If you’re lucky, acne is something you haven’t thought about since high school. But if you find yourself struggling with it in adulthood, it can be frustrating or even puzzling. Since you’re well past your acne-prone pubescence, then why did that crazy huge pimple pop up overnight on your nose (or chest or buttocks or back)?
“Everyone’s acne journey is unique,” says board-certified dermatologist Adarsh V. Mudgil, M.D. “Many patients have acne in their younger years that subsides, but for some, acne continues into their adult years, and others can even get acne for the first time in their 30s or 40s.” Aside from disregarding age limits, acne also ignores geographical boundaries, and it can materialize anywhere from your scalp to your bum and all places in between.
While it may be disturbingly satisfying to watch Dr. Pimple Popper extract a pint of pus from a mammoth back boil on YouTube, it’s a good idea to prevent that sitch in real life. Here’s how.
A pimple is essentially the result of inflammation in or around a hair follicle caused by an interplay between bacteria and a follicular “plug” — a combination of oil (sebum) and dead skin cells. Superficial pimples (acne vulgaris) such as whiteheads, blackheads, papules and pustules are generally caused by clogged pores and are most commonly found on your face, neck or back. Cystic acne is characterized by deeper pimples and inflammation beneath the skin and is generally hormonal in nature. “This kind of acne is commonly found along the jaw line and chin but can occur anywhere on the face, chest and back,” Mudgil says.
While it’s not technically acne, folliculitis looks similar and is caused by damage to a hair follicle, either through frequent rubbing of an area, wearing tight clothing or shaving. Germs, bacteria and/or yeast can easily enter the damaged follicle and cause an infection. The result: a smattering of angry red bumps typically found on the scalp, chest, butt and pubic area.
Is It Acne or Folliculitis?
“Folliculitis tends to be more transient [than acne] and has a trigger, such as shaving or occlusive clothing,” Mudgil says. “Acne tends to be persistent and cyclic, arising around ovulation or menses.”
There are three main reasons why you might experience acne as an adult.
No one wants to relive adolescence, but the same hormonal mechanisms that ignited your sex drive and initiated puberty are still at work into adulthood. “Adult acne is mostly due to hormonal fluctuations — estrogen goes down and progesterone goes up,” says Anna D. Guanche, M.D., board-certified dermatologist in Calabasas, California. Menstruation, menopause and polycystic ovarian syndrome (PCOS) are contributing hormonal conditions that can cause adult acne.
Stress also can trigger breakouts: Under stress, your body releases cortisol, which increases sebum production within the skin. “Excess oil is what bacteria loves and can enlarge the cysts and pustules of acne when the pores are clogged,” Mudgil says.
Treating adult acne can be tricky and is usually specific to the person experiencing the pimples. “Hormonal acne is androgen-dependent in both men and women,” Mudgil says. Meaning that if you’re breaking out, it could be caused by an excess of testosterone. Adjusting your hormones through prescriptive birth control pills can help if you’re still menstruating, and women experiencing menopause might want to look into hormone replacement therapy. “If you’re already on hormone replacement, your medication may have too much testosterone, which can cause acne to flare up,” Guanche says. Conditions such as PCOS can be treated with a combination of medications, which include oral contraceptive pills and/or spironolactone. “Spironolactone blocks the androgenic effect of hormones on oil glands, which helps prevent acne,” Mudgil says.
Surprise — the very products you use to care for your skin could actually be damaging it. “Ingredients to avoid include fragrances, essential oils, cocoa butter, algae extracts, lanolin and sodium lauryl sulfate, which is common in cleansers,” says Peterson Pierre, M.D., board-certified dermatologist and owner of the Pierre Skin Care Institute in Thousand Oaks, California. Assess your product arsenal and eliminate things you suspect could be problematic for several weeks, then reintroduce each product individually and give it a weeklong test run to see how you react, Pierre suggests.
It’s also important to discard outdated products. “Old products lose their effectiveness over time and can become unsanitary by harboring bacteria,” Guanche says. Clean your brushes and sponges regularly to give bacteria the boot, and purchase products touted as non-comedogenic to further reduce the chances of breakouts.
The term “non-comedogenic” is derived from the word comedone, which is another way of saying “blocked pore.” Thus, a product labeled “non-comedogenic” indicates that it will not clog pores.
Buttressing the “you are what you eat” philosophy, what you consume on the reg has as much of an effect on your outsides as it does on your insides. “Research has shown that high-glycemic-index foods cause a rapid rise in blood sugar levels, which can stimulate inflammation and lead to acne,” Pierre says. “There are also several trigger foods that can cause a flare-up, including nuts, dairy, gluten and greasy foods.”
High-sugar foods such as candy and drinks like soda and juice — yes, even the “healthy” offerings from your gym juice bar — should be consumed in limited quantities. And if you can’t live without your moo juice, Pierre advises to embrace the fat. “Skim milk causes a rapid spike in blood sugar, which can trigger acne, but the fat in whole milk blunts that reaction,” he says.
As with everything diet-related, there is never a simple solution and uncovering your issues may require a lot of trial and error. “Some patients can eat everything and have great skin, while others avoid all the trigger foods and still suffer with acne,” Pierre says. “Because acne is a multi-factorial condition involving genetics, hormones, stress, skin-care products and diet, addressing diet alone rarely delivers the beautiful skin everyone wants.”
Zeroing in on Zits
If you’re already managing your stress, avoiding trigger foods/products and have ruled out a hormonal imbalance, don’t fret. You can still reduce your propensity toward pimples.
Practice proper workout hygiene. Body acne is more prevalent in athletic women thanks to sweat, friction and your favorite hip-hugging Lulus. “Bacteria thrives in a sweaty, oily environment,” Guanche says. “Tightfitting clothing does not let the skin breathe, which further traps sweat and bacteria, causing acne, folliculitis or miliaria (aka, heat rash), which occurs when sweat gets trapped in the pores.” Skip your makeup routine when exercising, and shower with anti-bacterial body wash immediately afterward, Pierre suggests. No time to shower? Use oil-control cleansing wipes and change immediately out of your workout wear.
Shave this way. Always shave with the grain of the hair, not against it, to prevent ingrown hairs. “The sharpness and angle of the hair tip allows it to penetrate surrounding skin, irritating it as it grows,” Guanche says. You also should change your razor blade every three to four shaves. “Shaving may introduce bacteria into the hair follicle and cause a minor local infection,” Guanche says. And if all else fails, she recommends laser hair removal. “If there is no hair to shave, there is less risk of skin irritations!”
Go OTC. There are only a select few over-the-counter ingredients available to promote clearer skin that are backed by actual research, so read labels carefully when selecting your skin-care products. “Your best options are a retinol serum and a daily cleanser containing either glycolic acid, benzoyl peroxide or salicylic acid,” Pierre says.
Take the Rx route. If OTC remedies prove ineffective, visit your dermatologist to explore higher-caliber treatment options such as oral contraceptives, testosterone blockers, Retin-A, chemical peels or laser treatments.
When It’s Not a Pimple
Not all bumps are created equal, and what you might assume is a standard annoying blemish could in fact be something else. If a pimple does not go away after several weeks or if it continues to bleed or is getting larger, it could be one of the below.
Bug bites. “Bug bites can look like acne, but they’re usually itchy or painful, don’t typically come to a head, and are not centered around a pore or hair follicle,” Dr. Peterson Pierre says. Try your best not to scratch a bite, and use an over-the-counter anti-itch cream such as hydrocortisone to relieve symptoms.
Molluscum. This skin virus causes round, firm bumps on the skin and it may look like acne, but it’s painless. Molluscum may resolve on its own after several weeks. If not, see your dermatologist for a safe solution. “It is contagious and can easily spread if not handled properly,” Pierre warns.
Skin cancer. “Skin cancers are often tender, non-healing sites,” Dr. Anna D. Guanche says. “They might ooze a little but don’t generally have white pus in them to be squeezed out.” If anything looks suspicious at all, see your dermatologist immediately. Better safe than sorry.
Stop — Don’t Pop!
It’s rarely a good idea to take matters into your own fingertips when it comes to acne. “I understand the temptation to pop a pimple and the satisfaction derived from that activity,” Dr. Peterson Pierre says. “But when you squeeze it, the pus and debris can either come out of the skin — which is the desired effect — or it can go deeper into the skin and cause a much bigger problem, namely more pain, inflammation, redness and an increase in [blemish] size.”
His advice: See a professional for a proper pop. “These individuals have mastered proper technique and use specialized instruments to get the pus and debris out of the pore, accelerate the resolution of the pimple and minimize scarring.”
But if it is irresistible and you simply must pop a pimple, wash your hands and face first. Then choose a pimple that has come to a head and is close to the surface, and apply gentle lateral pressure to extract its contents, Pierre says. This should be a fairly simple process, so if your first or second attempts are unsuccessful, you should probably call it quits; further fussing will likely make matters worse.