When I was in my teens, my face was slathered in pimples. At least during that point in my life, my peers were also awash in spots.
Fast forward 25 years. I have a mortgage, a tween daughter and a full-time job. And I still have pimples. Only now I’m one of a handful of people my age who is still dabbing toothpaste on my forehead at night, still shopping for Clean & Clear, still searching for concealers powerful enough to hide the massive red spots that pop up seemingly daily (pro tip: save your money . . . even the experts couldn’t cover my chin pimple on my wedding day).
Turns out, I’m not alone (though it feels often like I’m the only adult going through this first world embarrassment). Adult acne develops in up to 22 percent of women and 3 percent of men, says Tsippora Shainhouse, a Los Angeles-based dermatologist in private practice.
And while teenage acne can be attributed nearly 100 percent to hormones, adult acne occurs for myriad reasons, from hormones to genetics, diet, stress, cosmetics and smoking. Adult pimples are also dispersed differently than the teenage genre (though when I was a teenager, there was rarely a spot on my face that my pimples didn’t target).
Where it happens
Shainhouse says that white women tend to break out on their cheeks and chin, while black women tend to experience acne along their hairline and cheeks. Black women are also at risk of acne keloidalis, or keloid scarring in the areas of inflamed acne cysts, especially on the chin, jawline and chest.
Why it happens
There are many causes of adult female acne.
Polycystic ovarian syndrome: Women with POS have elevated male hormones, irregular or anovulation and other clinical features including acne, Shainhouse says.
Stress and hormones are the two biggest adult acne triggers, says Kenneth Mark, a New York and Colorado-based cosmetic dermatologist. “Today, women in their 40s can be under more stress than when they were in their teens,” Mark says. “Juggling career, motherhood, marriage and a busy social single life can take its toll. Excess stress leads to production of androgen hormones and cortisol, both of which activate the sebaceous glands to produce excess sebum, which in turn causes acne lesions and flares.”
Women who are 50-plus tend to take more medications than younger women. Some of these medications, including chemotherapy drugs and psychiatric medications like lithium, are classic causes of acne, Mark says. Other typical medication culprits are seizure medications and hormonal medications.
The onset of menopause can trigger hormonal imbalances, which can have a direct effect on acne, and an indirect effect via sleep disturbances, which can cause stress and subsequently acne, Mark says.
What to do about it
Skip so-called anti-aging products: You may not want wrinkles per se, but right now you need to focus on getting rid of your acne, and many of the anti-aging ingredients can be irritating (we’re looking at you, Vitamin C) or can trigger acne breakouts (Vitamin E) in some women.
Stay away from teen-focused anti-acne products: “Most adult women have drier skin types, so acne washes and medications meant for teen acne can be too drying and irritating to their skin,” Shainhouse says. “Salicylic acid and benzoyl peroxide are great for teens, but not for most adult women.”
Choose a gentle cleansing wash and use it twice a day. You might consider a prescription one with sulfur.
Add a topical retinoid: Shainhouse says that this will help unclog pores and stimulate anti-wrinkle collagen growth — but start this regimen slowly, as it may irritate sensitive skin.
Consider a prescription low-dose daily oral antibiotic. This can calm inflammation.