Unless you were one of those lucky freaks with CGI-perfect skin, chances are you endured an acne outbreak as a teen. "It's just a phase," your mom assured you. "Everyone gets it."
Well, your hypothetical mom is only about half right: While as many as 80 percent of people deal with acne at some point in their lives, the majority of them find themselves relatively pock-free come adulthood. But for roughly 40 percent of men and women between the ages of 20 and 30—based on data from a few years ago—the breakouts persist well into adulthood. "It's extraordinarily common to see patients who have adult acne," says Roslyn George, director of the Wilmington Dermatology Center in North Carolina. So, yeah. What the hell?
Here are some basics: As a teenager, raging hormones are mostly to blame for breakouts—and they don't just magically chill once you're legally allowed to crack a beer. Women tend to have it worse than men, George says. "Whether it's [from] childbearing or just aging, hormones change," she says, and when they do, you're more susceptible to another round of pimples.
But as we noted, men aren't totally off the hook, either—spikes in testosterone, particularly from supplements, can cause acne to return, since increased levels of androgen have been shown to affect the sebaceous glands, which excrete the oily sebum that can clog pores and lead to acne, George says.
Diet is also a factor. A 2016 JAMA study found a link between diets with a "high glycemic load" (unfortunately, that includes bagels, baked potatoes, and other good stuff you can find here) and increased risk of acne. One reason could be that high-glycemic foods appear to trigger an inflammatory response.
Cortisol—a steroid hormone—also tends to be part of the problem. It circulates through your body during high-pressure situations. "Chronic, low-grade stress causes the adrenal glands to gradually and constantly squeeze out an excess of cortisol," explains Mary Lupo, clinical professor of dermatology at Tulane University. That kicks oil gland production into overdrive.
The best strategy to manage your symptoms, George says, is to ask for tried-and-true topical treatments that contain Retin-A, a vitamin A derivative that controls inflammation. Most people who use them report about a 60 percent improvement in a matter of weeks, George adds. Aczone, an FDA-approved gel, has also been shown in clinical trials to clear up breakouts when applied once a day for 12 weeks. But you need a prescription to get those, so if you're looking for something more accessible, try adapalene—a relatively new over-the-counter option that's also showing promising results.
Of course, if you're a chronic trash fire of anxiety, none of these treatments will address the root cause. "Trying to manage stress, whether it's through yoga, meditation, or exercise, will help," George says.
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