How to treat adult acne

Which treatment should you start with?

Choose treatment by the type and severity of your breakouts, not simply because the packaging says "adult acne". Blackheads and whiteheads are blocked pores; inflamed spots need treatment that also addresses bacteria and swelling. Deep lumps need medical assessment rather than another shopping experiment.12

Adult skin can find strong acne products too drying, especially as it ages. A gentle cleanser containing salicylic acid or glycolic acid is one starting option. If dryness or irritation is a problem, ask a pharmacist or dermatologist to help choose a suitable treatment rather than moving straight to something stronger.3

How should you build your daily routine?

1. 1Wash with a gentle cleanser twice a day. Do not scrub, because scrubbing can irritate skin and worsen acne.
2. 2Apply your chosen acne treatment as directed. A topical retinoid belongs across the affected area rather than only on visible pimples.
3. 3Remove makeup at the end of the day, even if its packaging has promised to do everything else.

Look for skincare and makeup labelled noncomedogenic, meaning formulated not to clog pores. Check hair and beard products too. Greasy hair products can reach your face and block follicles, because a product's job description does not keep it on your hair. For chest or back acne, wear loose, breathable clothing, especially during exercise or sweating. Do not pick or squeeze spots: doing so can cause scars.14

How long does treatment take?

Improvement in hormonal acne can take four to six weeks after treatment begins; topical retinoids often need several months before positive results become noticeable. An early lack of visible change is not, by itself, a reason to abandon treatment. Continue the treatment as directed to help prevent new breakouts, but seek medical help if acne worsens or remains persistent.25

Treatment aims to heal existing spots and prevent new ones, rather than negotiate with each pimple individually. Treating acne early also helps reduce the risk of permanent scarring.25

Why are you getting acne as an adult?

Hormonal changes can increase sebum, the oil your skin produces. Oil and dead skin cells block hair follicles, and bacteria contribute to inflammation. Adult acne often appears around the chin and jawline, but it can also affect the rest of the face, chest, shoulders and back. Location alone is not a diagnosis of hormonal acne.135

Breakouts can accompany periods, pregnancy, menopause or stopping birth control. Stress can aggravate acne, and greasy skincare or hair products can contribute. If acne starts after a medication change, tell your doctor what you have started or stopped. Testosterone treatments, corticosteroids, lithium and some seizure medicines can contribute to breakouts. New acne alongside irregular periods or excessive hair growth also deserves a discussion about a possible underlying hormonal condition.35

What can a dermatologist prescribe?

A dermatologist can assess the cause and severity of your acne and choose a targeted treatment. Options include prescription topical medicines, oral antibiotics, hormonal treatment and isotretinoin for severe acne that has not improved with other treatments. Laser and light treatment is rarely enough on its own.136

For women with acne driven by hormones, a dermatologist can consider certain oral contraceptives or spironolactone, which blocks testosterone's effect at the hair follicle. Men generally use topical treatments, antibiotics or isotretinoin instead. Many topical treatments are used in both men and women.34

Antibiotics should be used for the shortest appropriate course because prolonged use increases the risk of bacterial resistance. If acne does not respond adequately to a course of oral antibiotics, a dermatologist can consider isotretinoin rather than repeated antibiotic courses.4

What if you are pregnant?

Pregnancy changes which acne treatments are suitable. Avoid topical retinoids, salicylic acid and isotretinoin during pregnancy, and ask your healthcare provider to choose a suitable alternative. If you become pregnant while using acne medicine, contact your prescriber about what to stop. Pregnancy related acne sometimes improves as pregnancy progresses, but it can continue after birth.356

When should you get medical help?

• Arrange an appointment if treatment you can buy yourself is not helping.
• Get help early for deep, painful lumps or any scarring.
• See a doctor for hot, swollen, red skin that could signal infection. Redness can be harder to see on brown and black skin.
• Seek help if acne affects your mental health or quality of life; severity is not just a spot count.
• Have sudden, severe adult breakouts assessed, because a doctor can check for an underlying condition.