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The truth about adult acne: What dermatologists really want you to know

Acne can be difficult to treat, but are many effective ways to eliminate pimples

Man putting skincare facial treatment cream on face. Anti-aging skin care product. Male beauty morning routine at home lifestyle. Guy looking in bathroom mirror applying moisturizer under eyes.
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Few skin issues can be as damaging and debilitating as pimples. They may be perceived as something of a teenage cliche, but the simple fact is that 40-50 percent of adults struggle with pimples. That makes how to get rid of pimples an important problem to solve, especially given its potential longevity.

Fortunately, there are plenty of ways to tackle it. These include making basic dietary changes, implementing stress-reduction tactics, and using topical treatments with select ingredients. Finally, there are medical options available, but given that the basic idea is to avoid those at all costs, let’s focus on the choices that can help you avoid that option.

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Pimples and acne are far from just a “teenage problem”

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When it comes to misguided stereotypes, few are further off base than the belief that pimples are simply a problem during our teen years, says Dr. April Armstrong. She’s an experienced, board-certified dermatologist who sees them all the time, and she was also one of the stars of a recent MasterClass series on skin health, so she’s eminently qualified to address this problem.

Acne is not just a teenage issue,” she explains. “It’s most common in adolescents, with up to 85 percent experiencing some form of acne. But adult acne is increasingly recognized. About 15 to 20 percent of adult women and 5 to 10 percent of adult men continue to have breakouts into their 30s, 40s, and even 50s.”

For better or worse, there’s also a gender issue attached to acne. Once again, though, it’s not the stereotype of teenage boys having an existential crisis because they break out before a prom or a big date.

“Adult acne tends to be more common in women,” Armstrong explains. “[ This is] likely due to hormonal fluctuations related to menstrual cycles, pregnancy, perimenopause, or discontinuing birth control. In men, acne often persists if it began in adolescence, especially if they have oily skin or a strong family history.”

Basic treatments that go beyond the acne demographics

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There are also other common misperceptions. Some people think skin type and issues related to specific categories are the major causes of pimples, but there’s often a lot more behind the problem. In fact, the stereotype that men with oily skin and large pores are the most susceptible is just as far off base.

“It’s not the full story, especially in adults,” Armstrong explains. “For women, hormonal changes are a major trigger.”

There are other major causes as well. Cosmetic products can clog pores, which makes it important to look for products with “non-comedogenic” labels.

Medications can play a significant role, too. Armstrong mentions steroids, lithium, and certain antidepressants as potential issues in this category.

Finally, diet plays a part. Sugary snacks and other foods that are high on the glycemic index can make acne and pimples worse for many people, and so can dairy for those who are lactose intolerant. Making healthy diet changes can help lessen acne symptoms, but Armstrong describes the evidence behind this as “mixed.”

Regardless of the results of any changes people make, though, there is a consistent goal behind the education process when it comes to acne and pimples.

“It’s about turning curiosity into clarity,” Armstrong summarizes. “We give people the tools to understand their skin and make informed decisions about care.”

What about new ingredients and skincare tech?

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Fortunately, those suffering from acne-related symptoms like pimples have more advanced options, too. These include major developments in skincare products, based on the effectiveness of key ingredients, many of which are available in over-the-counter products. Specifically, we’re talking about the retinol family.

“Microsphere and polymer-based formulations of retinoids like tretinoin and adapalene reduce irritation without compromising efficacy,” Armstrong explains. “Similarly, encapsulated benzoyl peroxide minimizes dryness while maintaining antibacterial effects. These innovations are among the most successful and [are] well-supported by clinical data.

But retinol formulations aren’t the only choices. Armstrong also cites azelaic acid and niacinamide as ingredients that offer anti-inflammatory and pigment-reducing benefits. Azelaic acid  in particular has strong evidence for both acne and post-inflammatory hyperpigmentation, and she states that bakuchiol, a plant-derived compound, shows some promise as a gentler retinoid alternative.

Skincare tech is playing a small but growing role as well. Tech-based devices like LED masks offer modest benefits in reducing inflammation and the bacterium that helps cause acne. Meanwhile, “clean” or “natural” formulations in skincare ingredients are popular, but Armstrong indicates that they may lack rigorous evidence and can sometimes worsen acne due to irritation.

“The most effective progress in acne care has come from using proven ingredients in smarter, more skin-friendly formulations,” she says. “In comparison, some newer technologies and trendy products still need more robust evidence and are best used as add-ons, not main treatments, for now.”

Laying out the acne treatment options

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While acne treatment tends to be highly individual, it does follow what Armstrong calls a “tiered escalation.” The escalation process is based in part on a combination of the severity of symptoms, individual issues, and what other factors that come under the heading of what she describes as morphology.

“For mild acne, over-the-counter topical agents such as benzoyl peroxide and salicylic acid are commonly used as first-line options,” she explains. “[This is] due to their anti-inflammatory and keratolytic effects.”

For patients whose acne fails to improve with the use of over-the-counter products, prescription-strength topical retinoids are the next step in the solution process. The relevant names here are adapalene, tretinoin, and tazarotene, and using these agents in combination can be especially effective, according to Armstrong.

For those with moderate to severe acne, oral antibiotics such as doxycycline or sarecycline are typically part of the treatment regimen, typically for a period of 3-4 months.

Other procedures can be effective, too

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Drugs aren’t the only answer to get rid of pimples. Armstrong cites chemical peels with salicylic acid or glycolic acid as procedures that can be effective for those who react badly to makeup, or patients who experience post-inflammatory hyperpigmentation.

Laser and light-based therapies can also be effective. Armstrong mentions blue light and pulsed dye laser as treatments that can help reduce inflammation, and she says they are sometimes used in recalcitrant cases. For patients with acne scarring, microneedling and fractional laser resurfacing are well-supported interventions that improve texture and appearance.

“Ultimately, the most successful outcomes are achieved through an evidence-based, layered approach tailored to the individual’s severity, acne subtype, and tolerance of therapy,” Armstrong summarizes. “Long-term maintenance, often with topical retinoids, is critical to sustaining clearance, and patient education plays a central role in ensuring adherence and setting realistic expectations.”

Bob McCullough
Bob McCullough is a freelance author and journalist who has published dozens of novellas and novels, and his journalism has…
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