Why Am I Breaking Out as an Adult?

You got through high school with a clear face. Now you’re 41, and a pimple the size of a pea has set up camp on your jawline the week before a work trip. You’re also shopping for wrinkle cream. Your skin can’t decide what decade it’s in.

Why it shows up now

The American Academy of Dermatology (AAD)² says women tend to get adult acne more often than men do. Hormone swings are the headline cause: around your period, during pregnancy, in perimenopause and menopause, and when you begin or come off birth control.

Cleveland Clinic¹ describes hormonal acne as breakouts from excess oil, or sebum. It lists stress and lack of sleep among the triggers you can influence.

Stress has a mechanism. The AAD² says researchers have found a link between stress and flare-ups, and that stress raises androgen production, which stimulates the oil glands and hair follicles. Some people also carry a genetic tendency toward acne.

So a bad month at work and a bad week of skin may be connected.

Where it tends to land

Cleveland Clinic¹ says hormonal acne most often shows up on the cheeks, and can also appear on the neck, back, shoulders and chest. It can look like whiteheads, blackheads, red bumps, pus-filled pimples, and cysts, which are pockets of fluid under the skin.

The AAD³ points to a pattern in women with stubborn acne: along the jawline and lower face, and on the neck. That pattern is the one hormonal therapy is aimed at.

When it’s more than skin

Acne can be one piece of a bigger picture. Cleveland Clinic¹ lists polycystic ovary syndrome (PCOS) among the possible causes of hormonal acne.

The Office on Women’s Health⁴ says PCOS affects between 5% and 10% of women between 15 and 44, and the symptoms include irregular periods, extra hair on the face and body, acne on the face, chest and upper back, thinning scalp hair, trouble managing weight, and darkened skin along the neck creases.

So if acne comes with irregular periods or new chin hair, mention both at your appointment. Skin is easy to treat in isolation. The cause sometimes isn’t in the skin.

What helps at home

The AAD’s⁵ list of habits that worsen acne reads like a list of things most of us do on a bad day.

Twice a day is the AAD’s⁵ number for washing: when you wake up, before you go to bed, and after a sweaty workout. Use a mild cleanser and your fingertips, with a gentle circular motion. The AAD says scrubbing can irritate skin and flare acne.

Don’t pick. Popping a pimple can push pus, dead skin and bacteria deeper, which raises inflammation and can leave a scar.

Take your makeup off before bed, with no exceptions, the AAD⁵ says. Use makeup and skin care labeled non-comedogenic or oil-free. Don’t share makeup. Pat sweat from your skin with a clean towel.

And switch products less often. The AAD’s⁵ first item on the list is changing treatments too frequently. It wants you to use one product for 6 to 8 weeks before deciding it failed, and to apply it evenly across the acne-prone area, not only on the spots you can see.

The play

Try this: a six-week test

Choose one over-the-counter treatment from the AAD’s⁶ list of dermatologist-recommended ingredients: adapalene, azelaic acid, benzoyl peroxide or salicylic acid.

Apply a thin layer over the whole area where you break out, following the label.

Take a photo today. Take another at six weeks. Don’t change anything in between.

The AAD⁶ says to expect fewer breakouts in 4 to 8 weeks, and clearing around 16 weeks after starting. It also says toothpaste doesn’t help, because its abrasive ingredients irritate skin.

If you’re pregnant, the AAD⁶ says to see a dermatologist before treating acne yourself.

What a dermatologist can add

For stubborn jawline acne that hasn’t responded to other treatments, the AAD³ describes hormonal therapy. It names two options: birth control pills and spironolactone, a blood pressure medicine that’s also used for acne. Birth control pills take 2 to 3 months to show an effect. With spironolactone, the AAD says breakouts and oiliness can drop within a few weeks.

In one study of 85 women taking spironolactone alone, the AAD³ says about a third had complete clearing and another third had noticeably less acne. Spironolactone is not safe in pregnancy. The AAD warns that a baby can have serious birth defects if you become pregnant while taking it, so birth control is part of the plan. Whether either option suits you is a conversation with your clinician.

Cleveland Clinic¹ also lists a prescription retinoid cream for blackheads, steroid injections for cysts, and laser therapy.

When to get checked

The AAD² says to see a dermatologist if nothing clears your acne. Cleveland Clinic¹ says the same if it’s not going away or is getting worse.

Book an appointment if any of these fit:

• You have large, painful pimples that sit deep in the skin
• Your acne leaves scars or dark spots after it clears
• Six to eight weeks of one treatment hasn’t helped
• Acne comes with irregular periods, new facial hair, or thinning on top
• You’re pregnant or planning to be, and you want to treat it

Give the one product its six weeks. By the next work trip, you’ll know whether it earned its spot in your bag.