How to fight Adult Acne


how to treat and prevent adult acne

The number one question I get from my family and friends is, “How do I treat adult acne?” My friends (doctors and non-docs alike!), my coworkers, myself, even my Dad who is in his 60’s still struggle with acne from time to time. So what’s the deal with these pimples and how do we get rid of it?

First of all, what causes acne? Turns out it’s a mix of things. Skin cells called corneocytes are usually shed into hair follicles, but in acne, you get overproduction of skin cells that like to stick together as well as excess production of sebum, an oily substance that protects the skin. It’s a small opening in the hair follicle but a lot of gunk backed up beneath it, so this creates a bottleneck and a comedone forms (open ones are called blackheads, closed ones whiteheads). As more gunk accumulates at the bottom of the hair follicle, pressure builds up until the comedone walls under the skin rupture, resulting in inflammation and unfortunate pimples. Propionibacterium acnes is a bacteria that lives in the hair follicle that also worsens pimples by increasing inflammation and contributing to rupture of the comedone wall.

As far as treatments go, there’s a bunch! Here is an infographic I made about the power ingredients we use in dermatology to target those troublesome pimples.

how to fight adult acne infographic

We really approach acne in a step-wise fashion. In general, topical creams and medications are first-line, and oral medications are for more severe cases that do not respond well to just topical treatments.

If you have acne and haven’t tried anything before, try starting with a benzoyl peroxide wash or a product with salicylic acid in it. These are available over the counter and have a small side effect profile. Benzoyl peroxide and salicylic acid are actually the main active ingredients in Proactiv! Also make sure to use non-comedogenic makeup, meaning makeup that does not clog your pores and cause pimples. Make sure to really clean off your makeup at the end of the day too.

If the washes alone don’t work, I’d suggest seeing a dermatologist for some prescription strength medicine. A benzoyl peroxide wash plus a topical antibiotic like clindamycin and a topical tretinoin is a great combination to bring your acne fighting regimen to the next level. If you have inflammatory acne (more pustules than comedones) your doctor may choose to swap in an oral antibiotic instead of a topical one.

If you tend to get acne flares around your period or if you tend to have acne around the jawline or around the mouth area, then you may have a hormonal component to your acne. This can be improved by birth control pills or a pill called spironolactone, which helps to counter androgens (male hormones) that promote acne formation. These require prescriptions from a doctor, as there are side effects associated with each.

If nothing topical works and oral antibiotics don’t work either and you still have severe acne, your doctor may consider Accutane, which is an oral medicine derived from vitamin A. Accutane majorly decreases the size of your sebum-producing glands which in turn also kills bacteria that depend on sebum to thrive in your skin. Accutane is usually taken in a 4-5 month course and ~85% of patients get clearance of acne after using this medication. Know that there are many side effects associated with Accutane though, including but not limited to birth defects, depression, elevated cholesterol, abnormal liver enzymes, etc. Because of these severe side effects, you will need frequent blood tests, pregnancy tests, and close follow up with your dermatologist. This may sound cumbersome but it’s worth the effort if you really have troublesome acne that hasn’t worked with any other treatments.

Hope this post helps in clearing up some of the confusion around how best to treat these pesky pimples! What have you found works for you?

12 Comments on How to fight Adult Acne

  1. Jean
    February 1, 2016 at 10:14 pm (2 years ago)

    Thank you for your great article. What do you think of Nono? It is a small light therapy home device that I use and it works wonders for my acne.

    • Joyce
      February 5, 2016 at 6:39 pm (2 years ago)

      Hi Jean! You know, I don’t actually know about Nono and I’m curious to learn more. In the clinic we do use bluelight therapy to help treat acne. I wonder if it’s something similar? I’ll look into it and let you know!

  2. rn2mdblog
    February 5, 2016 at 3:35 am (2 years ago)

    Can you use topical benzoyl peroxide (otc) with topical clinda lotion?

    • Joyce
      February 5, 2016 at 6:25 pm (2 years ago)

      Yes, there is actually a prescription medication called Benzaclin which is a gel mixture of topical benzoyl peroxide with Clindamycin.

  3. Michelle
    March 20, 2016 at 11:48 am (2 years ago)

    Thank you for this article, love your blog especially since I’ll be an MS1 this fall! How do you use prescription benzoyl peroxide wash with prescription topical tretinoin? I read that they cancel each other out! I’d like to use both at night since they increase sun sensitivity.

    • Joyce
      March 20, 2016 at 1:32 pm (2 years ago)

      Great question Michelle. Benzoyl peroxide inactivates tretinoin, so I suggest using them separately. For example, use BP wash in the morning and then tretinoin at night because it is more photolabile and increases sun sensitivity.

      • Michelle
        March 20, 2016 at 4:42 pm (2 years ago)

        Thank you, I’ll try it!

  4. Carly
    March 10, 2017 at 7:52 pm (9 months ago)

    Hi Joyce, thank you for the great article. I have followed you for some time on social media and am grateful for these helpful posts! I was treated with Accutane over 10 years ago but still have some acne here and there, and the only time it gets very bad is when I pick at my skin (or I go off my oral contraceptive). I was wondering if you have any advice for those of us who struggle with anxiety and bad habits such as picking skin. Also, how should we treat acne once it has been picked (and in a half pimple/ half scab kind of state)? I have used Neosporin in the past. Thank you!

    • Joyce
      March 12, 2017 at 5:45 pm (9 months ago)

      Hi Carly, I know it can be tempting, but try as hard as you can to kick that habit! Picking can lead to infections and scarring of the skin, so stopping the habit will be the best treatment. If you do have a scab I typically recommend vaseline; if it looks infected (red, angry, pus-filled) you could see your dermatologist for a prescription for mupirocin or bacitracin, which are antibiotic ointments. We tend to stay away from Neosporin because people can develop skin allergies to it. If you start getting dark spots or scarring you want to be very vigilant about sun protection, since sun exposure darkens those scars. You may also consider seeing a derm for acne scar treatment, whether that’s with laser or filler. Good luck!

  5. sher
    July 4, 2017 at 10:35 am (5 months ago)

    Hey Joyce, thanks for this helpful post. I am a premed and your blog has been super inspirational to me! I have been struggling with acne that’s on the lower 1/3 of my face(jawline, mouth area, side cheeks), im on both oral and topical antibiotics now and I haven’t seen any improvements. Should I be concerned about PCOS?

    • Joyce
      July 4, 2017 at 8:27 pm (5 months ago)

      Hi Sher, sorry to hear that you have been struggling on acne. I would see a dermatologist to ask them if you may have hormonal acne, which may be treated with hormone modulating agents such as birth control pills or spironolactone. They can also make the assessment as to whether or not PCOS may be a concern. Good luck!


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