All Grown-Up and Still Breaking Out?

Treatment for adult acne

adult acne Your prom's a fading memory and now you get zits? If you’re breaking out in your 20s, 30s, 40s and beyond, you’re not alone. "Even if you never had acne as a teenager, you may experience it for the first time as an adult,” says Arielle Kauvar, M.D., director of New York Laser & Skin Care in New York City. “Some women even develop acne after menopause.”

Adult acne is the most common skin disorder in the U.S., affecting 40 to 50 million Americans. It tends to run in families. Pimples are clogged pores caused by an overproduction of oil, which stimulates the growth of bacteria called P. acnes. Many breakouts in adult women are a result of hormone fluctuations, which is why acne may flare during menstruation, pregnancy, perimenopause and menopause. “Other factors are skin-clogging cosmetics and stress—it increases the male hormone androgen which boosts oil production,” says Dr. Kauvar.

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For mild cases of acne, try over-the-counter products first, says Dr. Kauvar. “Washes containing salicylic acid, which helps unclog pores, and spot treatments with benzoyl peroxide, which reduces bacteria and removes dead cells to prevent comedones (blackheads and whiteheads), are effective for many people,” she says.
Use cosmetics that are "oil-free" or "non-comedogenic," and opt for gel, spray or chemical-free sunblocks that are less likely to clog pores. Skip abrasive scrubs, which can irritate skin and worsen acne. “Limit the use of hair gels or sprays if possible, and avoid getting these products on the facial skin,” says Dr. Kauvar.
If you don’t see improvement within a month or two, call your primary care doctor or dermatologist. “What works for one person may not work for another, and a combination of treatments is often needed,” says Sandra Read, M.D., a spokesperson for the American Academy of Dermatology. Typically, oral and topical antibiotics and topical retinoids, which unclog pores and prevent whiteheads and blackheads from forming, may be prescribed.
If you use antibiotics, consider switching to a different drug after a period of time, but be sure to talk to your doctor first. Antibiotics work by reducing the P. acnes population, but in some cases the bacteria may become resistant to the treatment over time, causing acne to flare. Controlled-release doxycycline, an antibiotic which also reduces inflammation associated with acne, may be particularly effective. “Occasionally, we do see people stop responding to treatments, so we must prescribe a different drug,” says Dr. Read. Some dermatologists limit use of antibiotics to a few months and then replace them with other non-antibiotic medications, such as topical retinoids, to reduce the risk of antibiotic resistance but maintain results.
Birth control pills and drugs such as spironolactone may also help clear acne by suppressing androgen. In severe or resistant cases, the oral retinoid isotretinoin may be prescribed—it’s effective but requires strict monitoring, especially in women of child-bearing years, due to its risk of birth defects. (Note: isotretinoin is only a risk for birth defects while the woman is taking it and for one month after.)

The most important thing to remember about adult acne: Be patient. It takes a minimum of 6 to 8 weeks to see results, which can be frustrating. “You’ve got to have realistic expectations,” says Dr. Read. “The bottom line is you must work with your dermatologist and not give up. We’ll find the right approach together.”