Adult Acne at 40? Here’s Why It Happens—and How to Treat It
Thought acne was just for teenagers? Think again. Dermatologist Dr. Emily Wise explains why breakouts happen in adulthood—and how to treat them.
Issue #6, Community
Just add braces, and we may as well be in middle school, hiding our faces again. Nobody liked it as a teenager, and we’re even less thrilled when it turns up during our menopausal years—no wonder its medical name is acne vulgaris! I asked our Core Expert, dermatologist Dr. Emily Wise, to explain what brings this adolescent scourge back and how best to treat acne-prone skin.
Why Acne Comes Back in Adulthood
Acne in adult women is very common—in fact, I see it in my dermatology clinic multiple times a day, every day! While adolescents and teens typically experience breakouts across the forehead and down the mid-face (T-zone), acne in women tends to show up as more inflammatory, deep/cystic, and often tender pimples on the lower third of the face (including the chin, jawline, and neck).
The current thinking is that this acne is largely triggered by hormones. Many women feel their acne flares during periods and pregnancy, with certain types of birth control, and sometimes during menopause. For most women, this type of acne is not a marker of any systemic or concerning hormonal problem.
Rather, normal levels of hormone stimulate the sebaceous glands to release sebum (an oil that resides in the glands), which promotes acne formation. If you have other symptoms that may indicate a systemic hormonal disturbance (for example, increased facial hair, deepening of the voice, or menstrual irregularities), you should talk to your doctor; you may require further evaluation and/or treatment.
Can Diet Play a Role in Adult Acne?
Certain foods, such as dairy products and foods with a high glycemic index (which can spike blood sugar levels), have also been thought to increase acne formation. While this is considered when counseling patients, because acne in adult women is often strongly hormonally driven, you should speak with a dermatologist before making any drastic changes to your diet.
The Best Treatments For Adult Acne
The most targeted treatment option is an oral medication called spironolactone. It has been used by dermatologists for years very safely but is still considered off-label. It works by reducing hormonal effects on the sebaceous glands and can often help even those with moderate to severe acne achieve clear or nearly clear skin in about 3-4 months’ time.
There are also prescription cream regimens that usually contain a combination of antibiotic and retinoid agents, which may help reduce hormonally driven acne. But typically, these are not as effective as oral therapy, and some topicals may increase your risk of sun sensitivity. Other treatment options include certain types of laser and/or light therapy.
A word about pimples: To reduce the risk of scarring, it’s important to avoid picking or popping acne lesions. But even pimples that are not popped may leave scars or discoloration. Given this, and especially if you are using certain topicals, it’s important to use sunscreen to reduce the risk of long-term hyperpigmentation.
Bottom line: If you are experiencing acne as an adult, I strongly recommend you speak with a board-certified dermatologist, who can customize a treatment plan with medications and/or skin-care products that are best-suited for your specific type of acne. Early intervention will also help minimize the risk of permanent scarring.
OUR CORE EXPERT
Emily M. Wise, MD is a board-certified dermatologist and founder of DermWellesley in Wellesley, Massachusetts, where she practices medical and cosmetic dermatology. She lectures regularly about acne management and also has extensive experience with laser therapy and neurotoxins such as Botox and Dysport. Dr. Wise is a member of both the Dean’s Advisory Board at the Boston University School of Medicine and the Medical Advisory Board for IMPACT Melanoma. @dermwellesley
