I hear the concern from women in my practice all the time: “But doctor, why do I have wrinkles AND acne? Shouldn’t I have grown out of acne by now?” Skin problems and acne breakouts affect almost everyone in their teen years, but it’s also not unusual to have adult-onset acne which erupts in our late 20s, 30s or beyond. Clinical studies estimate it can affect up to 50% of women at some point in their adult life.
Adult acne is partially caused by sebum, an oily substance produced by sebaceous glands in the skin. Sebum clogs pores, which attract bacteria leading to inflammation. For some adults, breakouts are a result of sensitivity to or overproduction of androgens (male hormones). But an imbalance in both male and female hormones (estrogen) can also lead to breakouts. For women, this can happen during pregnancy, perimenopause and menopause.
Treating adult acne is not easy since traditional topical medications are best suited to oily, teenage skin. These types of medications can be drying and actually worsen fine lines and wrinkles in adult skin. But thankfully, there are good treatment options available to help improve breakouts while slowing down the signs of aging.
Cleansers: Mild cleansers without fragrances can be helpful to cleanse the skin, but not strip the skin of natural oils. Avoid strong gels and products containing beads or granules, which are abrasive and can irritate leading to inflammation and worsening acne.
Creams and lotions: Retinol products can open and clean pores and simultaneously help reduce fine wrinkles. Products that contain salicylic and glycolic acids are helpful to reduce discoloration and fade old acne marks. Use benzoyl peroxide as spot treatment; as an all-over cream, it may be too drying for adult skin.
Prescription medications: Low-dose antibiotics, such as doxycycline, can help reduce inflammation in the skin thereby reducing breakouts. Oral contraceptives and spironolactone, can help stabilize the fluctuations of hormones, which is often a major contributing factor to adult-onset acne.
High-tech treatments: Laser and intense pulsed light treatments mainly target scars, but photodynamic therapy with aminolevulinic acid with blue and red light activation can kill acne-causing bacteria and reduce oil production. Another good option: a series of chemical peels that can improve both acne and the early signs of sun damage. The most advanced chemical peels don’t require extended recovery time and can achieve impressive results within a few sessions.
One final note: Don’t be afraid to moisturize and use sunscreen. So often in my practice I see adult patients who have a tendency to break out, but their skin is very dry. They refuse to use moisturizer or sunscreen because of the fear of increased acne. This is counterproductive and potentially harmful to the skin (if there is an avoidance of sunscreen). To find a good facial lotion that will not cause acne, look for the term “non-comedogenic” which denotes it will not clog pores. As for the sunscreen, I recommend to patients only those products with zinc as the active sunblock agent. Zinc has some drying and anti-inflammatory properties which makes it a perfect ingredient for acne-prone skin.