Adult acne – the causes and what can treat it

Are you sick and tired of having pimples on your face? Maybe you’ve noticed them on your back or your chest, too.

Acne is a common, frustrating, and sometimes painful skin condition. It can make you feel so self-conscious that you don’t want to go to work or socialize with friends.

While puberty is the most common cause, some people develop acne from their 20s onwards. This is called adult acne (or hormonal acne).

Aside from pimples, acne can also cause oily skin, and sometimes your skin may be hot or painful to touch.

If you’re affected by adult acne, while it may not be possible to completely cure it, there are effective treatments to help you manage it.

What are the different types?

Adult acne doesn’t only describe red pimples on the surface of your skin. It’s a term used for different types of spots, all varying in severity.

These include:

• blackheads – small and yellow-ish or black in color that empty when squeezed
• whiteheads – firmer than blackheads but they appear white, don’t have a head, and don’t empty when squeezed
• papules – smaller, red bumps that feel a bit sore
• pustules – red bumps on your skin with a white tip, often filled with pus
• nodules – larger lumps under the skin that feel solid and painful
• cysts – large pus-filled lumps under the skin that can look like boils and lead to scarring.

They can develop anywhere on your body, but are commonly found on the face, back, chest, neck and shoulders.

Each type of spot is split into 1 of 3 categories, which helps doctors to determine how severe your acne is. These are:

• mild – mostly whiteheads and blackheads, with a few papules and pustules
• moderate – more whiteheads and blackheads, with lots of papules and pustules
• severe – a lot of papules, pustules, nodules and/or cysts that may be painful. You may also have scarring.

What causes it and who's most affected?

Acne develops when the sebaceous glands on the surface of your skin produce too much oil (sebum). This mixes with dead skin cells and clogs your pores, leading to pimples and inflammation.

Bacteria called P. acnes, which are usually harmless, can contaminate the blocked pores, causing problems like cysts and pustules.

In adult acne, the overproduction of oil is usually driven by changes in hormone levels, meaning you’re more likely to develop it if:

• you’re a woman – women are more likely to have adult acne than men, with fluctuations in hormone levels thought to be the cause. For example, this can happen in the first 3 months of pregnancy, the time just before a period, and as a result of the condition polycystic ovary syndrome (PCOS).

Other factors that can also contribute include:

• if acne runs in your family – if one or both of your parents had acne, you might be more likely to develop it
• eating lots of higher glycaemic (GI) foods – some studies suggest that eating specific high-carbohydrate foods, such as bread, bagels and chips, may trigger or worsen acne
• using certain cosmetic products – might cause your skin to break out more
• if you’re stressed – this can increase the hormone cortisol, leading to more skin inflammation

Despite countless myths, adult acne is not caused by skin cleanliness – in fact, over-washing can make things worse.

How a pharmacist can help

If you have moderate or severe acne, or your acne is getting you down, seek help from your doctor.

If your acne is mild, and you have a few pimples, blackheads and whiteheads, a pharmacist can recommend topical gels or creams.

These may include benzoyl peroxide, an over-the-counter antiseptic with an anti-inflammatory effect. While it may take up to 6 weeks to work, it can help clear mild acne.

There are also things you can do at home to help your acne.

When to see a doctor

You should see a doctor if your acne is moderate to severe, medication from the pharmacy or self-care hasn’t worked, you’ve developed deep nodules or cysts, or your acne is making you feel very down.

In older adults, the sudden appearance of acne may mean there is an underlying condition that needs checking out.

How is adult acne diagnosed?

Getting an appointment as soon as you can will give your skin the best chance of recovery, and help avoid permanent scarring.

An acne diagnosis is usually made by looking at your skin to see which type of acne you have.

Your doctor will also ask you about factors that could be causing your acne, including whether you are having a stressful time, what your sleep patterns are like, and about any changes in your health.

Medical treatments for adult acne

Although acne can’t be cured, it can be controlled, but it’s important to understand there’s no instant fix. It’s likely to take 2 to 3 months before you notice an improvement, so keep up with your treatment even if you don’t see instant results.

Your doctor can prescribe medicine if pharmacy treatments haven’t helped, including:

• antibiotics (both topical and in tablet form) – they reduce inflammation and kill excess skin bacteria
• azelaic acid – an antibacterial cream or gel that helps with discoloration caused by some types of acne, kills bacteria and get rids of dead skin cells
• for women, the combined contraceptive pill – contraceptives that contain both progestin and estrogen to balance your hormone levels
• retinoids (topical and capsules) – such as tretinoin or adapalene. These work by reducing dead skin cells.

Not all acne treatments are safe for pregnant women, and some must not be used in combination with each other – check with your doctor.

Some people find treatments helpful such as light therapy (light shone on the skin to improve symptoms) and chemical peels (a solution applied to the face that makes skin peel so that new skin replaces it).

If your acne is very severe, is not going away with treatment, or is getting worse, your doctor might refer you to a dermatologist for advanced treatment.

How to manage adult acne with self-care

Acne treatments can take time to make a difference, but there are things you can do at home to give them the best chance of working. This includes:

• washing your skin with a gentle cleanser twice a day – doing so more often can irritate your skin and make your acne worse
• using lukewarm water – instead of very hot or very cold water
• not squeezing or picking your spots – this can lead to scarring and make things worse
• keeping your hair and fingers off your face – to reduce irritation
• using water-based non-comedogenic products that won’t clog your pores – this includes sunscreen to protect your skin from sun damage
• joining support groups and using online resources – acne can affect your mental health, but connecting with others in a similar situation can really help. Take a look at Acne Support UK, an acne community forum on talkhealth, and the American Academy of Dermatology.