Beauty’s Most Asked: adult acne – all your questions answered

In the first of our Beauty’s Most Asked Q&A sessions, award-winning skincare expert and professor of dermatology DR NICK LOWE offers his professional advice on the causes of, and treatments for, one of the most-asked-about skin problems: adult acne


I have always had clear skin, so why am I suddenly breaking out in my thirties?

“There could be various hormonal reasons for this. Often, women have been on the contraceptive pill since their teens and when they then come off it in their late twenties or thirties, they suddenly develop acne. Hormones in the pill have been blocking the acne from previously appearing, but once they stop taking it, the acne appears. Any shift in hormones can cause your skin to change, including when your natural estrogen levels start to drop around the perimenopause phase – which can start in your mid-thirties – or if you are undergoing IVF. Adult acne in those aged 30 and above is more common in those who had teenage acne, but not always.”

Could stress be affecting my skin?

“Absolutely. Don’t underestimate the effects of . It’s a big player in skin breakouts, as the release of cortisol affects your hormones. Being aware of this and actively finding ways to relax with or exercise can certainly help.”

And what about my diet?

“Cutting out dairy can work for some people, and there’s also some evidence to suggest that milk chocolate aggravates acne, which may be due to its high dairy content. It’s generally good to eat more healthily and cut down on foods with a high glycemic index, which cause insulin to spike – and high levels of insulin can cause acne.”

Is adult acne any different to teenage acne?

“Only in that the skin is less oily with adult acne, and, for some women (but not teenagers), it can be associated with diffuse .”

Which treatment is best?

“What’s really key is not to wait before you get help. You don’t want the acne to get a hold on the skin, as it will worsen and be more difficult to treat, and potentially leave more scarring. All acne can be successfully treated if you get the right professional help, but it usually takes a combination of treatments. If it’s noticed early, I often use a short course of antibiotics with some topical treatments. LED red and blue lights are also good: the blue light kills the acne bacteria, and the red light reduces inflammation. We use specific acne and also the latest IPL machines (Intense Pulsed Light). Often used for hair removal and pigmentation, these now have filters that target inflammation and the acne bacteria. A dermatologist should have a combination of treatments they can use so, as soon as you see a change in your skin, get the appropriate help.”

Do I need to take medication?

“I often prescribe short-term antibiotics, but one medication many dermatologists have rediscovered, especially in the US, is the old-school drug Spironolactone. It’s actually a diuretic that has the added benefit of blocking the effects of androgens (male hormones), so it benefits oil glands and hair follicles but with fewer side effects. We do medical checks first and long-term studies confirm this, and it can be taken for several years – but it should not be taken if you are pregnant or indeed planning a pregnancy.”

What can I do at home?

“Be gentle! You can’t scrub or peel acne away. People are often too aggressive with their skin, which results in long-term scarring and problems, so treat your skin as though you have the most delicate, reactive complexion there is. Some of the over-the-counter benzoyl peroxide products available can be drying and irritating, so I prefer to recommend gentle salicylic acid peels, which are better for breakouts than glycolic acid. Niacinamide (a form of vitamin B3) is a widely used ingredient that calms and repairs a damaged , plus it helps reduce some surface oil. Azelaic acid and zinc can also help, especially when used with other ingredients, such as niacinamide, rather than alone. Eucalyptus oil extract is also great, as it’s a non-antibiotic killer of acne. Don’t overclean the skin, as there is no evidence at all that hygiene – either good or bad – contributes to acne. The root cause is mostly hormonal.”


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