Staring Down Acne

Adult acne is on the rise, and its effects can be painful and demoralizing. Here are 45 strategies to help you break free of breakouts.

Staring Down Acne
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Yo, has your face gone, like, totally retro? Is your skin a zit pit? Acne isn't just for teenagers anymore--and there's a special misery to breaking out when you're 37 and fretting about crow's-feet. "The vast majority of people once outgrew adolescent acne, except for an unlucky few," says Richard Fried, M.D. a dermatologist and clinical psychologist in Yardley, Pa., and author of Healing Adult Acne. "Now about half of adults deal with acne in some form, and many who never had significant acne develop it for the first time."

So what's responsible for the jump in grown-up acne? Pollution, new medications, and hormone-fed meats are among the irritants cited. "The one common denominator we see among adult acne patients, however, is stress," says Linda K. Franks, M.D., assistant clinical professor of dermatology at New York University School of Medicine. "People are juggling work and family, and generally have busier lives."

Women get the worst of it: About 54 percent of adult females are afflicted with acne, compared to 40 percent of adult males. Chalk up the difference to age-related hormonal changes (which are exacerbated by stress), more oil production, birth-control use, pregnancy, stress, and menopause.

To add inconvenience to injury, the pimples may act the same, but the skin does not. Drier and less resilient, an adult woman's skin can be easily damaged by some of the treatments she may have relied on during her adolescence.

taking root
All acne originates in hair follicles, which either become inflamed and produce pimples, or plug up with whiteheads and blackheads. Male hormones called androgens (present in both genders) trigger acne by raising levels of sebum, or oil, produced by sebaceous glands at the base of these follicles. Hair is normally softened and lubricated by oil, but excess amounts paired with dead-skin-cell buildup cause blockage. When bacteria are present, the follicle becomes irritated, forming pustules.

Some people simply produce more sebum and have greater numbers of sebaceous glands. Others have a poorer rate of skin-cell turnover and are more sensitive to hormones. And acne is partly tied to genes: If your parents battled acne, odds are, so do you.

Only 7 percent to 14 percent of adults suffer from chronic, "clinically significant" acne. Yet even sporadic outbreaks have a high emotional cost. "Studies show that a person can be as profoundly depressed with one zit on her chin a month as someone with a face full of acne," says Fried. "We've seen women who feel burdened, imperfect, and unattractive in their 40s and 50s because of acne, and data show that those with acne suffer from higher rates of divorce, unemployment, suicide, and sexual dysfunction. Acne is not trivial."

The most common form of acne is acne vulgaris, but there are other types caused by irritants such as heat and humidity or exposure to certain pesticides. In the worst cases, cysts can form deep beneath the skin and result in scarring.

Nancy, a 45-year-old medical biller from Massachusetts, had to cope with painful cystic acne throughout her teens and 20s. She went on and off oral antibiotics, which slow bacteria growth. "But it never permanently went away," she says.