I am an adult. Why do I get acne?

Q: I rarely got pimples when I was a teenager. Now I get them all the time, and it’s embarrassing. Why do I get acne as an adult?

Once you’re an adult, you probably think you’re done with pimples for good. But dermatologists say it’s common to get acne in your 30s, 40s and beyond, even if you never had pimples as a teenager.

Adult acne can be a shock, says Dr. Carmen Castilla, a dermatologist in New York City, and it can be more embarrassing than when you were younger.

The good news is that while the cause of adult acne isn’t always as “textbook” as it was when you were a teenager, says Dr. Ross Radusky, a dermatologist in Dallas, says it is treatable at any age.

Causes of acne in adults

According to the American Academy of Dermatology, all cases of acne occur when your pores become clogged with oil, dead skin cells and dirt. But if you develop acne as an adult, it could be due to several factors that didn’t play a role during your teenage years:

Hormones

Acne in adolescents is usually caused by changing hormones during pubertyBut normal hormonal fluctuations that occur later in life may also be the cause of most cases of acne in adults, said Dr. Lauren Ploch, a dermatologist in Aiken, SC.

Your skin produces more oil when your hormones fluctuate, and that excess oil can clog your pores and interact with bacteria on your skin, causing acne.

Hormonal acne is common in women throughout their lives, especially during the days surrounding menstruation; during pregnancy or menopause; or when starting or stopping oral contraceptives, according to the AAD

Men with naturally high testosterone levels may also be prone to acne.

Medicines and supplements

Acne can be a side effect of certain medications, including some mental health medications like lithium or corticosteroids like prednisone, said Dr. Ploch.

Testosterone medications, birth control pills, some seizure medications and certain supplements such as B vitamins and whey protein can also cause acne, she said.

Genetics

Acne is sometimes a lifelong problem for people with certain skin types — for example, if you have naturally oily skin or slower skin cell turnover, where you retain dead skin cells that clog your pores, said Dr. Ploch. These problems can increase with age and hormonal changes, she said.

A family history of acne in adults may mean you’re more likely to get it too, said Dr. Castile.

Stress and other lifestyle problems

Stress increases levels of the hormone cortisol, which stimulates the skin’s oil production and can lead to breakouts, said Dr. Radusky. Stress-related acne usually clears up once the stressor subsides.

Stress can also affect other areas of life, including: your sleep and eating habits, which can also contribute to acne, said Dr. Ploch.

Treating acne in adults at home

You can usually treat mild acne with topical over-the-counter products.

A wash with benzoyl peroxide can be a good starting point because it has antibacterial and skin-drying properties and helps unclog pores, said Dr. Ploch. Adapalene (a retinoid drug) and azelaic acid (a drug that kills bacteria and unclogs pores) can help clear up acne, said Dr. Castile. Products containing salicylic acid also help exfoliate the skin, which promotes the renewal of dead skin cells and prevents pores from becoming clogged.

Dr. However, Radusky said that because your skin becomes drier as you age and loses collagen, these products may be too drying and irritating for some adults. If so, he recommends using products with glycolic acid, a gentle chemical exfoliant, to stimulate cell turnover without drying out your skin.

It can take four to six weeks to see improvements with over-the-counter products, so it’s important to use them consistently, Dr. Castilla said. Look for moisturizers, sunscreens and cleansers labeled “oil-free” or “noncomedogenic,” said Dr. Ploch, which does not clog your pores.

When should you see a dermatologist?

If drugstore products don’t work; if you notice scars or dark spots as a result of your pimples; or if your acne is making your self-esteem drop, see a dermatologist, said Dr. Radusky.

They can help you determine the cause by assessing your medications, diet, allergies, stress, medical conditions and more. A dermatologist can also ensure that your pimples are actually acne.

“There are a lot of people who get acne as we get older,” said Dr. Radusky.

For example, he said: rosacea sometimes looks like acne, and a type of fungal infection called malassezia folliculitis can also cause pimple-like bumps.

Based on the cause and your skin type, Dr. Castilla that dermatologists have many treatments to offer, including topical prescription medications and topical or oral antibiotics.

Spironolactone, an oral medication that blocks certain hormones in the body, is sometimes recommended for severe hormonal acne in women. And isotretinoin, commonly known as Accutane, is an effective oral acne medication, although it can cause serious side effects, including birth defects and depression. It is usually prescribed for “deep, painful acne cysts and nodules,” according to the AAD.