There are a few widespread beauty myths that most of us grow up believing: that sleeping on wet hair will give you a cold, that shaving makes your hair grow back thicker, and that acne only happens to teenagers. For years, this last one felt like a given to me, and when I got out of puberty unscathed by breakouts, I thought I was in the clear.
My aha moment about my skin arrived about a month after my 24th birthday, when I showed up for a facial with esthetician Renée Rouleau, my face dotted with both active breakouts and scars from adult acne. It seems my streak had come to an end. "Is this a typical day for your skin?" she asked me. "I want to say no," I told her. "But this seems to be what my skin is now. And I need help."
Meet the Expert
- Renée Rouleau is a celebrity esthetician based in Austin, Texas. She is also the founder and creator of her eponymous skincare line.
- Joshua Zeichner, MD, is the director of cosmetic and clinical research at Mount Sinai Hospital in New York. Zeichner won the Elle Skin Genius Award in 2015 and has been featured in publications, such as Allure, Cosmopolitan, Elle, and InStyle.
Fortunately, while undoubtedly frustrating, adult acne is relatively common. To share the truth about adult acne, I got back in touch with Rouleau as well as Joshua Zeichner, MD, director of cosmetic and clinical research at Mount Sinai Hospital's Department of Dermatology.
Here, find clear, trustworthy information about the causes of adult acne and its treatments (much of which helped me clear my own!).
Types of Adult Acne
- Papules: Red bumps that sit on the skin.
- Pustules: Red bumps, similar to papules, that are pus-filled.
- Nodules: Like papules, this type of adult acne can be identified as red bumps. However, they are larger in size.
- Cysts: Tender, under-the-skin bumps.
- Blackheads: A non-inflammatory type of adult acne, blackheads typically occur along the T-zone.
- Whiteheads: Like blackheads, whiteheads are non-inflammatory and commonly occur along the T-zone.
Causes and Prevention of Adult Acne
Stress: Stress and lack of sleep induce the overproduction of the hormone androgens, which encourages our sebaceous glands to create more oil. This is the reason why in stressful periods, people experiencing an increase in acne get more inflamed, pus-filled papules than simple whiteheads or blackheads, according to Rouleau.
Hormones: Zeichner explains that changing or discontinuing birth control can throw off one's hormonal balance, leading to breakouts. Additionally, fluctuations in hormone levels right before and during a young woman's period can stimulate sebaceous glands to produce excess oil, resulting in monthly breakouts, according to Rouleau.
Diet: Foods with a high glycemic index have been linked to acne breakouts. These are foods with a high sugar load, which is thought to promote inflammation in the skin. The same is true of cows milk, particularly skim milk, according to Zeichner.
1. Dietary Changes
We recommend this MCT oil for a dairy-free fat substitute.
Diet-wise, Rouleau suggests limiting fried and sugary processed foods, which cause prolonged insulin increases that can contribute to hormonal acne. If cystic acne is your issue, avoiding dairy can help: "Since most dairy cows are given growth hormones, the consumption of milk, cheese, and yogurt become factors that influence endogenous hormones and mimic the hormones that trigger oil production in the skin to ignite the acne process," Rouleau explains. She suggests doing an experiment by cutting out all dairy products for two weeks to see if this is, indeed, the cause of your cystic breakouts. In the meantime, introduce some skin-loving, dairy-free fats into your diet, like MCT oil.
[Ed. Note: Most acne improvements may need about six weeks to prove themselves, even from dietary changes.]
If you want to indulge a bit, stick to dark chocolate (in moderation), which contains fewer inflammatory ingredients (e.g. sugar and dairy) than milk chocolate. A high-fiber diet and a healthy gut are also believed to promote better skin. You know what they say—you are what you eat.
2. Vitamin Intake
We recommend this supplement for a high dose of vitamin B6.
Looking for a treatment that will help address multiple causes of acne? An easy fix that handles diet, hormones, and stress all in one is taking vitamin B6 every day of the week before your period. "This supplement may help ease PMS symptoms by improving metabolic function and hormone metabolism," says Rouleau. This, in turn, will help manage those unwarranted hormonal breakouts. "In addition, vitamin B6 can help the body manufacture neurotransmitters, such as serotonin, which aids in the body's ability to cope with stress." So, you can count on the supplement helping to tackle more than one common cause of acne.
3. Birth Control
If B6 isn't enough to help with your hormones, you might consider switching up your birth control routine, whether that means changing the type you're currently on or starting up with it for the first time. Certain birth control pills can help regulate your hormone levels, and therefore help regulate hormonal breakouts. "Consult with your doctor to experiment with different types of birth control pills," Rouleau recommends. "Many of my clients have found that making a change can have a positive influence on lessening acne and occasional hormonal breakouts." Keep in mind that while this method can be effective, it takes time for your body to fully adjust to new birth control.
4. Topical Products
While what you do on the inside makes a difference, treating acne from the outside is also important. That's where topical skincare products come in. "You don't know where your next pimple will pop up, so it is important to treat the entire face," Zeichner advises. Rather than waiting for your next breakout to show face, follow a skincare routine that will help prevent future blemishes.
Key acne-fighting ingredients include salicylic acid and benzoyl peroxide. "Use a salicylic acid cleanser to remove excess oil and dead cells from your skin's surface to keep pores clear," Zeichner says. Make sure to choose a sulfate-free option like the Renée Rouleau AHA/BHA Deep Pore Cleanser to avoid dehydration and irritation. Benzoyl peroxide works to eliminate acne-causing bacteria. If this ingredient is too irritating to use on your whole face, "then reserve it to spot-treat," says Zeichner.
But don't make the mistake of overloading your skin with acne fighters. "Especially in the 20s, it's very important to use products only for your skin type," says Rouleau. (Take this helpful test to find out what that is for you.)
5. Prescription Treatments
Sometimes, the treatments you can get at the drugstore or department store just don't cut it, no matter how good they may be. If your acne doesn't seem like it's going anywhere anytime soon, and you can't seem to pinpoint its cause on your own, it might be a good time to book an appointment with a dermatologist. They may prescribe retinoids, antibiotics, azelaic acid, or birth control pills, depending on the acne you're dealing with. They might even recommend laser treatments, which are expensive but effective. That said, it's a good idea to keep track of your breakouts, diet, and other factors that could be influencing acne, so you can share this with your dermatologist and give them better insight into your individual situation.
6. Light Therapy
We recommend this light therapy mask to promote clearer skin.
If you're into trying the latest and greatest in skincare technology, Zeichner recommends checking out an at-home light therapy treatment for your acne: "A light therapy mask is advantageous because it treats the entire face and is non-irritating." The face is covered in thousands of pipes, which connect oil glands to the surface of the skin; "combine light with your traditional acne treatments for a more powerful approach."
7. Reduce Your Stress
This is important for reducing breakouts but also for life. We mentioned earlier that taking supplements, such as vitamin B6, can help with stress, but there are also small changes you can make to your lifestyle. Find activities and practices that help you manage stress. Whether it's yoga, a guided meditation, breathing exercises, a walk, or just carving out some time for yourself, do what keeps you calm and collected—your skin should follow suit. To tackle two treatments in one, consider using a face mask formulated to promote a clear complexion (we love Origins' Clear Improvement Active Charcoal Mask To Clear Pores, $26) and some well-deserved self-care.
American Academy of Dermatology Association. Adult acne.
American Academy of Dermatology Association. Can the right diet get rid of acne?
Lee YB, Byun EJ, Kim HS. Potential role of the microbiome in acne: a comprehensive review. J Clin Med. 2019;8(7):987. doi:10.3390/jcm8070987