Adult Acne Is Real, Treatable, and Worth Seeing a Dermatologist For

Gillian Maegan Montalbo had a fairly easy time with her skin as a teenager: a few bumps on the forehead and nose, nothing worse. Then she entered the workforce, and the breakouts came back harder. The acne settled on her cheeks and chin, and she found it difficult to look her bosses in the eye. The marketer and content creator, who lives in the Philippines, says it took a toll on her self-esteem and self-confidence.

Hers is a common story, according to an Associated Press feature by Adithi Ramakrishnan. Pimples are associated with adolescence, but adults get them too, and not only on the face. Acne can appear on the chest and shoulders, and on the back, where it goes by the internet's name for it, "bacne." The best treatment differs from person to person, depending on what is driving the breakouts and what they look like. They can also leave dark marks and scars that take longer to heal than the pimples themselves.

The causes shift with age. Teenage acne tends to show up on the forehead, nose and cheeks. Dr Crystal Aguh, a dermatologist and director of the Ethnic Skin Program at the Johns Hopkins School of Medicine, says older adults, women in particular, can get hormonal acne along the jawline and chin. Steroids can trigger it in some people. A single pimple forms when pores clog with oil, bacteria and dead skin cells, and it may fade over weeks to months. Patches that persist and spread may be acne, which dermatologists treat as a medical condition. "Essentially, you're not getting a break from a breakout," Aguh said. Genetics, hormones, environment and diet, including excessive dairy, all play a part. Facial and body acne share similar causes, though skin bacteria sometimes matter more on the body. Breakouts range from milder, painless whiteheads and blackheads to painful red bumps and deeper cysts, the mark of cystic acne.

The first piece of advice is the hardest to follow: do not pick or pop. Chicago dermatologist Dr Lauren Fine says the urge is universal, but squeezing will almost always make things worse. It can push inflammation deeper, spread the acne and raise the risk of marks and scars. For darker-skinned people those marks last longer, Aguh said, because stressed skin produces extra pigment.

Treatment runs from over-the-counter products to prescription drugs. The face is somewhat easier to treat than the rest of the body, since it has more sweat glands and does not dry out as easily. Creams are hard to apply to places like the back, so doctors often turn to oral medication there. For milder facial acne, dermatologists may suggest washes or creams with benzoyl peroxide, salicylic acid or retinoids such as adapalene. More frequent breakouts may call for stronger regimens, including antibiotics or tretinoin. Isotretinoin is an option when those fail or when cystic acne is severe.

Adult hormonal acne, especially in women, can be handled differently than teen acne. Some dermatologists recommend birth control to stabilise hormones, or spironolactone. Cortisone shots can calm an active spot in a pinch but are not a long-term fix, Fine said. Hydrocolloid pimple patches absorb fluid from oozing pimples and keep hands away. Aguh considers them suitable only for mild acne, and Fine does not recommend them because some of her patients developed discolouration from them.

For lingering dark marks, exfoliants and washes with glycolic acid can help, as can over-the-counter adapalene and retinol creams. Serious scarring may call for lasers that reach deeper into the skin. Finding the right plan takes time and results take longer. Some people also experience skin purging, breakouts that occur when a new product quickly brings clogged pores to the surface.

Montalbo's acne cleared within a year of seeing a dermatologist, though scars remained and she had to rebuild her confidence. Her father, who also struggled with acne, urged her to see a doctor and find the right products. During the worst of it, a close friend travelled overseas with her and remarked that she had never noticed the acne. "When you are with the right people, they won't mind how you look," Montalbo said.

The guidance from the doctors is plain: if breakouts stick around or change the colour or texture of your skin, see a dermatologist. "We know how to treat acne," Aguh said. "So don't suffer alone."