Acne begins when glands at the base of hair follicles secrete too much sebum, an oily substance that lubricates the skin. Excess sebum, along with dead skin cells, can clog the follicles causing whiteheads or blackheads. If bacteria on the skin invade the clogged follicles, the follicle wall can rupture, resulting in redness and inflammation—that is, a red pimple.
Teens develop acne when a flood of hormones causes the oil glands to go wild. What triggers this cascade of events in adults is less clear, but besides genetics, hormonal changes remain a leading culprit. This explains why many women have acne flare-ups prior to their menstrual periods and during pregnancy. Some women experience acne for the first time, or a worsening of it, at menopause. Certain medical conditions may cause hormonal imbalances as well. Blemishes are also blamed on resistant bacteria, cosmetics and some medications; emotional stress, climate changes, too little rest and smoking may be other factors.
Despite persistent beliefs, no connection between diet and acne has ever been proven. Studies have failed to show that even large amounts of chocolate trigger acne outbreaks. The same goes for French fries and other greasy foods, sweets, sodas, nuts and dairy products. The best evidence, while still limited, suggests foods with a high glycemic index (such as refined grains and sugary foods) may exacerbate acne. Avoiding these high-glycemic carbohydrates may help.
If acne persists or develops suddenly, see a dermatologist. Topical medicines (these include benzoyl peroxide, antibiotics and retinoids) can help mild-to-moderate acne, and oral medications more severe cases. What works for teens generally works for adults, but adult skin may be more sensitive and ingredient-resistant. A dermatologist may also do light therapy, chemical peels and gentle extractions. For a hormone imbalance in a woman, doctors may prescribe oral contraceptives or an anti-androgen. Isotretinoin (Accutane) is very effective for scarring acne, but has serious side effects and must not be taken by women of child-bearing age.
Wash your face thoroughly, but don’t scrub too hard. Use a mild soap or facial cleanser, rinse well, and blot dry. Don’t waste your money on medicated cleansers or granular face scrubs. Also try over-the-counter skin products containing benzoyl peroxide, which kills bacteria (start with lower concentrations of 2.5 percent or 5 percent). Salicylic and glycolic acid help remove dead skin cells and surface oils. There are several new anti-acne product lines designed for adults, which claim to be less irritating. You might have to shop around to find the product that works best for your skin type, or ask a dermatologist to recommend one.
Use oil-free moisturizers, sunscreens and cosmetics labeled “non-comedogenic” or “non-acnegenic.” Oil-based cosmetics can block sebum from naturally reaching the skin’s surface, though a recent report clears mineral oil of blame. Remove makeup completely before going to bed. Don’t overmoisturize.
Limit sun exposure. While sunning may help dry up acne, its long-term damage outweighs any short-term benefit. Also resist the urge to pick or pop pimples. This only increases inflammation and the risk of pitting and scarring. And by the way: Don’t confuse acne vulgaris with acne rosacea, a chronic inflammatory skin disorder that causes tiny pimples around reddened areas on the face. If you think you may have rosacea, see a doctor, since the condition may worsen without treatment. Do not self-treat it with over-the-counter medication.