Whether you’ve had acne for years—or you're experiencing a fresh bout in your late twenties or early thirties—breaking out as an adult can be frustrating, painful, and downright depressing. When I got my first round of cystic hormonal acne at age 32, the cause was clear: I was taking steroids to treat an autoimmune condition and acne is a known and common side effect of the medication. But for people who don’t have the luxury of clarity, investigating the cause can be an essential part of the solution. Keep scrolling to see the most common causes of adult acne (and the most effective treatments, according to a dermatologist, an herbalist, and an acupuncturist).
The Sneaky Causes of Adult Acne
New York City based integrative dermatologist Cybele Fishman, M.D. said that lifestyle factors including diet, stress levels, and amount and quality of sleep can affect breakouts, especially hormonal ones. “For women, an oversensitivity of the testosterone receptors in the skin can contribute to hormonal acne as well,” she said. Perhaps most importantly, it’s helpful to remember that acne may not be your fault. “People think they are doing something wrong if they have acne,” Dr. Fishman said. “But genetics play a large role.”
On the one hand, it’s reassuring to understand that acne may not be caused by something we’re doing or not doing, but don’t let that discourage you from trying something new. Herbalist, natural beauty expert, and makeup artist Jessa Blades encourages her clients with acne to believe that their bodies are trying to communicate by way of the skin. “I’ve found there’s a very small amount of people for whom acne is a topical problem, like using the wrong cleanser,” Blades said. “Most people, in addition to changing their skin care, also need to change something else.”
In Traditional Chinese Medicine, acne signals “damp heat,” in the body, said Gianna de la Torre, a licensed acupuncturist who specializes in facial applications, and founder of Wildling Beauty. Like Blades and Dr. Fishman, de la Torre has seen clients whose acne improves with lifestyle adjustments and stress management. “Excess heat in the body is often linked to stress,” de la Torre said. “Generally speaking, that heat can come from a weak spleen, which is common in our culture. It’s what happens when we over-sit, over-think, and over-work." Um, hi.
The Best Adult Acne Treatments
Even if the cause is unclear—and many times it will be—these tried and true tips, tricks, and tools are recommended by the pros.
1. Try LED Treatments
While she mentioned that at-home LED masks are not as effective as in-office treatments, Dr. Fishman recommends ones that feature both red and blue light. “The blue light kills bacteria and the red light is anti-inflammatory,” she said.
2. Include Retinoids Into Your Routine
“Whether they are prescription or over the counter, I think retinoids are the mainstay of any acne regimen,” said Dr. Fishman. For a super gentle version, try products that contain bakuchiol, an all-natural alternative that isn’t as sensitizing as retinol.
3. Choose the Right Acids
Choosing the right acid for your skin type is key to achieving good results. “I recommend salicylic or glycolic for more oily skin, but for sensitive skin with acne, I like lactic acid, mandelic aid, or gluconolactone,” said Dr. Fishman.
4. Cut Out Milk (Especially Skim)
Both Dr. Fishman and de la Torre agree that removing milk from your diet can make a huge difference for people with acneic skin. “If you must have cow milk, make it whole not skim,” said Dr. Fishman.
5. Avoid Essential Oils
Many essential oils are microbial, Blades said. “And while they have a time and a place in skin care, I recommend essential-oil free products for acneic skin,” she said. Her top product picks are Marie Veronique’s collaboration with Kristina Holey and anything by Materia Medica Lab.
6. Try Rose Flower Essence
Living with acne and having enough patience to heal it can be trying on the spirit. According to Blades, rose flower essence is a heart opener that enhances self-love and self-compassion, which can help support the healing process.
7. Try Heat-Clearing Acupressure
Stimulating certain meridian points using pressure from your own hands can create change in the body. De la Torre recommends acupuncture point Large intestine 4, which falls on the webbing between the index finger and the thumb. Using the index finger and thumb from one hand, apply pressure to the webbing of the other and breathe deeply. De la Torre pointed out this is also an excellent point for headaches.
8. Eat Bitter Herbs for Liver Support
“The skin is our largest detox organ,” Blades said. “If it’s breaking out, it’s often a sign that our detox pathways need support.” Other detox organs include the kidneys and the liver, which may be over taxed if the skin is breaking out. Bitter herbs like dandelion, artichoke, and burdock help to support the liver, and eating them (versus taking extracts or drinking teas) is the safest way to benefit from their cleansing effects.
9. Opt for “Slow Burn” Movement vs. Intense Cardio
Since acne is a product of too much heat, it’s best to avoid heat-intense workouts like spinning or running according to de la Torre. “To balance out the energy, it’s best to keep workouts more relaxing, a slow burn like yoga or pilates is ideal,” she said, and won’t contribute at all or as much to excess heat.
10. Track Your Cycle
If you’re a person who menstruates and suspect your acne is hormonal, Blades recommends using Clue or Daisy to track your cycles. If you suspect your acne may be hormonal, start charting when your breakouts appear, when and if they worse, and when they heal. The patterns that emerge may be helpful in linking breakouts to hormonal imbalances that can be addressed by your care team.
One common theme that all three experts agree on? Every body is different. You may or may not respond to these techniques. If you do decide to try them, make sure the changes are incorporated in a slow and gentle way. With too many tweaks at once, it’s easy to shock the skin which can make inflammation and acne worse. In other words: Don’t try these all at once! Take it easy and incorporate these practices into your routine one-by-one.