What Is Adult Acne and How Do I Treat It?

by Fayne Frey, M.D.

Acne, the bane of almost everyone’s existence at some point during their lives, is a chronic inflammatory skin condition. It affects over 50 million Americans annually, both male and female, and is the most common skin condition in the United States.

Here’s a scenario you may be familiar with. You wake up, clear the sleep from your eyes, and shuffle off to the bathroom where you take that first look at yourself in the mirror. There it is, an angry-looking inflamed red pimple. It’s sore to the touch, but that’s not the worst of it. There’s the psychological torment and embarrassment plastered on your face. You reach for your concealers and the battle to hide that blemish begins. We’ve all been there. How do you get rid of adult acne?

We’ve all seen the cure-all antidotes, quick-fix spot treatments, and do-it-yourself remedies on the internet, in beauty and health magazines, and in mainstream media. Most people will try anything to rid themselves of acne. But what does science say? When it comes to acne, what is fact and what is fiction?

Understanding Adult Acne

It’s important to understand that acne, or acne vulgaris, is the same condition whether found during adolescence or adulthood. Yes, acne affects younger people most commonly, but adults get it too. Acne does not discriminate.

This condition is a chronic inflammatory condition of the hair follicle and its associated oil glands (pilosebaceous unit). Typically, acne develops when oil and dead skin cells plug pores on the skin, promoting the growth of the commensal bacteria, Cutibacterium acnes. Inflammatory molecules secreted by these bacteria initiate an inflammatory response, resulting in the development of pimples. Acne is born.

In a nutshell, hormones and oil production, inflammation, dirt, and bacteria all come together to make a mess of your skin.

What Does Acne Look Like?

Acne most commonly occurs on the face, chest, back, and shoulders, which are the areas with the largest number of oil glands. While adolescents experience facial acne mostly on the forehead and cheeks, menopausal women tend to develop acne on the lower face, around the chin, and jawline. Studies suggest that about 15% of women experience menopausal acne before during and after menopause. Acne lesions come in several different forms:

Non-inflammatory Acne

Non-inflammatory acne is a type of acne where there is no swelling, redness or discomfort. Enlarged or clogged hair follicles formed by trapped oil and dead skin cells, called comedones, come in two forms; whiteheads and blackheads.

• Whiteheads appear white or yellowish. A thin layer of skin closes off the oil and debris in a whitehead from the air so the trapped clog retains its natural lighter color. Closed comedones are more difficult to remove and are often precursors to inflammatory acne.
• Blackheads are black or gray. Because the clog in a blackhead is open to the air, the material in the clog oxidizes and trunks a darker color.

When to See a Dermatologist for Acne Treatment

Best Treatment for Adult Acne

What is the best treatment for adult acne (which dermatologists simply call “acne”) to help minimize breakouts? There are simple remedies people try at home, and both over-the-counter creams and cleansers, and prescription antibiotics. The appropriate treatment for your acne depends on the type of acne.

These treatments reduce the oil production within the sebaceous gland and decrease bacterial overgrowth within the follicle (Note: The sebaceous gland is a microscopic gland that produces an oily substance that protects the skin from drying out.) The goal of these treatments is to reduce inflammation and normalize normal cell turnover within the hair follicle.

Face Washing

I hear from my patients often that one of the first things they try is to wash their face better with cleanser. Does this work? Some so-called experts advise doing so several times a day. The truth is that there is no consensus in the dermatological community on how often an individual with healthy skin should wash their face with a cleanser.  However, there is some research that shows it is advantageous for acne sufferers to cleanse their face with a mild soap-free cleanser twice daily.

Pimple Popping

It’s common for people to “pop” their pimples or squeeze out the contents to get rid of the acne lesion. These techniques rarely, if ever, eliminate the problem and may even extend the inflammation deeper into their skin. This may cause lesions to become more noticeable, and more painful, and possibly extend their life. It may also cause a more severe skin infection and/or scarring. So I wouldn’t say this is the best treatment for adult acne.

Over-the-Counter (OTC) Acne Treatments

Salicylic Acid: Many people choose to try over-the-counter acne treatments before seeking medical attention. If you have mild comedonal acne, you may benefit from OTC products that contain salicylic acid. Salicylic acid, a keratolytic agent that disrupts the space between the most superficial skin cells, causes dead cells to shed from the topic layer of skin. It is beneficial when used in concentrations of 3%-6%. More concentrated products containing salicylic acid may irritate the skin.

Benzoyl Peroxide: With mild inflammatory acne, you may benefit from OTC products containing benzoyl peroxide. The antibacterial effects of benzoyl peroxide help reduce acne-causing bacteria. While metabolized on the skin’s surface to benzoic acid and free oxygen, a free radical, benzoyl peroxide has never been shown to cause skin aging!

Adapalene: Adapalene, a vitamin A derivative or retinoid, is also available OTC for acne sufferers. Retinoids decrease inflammation by binding to specific receptors within cells. However, retinoids may cause skin redness, dryness, itching, and burning and are not always well tolerated. These vitamin A derivatives are sun sensitizing so sun avoidance and applying sunscreen often and liberally is important when using these products. Initial worsening of acne during the first several weeks of retinoid use is not uncommon.

Prescription Acne Medication

You can treat most cases of mild acne with topical over-the-counter solutions. If your acne does not respond to OTC treatment, consult a dermatologist to discuss possible prescription acne medications. Your treatment will depend on factors like the type of acne, severity, and location.

Your doctor might prescribe topical prescription products that normalize cell turnover and decrease oil production or a topical antibiotic cream. For individuals with more resistant acne, oral antibiotics can help reduce inflammation. Combination topical anti-acne preparations are also available. In addition, your doctor might prescribe oral retinoids for severe nodular acne to reduce inflammation and potential scarring.

For menopausal acne, hormone replacement therapy (HRT) is an option. Supplementing declining estrogen and progesterone levels can minimize menopausal acne breakouts. HRT comes as a patch, pill, cream, or gel. Because there is a relative increase in androgens in the menopausal female, you may experience symptoms such as acne, increased facial hair (hirsutism), and hair loss on the scalp (androgen alopecia) with HRT. I recommend a thorough evaluation by a dermatologist or endocrinologist to determine the presence and extent of hormonal imbalance to treat your acne most effectively.

Common Adult Acne Myths

People with acne suffer. They endure the discomfort and pain of the acne lesions themselves, and they suffer the humiliation of having to face the world with angry looking lesions on their face. So, they live with both physical and emotional turmoil. As a result, many are willing to try almost anything to get rid of the acne. I get it. But be careful; it’s important to separate fact from fiction. Some treatments are simply myths. Here are a few that my patients bring up often in my office.

Myth #1 Change your pillowcase once a week

How often does a person really need to change their sheets and pillowcase? According to many “experts” (not sure what constitutes a linen-changing expert or how you become one), you need to change your sheets and pillowcases once/week or every two weeks at the most. Which one is it? My guess is that the time of year is a factor. If you sweat due to the high ambient temperatures of the summer, have night sweats, or perspire from a fever, you might want to change your sheets more often. Another possible factor is if there is a shedding pet that shares your bed. Then I could understand the desire to wash the sheets and pillowcases more frequently, at least to appease our cultural desire for cleanliness. Of course, most of us enjoy placing our heads onto a fresh pillowcase exuding the fresh scent of roses. But what happens if those sheets and pillowcase aren’t changed until three or four weeks passed? Who knows? Scientific studies correlating pillowcase or sheet changes with acne breakouts are non-existent.

Myth #2 Use a silk pillowcase

I love silk pillowcases. They are beautiful and feel lovely. But here again, no research exists to prove a silk pillowcase improves or prevents acne compared to any other pillowcase material. But don’t tell that to a silk pillowcase salesperson!

Myth #3 Makeup causes acne

Acne cosmetica, a mild form of persistent acne seen primarily in adult women triggered by the use of cosmetics, was a term coined in 1972 by the late brilliant scientist Dr. Albert Klingman. While it is true that some women break out after applying certain cosmetics, it is also true that for some women, the use of cosmetics improves their acne.

This topic is a very controversial one even among the dermatologic community. There is increasing evidence that acne cosmetica isn’t caused by the product itself but by a particular pore-clogging, or comedogenic ingredient, found in the cosmetic formulation. Some major manufacturers conduct testing in an attempt to minimize breakouts caused by the use of their products; they then label the products that pass the tests as “non-comedogenic.” However, there are no federal guidelines for standardized testing that guarantee any particular product won’t cause or exacerbate acne in any given individual.

My opinion on this matter is not based on valid science because there isn’t any, but after thirty years of dermatologic experience and product testing, here’s what I recommend for my acne patients: Choose your makeup and other facial products carefully. Opt for oil-free products. If possible, purchase “non-comedogenic” products from reputable manufacturers, not because it guarantees a breakout won’t occur, but because the product likely had some level of testing. And that’s better than nothing.

Myth #4 Chocolate causes acne

There are over 50 million people in the United States with acne. And there are almost 270 million Americans who eat chocolate. The relationship between chocolate and acne is controversial because there is little if any, evidence that proves eating chocolate causes or worsens acne.

There is weak scientific evidence that suggests heavy consumption of dairy products may exacerbate this condition. Stronger scientific evidence suggests an association between acne and a diet with a high glycemic index. A high glycemic index diet raises blood sugar and insulin levels. Foods with a high glycemic index include white rice, white bread, potatoes, and other carbohydrate-rich foods.  Oil production within hair follicles seems to be elevated by hormones that are stimulated by high insulin levels which may increase acne formation.

There may be a relationship between acne and diet, but more research is necessary.  If you find a relationship between eating any food and your acne breakouts, I recommend you avoid or limit that food.

Myth #5  Putting toothpaste on acne is beneficial

Toothpaste is formulated to be applied to a hard surface enamel. It has a basic pH, one that may be harmful to your more neutral skin surface. Applying toothpaste to your skin may dry it out and can exacerbate acne breakouts. Historically, toothpaste contained an ingredient called triclosan, a known antibacterial ingredient, and the rationale for applying toothpaste on acne breakouts. But, in 2019, triclosan was taken off the market; it is no longer found in toothpaste. To date, there are no double-blinded studies proving toothpaste is an effective acne treatment. There are, however, plenty of patients seen in dermatology offices for irritating inflammatory reactions resulting from applying toothpaste to their faces.

Myth #6 There’s a phone APP to treat my acne

Smartphones are great. And, yes, they are smart. They use artificial intelligence to identify music and generate images. In addition, they can provide real time language translators and enhanced photography. But they can’t treat your acne. Some app developers claim that the light source from the phone could cure and treat certain conditions, including acne. These apps were actually sold on the iTunes App Store, until the FTC stepped in. When it comes to treating acne, as of today anyway, there’s no app for that.

Myth #7 Home Remedies

Open your kitchen cabinets and you will find many products touted to improve acne such as honey, tea tree oil, egg whites, and colloidal oatmeal. Unfortunately, there is no scientific evidence that supports the beneficial claims of these treatments. And many home remedies, especially plant-based products like tea tree oil, oregano oil, and lemon juice can cause allergic reactions. My advice: use honey in your tea, and egg whites to cook and eat for breakfast along with your oatmeal. Pass on the tea tree oil. If you want to use a home remedy, first consult with your dermatologist and proceed with caution.

The Bottom Line

People of all ages with acne often suffer both physical and emotional turmoil. The good news is, however, that there are many reliable, scientifically proven treatments available for this condition. Unfortunately, there are also many “skincare experts” and “snake oil” salespeople selling magical fixes that have little or no benefit for acne sufferers. We live in a capitalistic market driven by profits, and these bad actors take advantage of frustrated individuals who desperately want to eliminate their acne. In 2023, the United States (U.S.) acne treatment market was valued at $2.65 billion!

So, be careful. There are many myths about what causes and effectively treats acne, and most have been debunked. We know acne is a chronic inflammatory condition that affects hair follicles and associated oil glands. And we know that mild acne can often be effectively treated with OTC products like salicylic acid or benzoyl peroxide. But severe acne or acne that doesn’t respond to OTC products should be treated by a dermatologist who can prescribe prescription medications such as antibiotics or retinoids. Your trusted health professional can help you determine the best treatment for adult acne based on your specific needs.

About the Author: Fayne Frey, MD

Fayne Frey, M.D., is a board-certified clinical and surgical dermatologist practicing in West Nyack, New York. She specializes in the diagnosis and treatment of skin cancer and is a nationally recognized expert in the effectiveness and formulation of over-the-counter skincare products. As a speaker, Dr. Frey captivates audiences with her wry observations regarding the skincare industry. She consults for numerous media outlets, including NBC, USA Today, and, the Huffington Post, and shares her expertise on both cable and major TV outlets. Dr. Frey is the Founder of FryFace.com, an educational skincare information and product selection service website that simplifies the overwhelming choice of effective, safe, and affordable products available. She is also the author of, “The Skincare Hoax: How You’re Being Tricked into Buying Lotions, Potions and Wrinkle Creams”.  In addition, Dr. Frey is a fellow of both the American Academy of Dermatology and the American Society for Dermatologic Surgery.

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