The Counter: How I Handle Adult Acne

Jan 25, 2024

In the past few months, several of my friends and readers have reached out to ask for advice on handling adult acne.  Even women who had never had acne, suddenly find themselves dealing with the spotted scourge after-35.  And since the mental health impacts of having acne are very real, I thought, that as a lifelong acne sufferer, I could offer some advice on what works for me.

First // See a Dermatologist // Recently, a girlfriend, whose clear skin I’ve always envied, found herself afflicted with painful cystic acne.  Ugh, the worst.  A visit to the dermatologist and a blood test later and she discovered her testosterone levels were higher than normal.  Hormonal changes are often the cause of adult onset acne, so seeing a doctor is a must.

Even if the cause turns out to be something else, given that your skin takes longer to bounce back in middle age, it’s best to start with the professional advice first.

Second // Simplify your skincare routine // Instead of reaching for more serums, more masks, and more harsh cleansers, choose a gentler, simpler routine to treat acne.  Avoid harsh scrubs and masks, which will only irritate skin more.

My routine is pretty simple: a gentle, gel cleanser, a vitamin-C serum, a European sunscreen, and a moisturizer.  At night, I swap the serum for this pore exfoliating liquid and a night cream, which I mostly apply around my eyes and on my forehead, unless things are very dry.

When things get really out of control (usually after my cycle), I reach for this sheet mask that always clears things up.  It’s a gift.  I also really like zit-stickers — these ones for normal blemishes, these ones for the deep, painful kind.

Third // Get Your Hair Off Your Face // A few years ago, I started pinning back my bangs and wearing a ponytail to bed each night. It made a huge difference in controlling my breakouts.  Your hair has oil and hair product in it, and you don’t want that sitting on your skin or soaking into your pillowcase, and making its way to your skin.  And speaking of pillowcases. . .

Fourth // Change Your Pillowcase // I keep three pillowcases in my night stand so that I can change mine regularly.  Your pillowcase can become a breeding ground for bacteria or just get covered in things that won’t make your skin happy.  I still use a cotton pillowcase, but will likely switch to a silk one soon, since they’re gentler on my aging skin.

Fifth // Cut Back on Sugar // Eating sweets causes inflammation.  Inflammation causes sebum production to spike.  Excess sebum means acne.  I’ve found that just limiting my sugar consumption really helps my acne, even if it just reduces redness.  At 41, I will take all the help I can get.

Do you have adult acne?  What do you find helps?

{this post contains affiliate links that may generate commission for the author}

Beauty, Posts, The Counter

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  1. Nadine says:

    So glad to see seeking medical advice as step number one. I put up with what I assumed was adult acne related to hormonal shifts in my late 30s and early forties. It turned out to be caused by an autoimmune disease instead. Now that I’m dealing with the source of the problem, my skin is healing.

  2. Rachel says:

    The Mighty Patch spot treatments are amazing. $8 for a box of 24 at Target.

  3. jules says:

    I agree with the simple routine is best. And also…. don’t touch your face! It’s physically impossible for me to resit touching them, popping them, scraping them, but leaving them alone to the best of my abilities makes a difference.

    I also suffered from a lot of acne last year until I spoke with a skincare consultant. She noticed that the moisturizer I was using could be too thick, causing my breakouts. I switched to a lighter moisturizer (the Clinique Dramatically Different) and my skin improved a LOT.

  4. nancy m says:

    i stopped birth control and got hormonal acne on my chin. My derm (via Teledoc! So easy!) prescribed Spironolactone, and a gentle acne face wash only used 2x a week. I’ve also included a salicylic spot treatment, and in a week, my skin is a lot more clear and inflamation has subsided. I also highly recommend switching out your pillowcase more frequently, that made a difference!

  5. Stella says:

    My adult acne is mostly under control. I use tea tree oil and zit stickers for the occasional breakout. In the past, I was on 4 courses of Accutane, but what really helped my cystic breakouts get under control was azelaic acid (Azelex).
    Less is more when it comes to products–in fact, checking ingredient lists to avoid highly comedogenic ingredients was also helpful. (Although what might be a trigger for some might not affect others — YMMV…)

  6. KateL says:

    All of these tips plus clean your make up brushes! They are often a contributing factor to my chin and hairline breakouts.

  7. strin012 says:

    In addition to hormonal acne, I have severe skin allergies. My derm had me do patch testing to identify the allergens that were causing breakouts. I use the Skin Safe app to scan products and it tells me if it’s safe to use.

    I have mostly switched to using Vanicream products (face wash, body wash, shampoo and conditioner) and other very gentle formulas, which has helped a ton.

    When I do get a breakout, I use (and swear by) Peace Out Acne healing dots. They’re a little spendy, but they. work. so. well. I cut them in quarters to stretch them out, which has worked just fine.

  8. KL says:

    I was one of the lucky ones who never had to deal with acne after a few minor teenage breakouts. Then, I turned 30 and suddenly had cystic acne in the same spot constantly (I had to look up what it was to learn about cystic acne, it was so weird to me to have these painful lumps under my skin). I tried paring back my already-basic routine — no makeup, consistent cleansing, Cerave moisturizer, various spot treatments for the acne which helped it heal faster but didn’t stop new ones from popping up.

    Finally I went to the dermatologist, who gave me 2 prescriptions: oral spironolactone to treat the underlying hormonal changes, plus topical tretinoin. I have dry skin and struggled to adjust to the tretinoin at first, but within 2 weeks of starting spiro (the derm said to give it 3 months) my cystic acne completely went away. Like a miracle.

  9. Julia says:

    One of the main things that helped me was using a higher end benzoyl peroxide face wash (PCA Skin BPO wash) and moisturizer (i use Jan Marini). I used to be a proactive user and knew that BPO helped me (some might find salicylic acid works better for them). But finding the higher end products made with more gentle ingredients really helped. The drug store products were too harsh and aggravating.

  10. Julia says:

    Oh also, the face masks noted above are incredible for hormonal cystic acne (and I’m sure all acne)! But when looking for patches, I use salicylic acid ones (Peter Thomas Roth has some) for pimples that won’t unclog, and hydrocolloid ones once they’ve popped.

  11. Kate says:

    I see a licensed esthetician once per month, and it has been absolutely life changing. She discovered that my non-comedogenic/sensitive skin products were, in fact, clogging my pores. To combat that, I was using acne products that were too harsh for my sensitive skin, and I got into a vicious cycle where my moisture barrier was completely destroyed.

    She uses Face Reality products almost exclusively with her acne patients, and they’ve worked wonders for me. They’re reasonably priced and don’t irritate my hypersensitive skin.

  12. Laney says:

    Highly recommend this ingredient spreadsheet, nothing is one size fits all but it helped me realize some common ingredient triggers for my acne – https://intothegloss.com/2019/12/acne-spreadsheet-aes-clinic/

  13. Sam says:

    I dealt with hormonal cystic acne on my chin since high school, trying every topical treatment my derm could recommend, that would only work temporarily. I finally learned in my 30’s that it was exacerbated by my dairy intake so I cut back there and went on Spironolactone. Then I started seeing an aesthetician a few years ago who simplified my skincare routine and I’ve seen great results (mostly Dermalogica and Clarity products; glycolic acid has been great at treating anything that pops up). I just stopped Spiro after 5+ years and so far have transitioned well.

  14. Jessica says:

    I am just going off of spironolactone after 4-5 years of being on and it doing wonders for my skin. Just a warning for everyone else in the same boat, as you get into the mid-40’s range it can be unhelpful to shifting hormones in some (my) circumstances. Waiting to see if my skin goes back to being less than great, have not had to worry about it for years. Argh.

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