Adult acne: Why women get it and how to treat it

In our 40s, the rules for getting clear, glowing skin change. Here’s what you need to know.

By Donna Sozio


When I turned eighteen, I naively thought I’d never get a pimple again. Zits were for teenagers, and I was leaving that awkward phase behind. Well, no such luck. I soon became acquainted with adult acne, which flourished in my 20s, left in my 30s and – hello? – came back in my 40s. But this time, rather than pick my skin, I picked the brains of leading skincare experts to discover why my acne had returned and, more important, what I could do about it. 

It turns out that treating big-girl acne is bit trickier than slapping on a pimple cream from the drugstore like I did when I was a teenager. “Adult female acne is difficult to treat with standard over-the-counter options. Mature skin is drier, more sensitive, and has a harder time recovering from inflammation,” says Dr. Melissa Kanchanapoomi Levin, board-certified dermatologist and founder of Entiere Dermatology. While there isn’t one definitive solution for adult acne, an effective inside/outside approach, say most specialists, is your best bet. 

Adjust Your Diet

As we age, food sensitivities often increase. Dr. Nigma Talib, naturopathic doctor, and author of Younger Skin Starts in the Gut, says that after 40, we start to lose hydrochloric acid, which helps properly digest food and absorb important nutrients like protein. Simply put, because of the loss of hydrochloric acid, we don’t digest food like we used to and foods that never bothered you before may now become an irritant leading to flare-ups on your skin. 

To discover which foods may be an acne trigger, functional medicine expert, Dr. Will Cole, IFMCP, DC, and author of The Inflammation Spectrum suggests an elimination diet to pinpoint the exact culprit. Dr. Levin adds that studies and data currently support that diets with a high glycemic index (that elevate your blood sugar levels) and dairy products (from hormone-fed cows) can increase the risk of adult acne. She recommends a heart-healthy, low-glycemic diet of vegetables, fruit, lean meats, nuts, and seeds. 

Rethink Your Skincare

Dr. Levin suggests maintaining a healthy hydrated skin barrier by gently washing your face with either Cerave Hydrating Cleanser or Sente Daily Soothing Cleanser. Or use Neo Strata Foaming Glycolic Wash to exfoliate if your pores are very clogged. Moisturize with non-pore-clogging products like Cerave Facial PMElta Barrier Renewal Complex or Alastin Restorative Skin Complex. And, of course, always use sunscreen. Dr. Levin recommends Isdin Eryfotona Actinica or Alastin Hydratint Promineral Broad Spectrum. She also suggests introducing one new product at a time so that if your skin is irritated, you know which product is responsible. 

Dr. Dennis Gross, board-certified dermatologist and dermatological surgeon, recommends adding regular, gentle exfoliation to your skincare routine. Alpha and beta hydroxy acids, such as those found in his two-step Alpha Beta Daily Peels, remove dead skin cells, which can clog pores and lead to breakouts. 

Michelle Ranavat, creator of Ranavat Botanics, takes an Ayurvedicapproach to skincare. Naturally, our skin’s pH is 5.5 and slightly acidic. Studies show that a pH above or below this marker is linked to acne. Her Luminous Ceremony Cream Cleanser is close to the skin's pH level. 

Read More: The Top Anti-Aging Skincare Products for Female Skin

Try Supplements for Adult Acne

“If you have irritation in your gut, you’ll have irritation on your skin,” says Dr. Talib. She suggests taking probiotics– live bacteria and yeast that can restore healthy gut flora – at the strength of 20 billion per dose. That may seem like a lot, but it is easily reached in one or two capsules. When taken internally, probiotics kill off harmful bacteria in your gut to help prevent skin inflammation that can lead to acne. She also recommends adding her Beauty in a Bottle vitamin formula that contains A,C,E, and Zinc to boost your immune system, which helps fight off acne-causing bacteria on your skin.  

Dr. Cole recommends Biotin and collagen supplements to keep skin youthful and glowing by supporting skin cell health. Reserveage’s Collagen Booster combines collagen and hyaluronic acid for skin hydration. 

Consider Retinoids and Natural Topicals

A retinoid, a chemical compound derived from vitamin A, can speed up skin cell turn over and stimulate much-needed collagen. While prescription-only Retin-A is most commonly known, it’s simply a brand name. There are a variety of retinoids available.  

“Safe for sensitive skin, retinoids are the backbone of acne treatment,” Dr. Levin says. “Retinoids treat and prevent acne by unclogging pores, normalizing skin cell turnover, and acting as an anti-inflammatory agent. Retinoids have been proven to improve skin discoloration and texture and can lessen the appearance of prior outbreaks.” Dr. Levin adds that Differin Gel, the first over-the-counter FDA-approved acne-treating retinoid, is an absolute game-changer. More recently, Tretinoin, which is vitamin A, and has long been considered a more aggressive alternative to Retin-A, has been introduced in a well-tolerated form called Altreno Lotion.

A natural topical to consider is Odacite Bl+C Pimple Serum Concentrate. Studies show that most people prone to acne lack linoleic fatty acid in their sebum. This topical is formulated with a 67% concentration of linoleic acid. Comfort Zone’s Active Pureness Corrector combines exfoliating glycolic and mandelic acids. Applied to the breakout area, it can help speed up healing. 

Lean into Light Therapy at home

Dr. Gross says the most powerful treatment for acne and aging concerns is red and blue LED light. Blue LED light treats breakouts and kills acne-causing bacteria and regulates oil production without the drying or irritating your skin. Red LED light stimulates your body’s natural production of collagen, increases circulation, and diminishes dark spots. Dr. Gross adds that boosting collagen production can also help lessen the look of acne scars. His at-home light mask, DRx SpectraLite FaceWare Pro features both 100 red and 62 blue LED lights to target fine lines, wrinkles, and acne simultaneously.

Acne affects up to 50 million Americans each year, and the majority of adult patients seeking dermatological consultations for the treatment of acne are women.

The American Academy of Dermatology

Try A Deep-Cleaning Facial...

TIME Magazine reported that more than 141 million Americans lived in areas with unhealthy air pollution with Los Angeles, once again, topping the list. Air pollutants have been shown to cause both premature aging and acne. Add to pollution the daily application of long-lasting makeup, and your once-glowing complexion may be hiding under layers of build-up. 

A deep-cleaning facial can give your skin a fresh start. Margot Mangiarotti, Spa and Wellness Manager at the Four Seasons Hotel Los Angeles, suggests the patented IS Clinical Diamond Youth Facial, which exfoliates and extracts impurities with vacuum pressure and infuses skin with a pore-clarifying serum. 

...Or Lymphatic Facial Massage

The lymphatic system helps your body eliminate toxins and waste. If your lymphatic system is sluggish, you may experience breakouts, particularly along the jawline. Ranavat suggests adding a lymphatic drainage massage to your skincare routine with the Kansa Wand. Used for over 5,000 years, this teakwood and metal wand is said to increase circulation, detoxify your skin, and improve your skin’s pH level — all of which will help reduce breakouts. 

Discuss In-Office Treatments with your derm

When your acne issues just aren’t clearing up with topical treatments, it may be time to see a dermatologist for an in-office procedure like an extraction or corticosteroid injection for deep cysts and inflamed pimples. Dr. Levin recommends a gentle but effective fractionated resurfacing laser treatment like LaseMD that helps reduce pore size, fine lines, and inflammation. Results typically require three treatments and prices range from $400-$1000 per session. 

Dr. Gross designed the Photofrax Laser System for the treatment of acne and acne scars. It addresses deeply clogged pores, kills bacteria, normalizes oil production and stimulates your skin’s own collagen fibers to fill in scars. Patients typically see clearer skin in two days after the first treatment. Scars are said to improve within two weeks with minimal redness. One to three treatments are recommended. Prices start at $750 per session.

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