Treatment, $26; and PCA Skin Acne Cream, $40.
Sulfur doesn’t have as much research behind it for acne as some of the other options on this list, but it is often a recommended treatment for acne-like bumps related to rosacea.
Find it in: Mainly spot treatments and face masks, like Murad Clarifying Mask, $40; Peter Thomas Roth Sulfur Cooling Mask, $52; Sunday Riley Saturn Sulfur Acne Treatment Mask, $55; and First Aid Beauty Anti-Redness Serum, $36.
Azelaic acid is another rosacea/acne crossover medication that’s great at clearing the bumps sometimes seen in rosacea as well as pimples. As SELF explained previously, the exact mechanism by which azelaic acid works isn’t totally understood. But we do know it’s effective.
Find it in: Azelaic acid is available in a few prescription forms, but it’s also present in over-the-counter products at lower concentrations. For concentrated options, check out The Ordinary Azelaic Acid Suspension 10%, $11, and Paula’s Choice 10% Azelaic Acid Booster, $39. But azelaic acid is also included alongside other acne-treating ingredients in Ren Ready Steady Glow Daily AHA Tonic, $40, and PCA Skin Acne Gel, $64.
Retinoids are vitamin A derivatives, including retinol, retinal (retinaldehyde), and retinoic acid. They come in over-the-counter options (usually the active ingredient is retinol in these) and stronger prescription versions. “Topical retinoids are fortunately one of the most effective treatments for acne and also happen to be a highly effective anti-aging ingredient,” Dr. Tzu notes.
The biggest downside is they’re harsh and can sometimes be too much for sensitive skin, especially when you’re first starting to use them. That’s why it’s important to use them just a few days a week at first, to always moisturize effectively, and to be extremely diligent about wearing sunscreen when using a retinoid.
Find it in: Retinol is available in many over-the-counter products, and that’s generally the best place to start, because retinoids can be irritating. There are really a ton of retinol products out there, so check out these dermatologist-recommended options. If you want to try something stronger, you can opt for Differin (adapalene), $18, which used to be prescription-only but is now available over-the-counter. For more severe or stubborn acne, talk to a dermatologist about getting a prescription retinoid.
“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,” Dr. Schultz says. Whether you choose to use a chemical or physical exfoliant, know that this step will help prevent breakouts by keeping your pores clear and helping to remove any clogs you currently have.
If your skin can handle it, glycolic acid is Dr. Schultz’s go-to ingredient, and he suggests using leave-on products or masks rather than cleansers, which will only stay on your skin for a short amount of time.
That said, be careful not to exfoliate too often, which can result in irritated, flaky, dry skin. Between one and three times a week is plenty for most people, but your skin may be able to take more or less than that depending on your individual skin type and concerns.
Spot treatments are key for treating a pimple ASAP, especially ones containing benzoyl peroxide, which work by killing the bacteria that’s often responsible for acne. It can be a little harsh, though, so those with sensitive skin should be careful with it.
Try this classic spot treatment: Neutrogena On-the-Spot Acne Treatment, which contains benzoyl peroxide, heavy-duty action.
As we mentioned, pimples form when a pore gets clogged with dirt, oil, and dead skin cells. If bacteria are also present, the pimple might get inflamed, meaning it becomes red, swollen, and painful. Not all pimples are inflamed, but those that are tend to be extra unpleasant to deal with. So finding ways to calm them down while treating the root of the problem is essential.
If you have inflamed acne, look for products that contain soothing ingredients (like colloidal oatmeal, aloe, or centella asiatica) alongside acne-fighting ingredients, like salicylic acid.
Depending on the root cause(s) and severity your acne, you may find that topical treatments don’t cut it. For instance, hormonal acne is fueled by internal processes that can’t really be tamed with external medications.
In that case, your dermatologist may recommend an oral medication. “Medications that manipulate hormonal levels, such as oral contraceptives and spironolactone, are helpful in curbing hormonal chin and lower face outbreaks,” Dr. Tzu says. Additionally, oral retinoids like isotretinoin (formerly Accutane) are considered the big dermatological guns when fighting acne. Ask your derm about what might work for you.
When it comes to cystic acne, topical treatments are unlikely to cut it. And because those big, painful zits are so deep in the skin, they’re more likely to leave a scar if you pick and prod at them than other types of acne. “The only way to reduce it quickly is to drain it, and that’s not a DIY deal,” Dr. Schultz warns.
One option, if you have access to a dermatologist, is to get a cortisone shot to deal with a stubborn cyst. “Cortisone shots are the true ‘spot treatments’ for painful cystic acne lesions,” Dr. Tzu says.
There are ways to deal with them at home, though, by applying a warm or cold compress (whichever feels better to you), applying a small amount of over-the-counter hydrocortisone cream to calm the inflammation, and just waiting it out.
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