Adult acne treatment: The Optum Store Guide

Acne is a skin condition that causes pimples, whiteheads and blackheads. It typically shows up on the face, chest, upper back and shoulders. These are the areas where you have the most oil glands (also called sebaceous glands).

To understand acne, you need to be familiar with these glands. Sebaceous glands produce sebum, which is a mix of oils that are secreted onto the skin via pores (also called hair follicles). Sebum helps your body in many ways:

• It lubricates the skin and hair
• It protects against friction
• It transports antioxidants to the surface of the skin
• It helps with wound healing

Sebaceous glands are nearly everywhere on your skin. The only places you don’t have them? The palms of your hands and the soles and tops of your feet. Acne can show up anywhere that you have these glands, including the scalp, neck and buttocks.

A pimple develops when your body produces too much sebum. Normal bacteria on the skin multiply as a result of the increased oil. Then your pores become blocked with excess sebum and skin cells. In response, your body creates an inflamed (swollen) bump filled with pus. Pus is what causes the white tip on a pimple.

Hormones affect your sebaceous glands, prompting the skin to produce more oil. During puberty, hormones called androgens increase in boys and girls, according to the Cleveland Clinic. Androgens prompt the sebaceous glands to make more sebum, which leads to acne.

Studies have shown that in adults, women are more likely to have acne than men. One reason: Fluctuating hormones during women’s menstrual cycles continue to play a role during their childbearing years. About 12% of women and 3% of men may still have acne even in their 40s, says Johns Hopkins Medicine.

Many people think chocolate and greasy foods cause acne, but that’s a myth. Still, scientists do know there’s link between certain foods we eat and breakouts. Foods with a high glycemic index (GI) can cause acne or make it worse.

High-GI foods (such as processed carbohydrates) cause blood sugar to spike. They also contribute to the risk of Type 2 diabetes, heart disease and other conditions. So avoiding these foods is not only good for your skin — it can also improve your overall health.

Cutting high-GI foods out of your diet can lead to clearer skin. Foods to avoid include:

• Candy
• Couscous
• Pasta
• Potato chips
• Refined breakfast cereal
• Sugary drinks
• White bread
• White potatoes
• White rice

You might also try cutting back on milk. Some studies suggest that drinking cow’s milk may raise the risk of developing acne, according to the AAD.

Dermatologists say it can be helpful to keep track of what you eat and whether certain foods seem to trigger an outbreak. If cutting them out helps your skin, that’s a win.

Acne can run in families, so there is a genetic link. That’s because it’s related to skin type, hormones and body chemistry. If your parents had acne as adults, you’re probably more likely to struggle with it. This is helpful information for your dermatologist to know. And if you had acne in your teens, keep in mind that your children could be at higher risk of developing acne, too. (Read more about teenage acne here.)

Acne can show up in a variety of ways. And it’s possible to have several types at the same time.

Whiteheads and blackheads: When a pore becomes blocked with sebum and dead skin cells, it creates what’s known as a comedone. A blockage that’s closed at the surface and bulges out to cause a bump is a whitehead. If the blockage is open at the surface, the air exposure causes the plug to look dark. That’s a blackhead, also called an open comedone. This type of acne isn’t usually red and inflamed.

Papules and pimples: A papule is a tender, raised red spot caused by an inflamed, blocked hair follicle. Pimples are papules with pus at their tips.

Nodules: These are painful lumps under the skin. They can be small or large. They are caused by the bacteria P. acnes, which gets trapped in a pore and creates a painful infection in deeper layers of the skin. Nodules don’t have a pus-filled head. Squeezing them can cause further inflammation.

Cystic acne: These deep acne blemishes penetrate the skin. They tend to leave scars and should be treated by a dermatologist. This is a type of inflammatory acne. The cysts can be painful and large. They are similar to nodules, but they contain pus.

The 2 main types of treatments are topical creams, gels or lotions, and oral medications. You can buy some over the counter (OTC), but most are available only by prescription. Depending on the type of acne you have, your dermatologist might recommend 1 or more of the following:

Common topical treatments

• Benzoyl peroxide: This treatment is an antiseptic that targets the bacteria on the surface of skin. It comes in varying strengths and is available OTC.
• Salicylic acid: This common prescription medication reduces redness and swelling and unblocks skin pores. It comes in a variety of strengths.
• Retinoids: They are derived from vitamin A. These creams and gels are effective acne treatments. They work by promoting cell turnover to keep follicles from becoming blocked. There’s only one OTC retinoid option, called Differin®. It’s a gel that you apply to your face once daily. Trentinoin is the generic name of prescription retinol. Brand names include:
  • Atralin™
  • Avita^®
  • Refissa™
  • Renova^®
  • Retin-A^® and Retin-A Micro^®
  • Tretin-X^®
• Topical antibiotics: These prescription creams kill the excess bacteria on the skin and in the pores. They are often combined with benzoyl peroxide to reduce the risk of antibiotic resistance. Options include:
  • BenzaClin^® and Duac^®
  • Benzamycin^®
• Azelaic acid: This prescription treatment promotes cell turnover, reduces bacteria in pores and tamps down inflammation. Side effects can include burning, peeling or blistering skin and dryness.
• Salicylic acid: This prescription treatment can help clear blocked hair follicles. But it sometimes causes skin discoloration and irritation.

Common oral treatments

• Antibiotics: Oral antibiotics target an overgrowth of bacteria on the skin. This can be especially helpful if acne isn’t on your face. Common oral antibiotics for acne include tetracyclines and macrolides. (Pregnant women shouldn’t take tetracyclines.) It’s best to avoid taking antibiotics over long periods to reduce the risk of antibiotic resistance.
• Combined oral contraceptives: For women, oral contraceptives that include both progestin and estrogen can level out hormone fluctuations. This helps reduce breakouts and clear up skin.
• Anti-androgens: These control levels of the hormone androgen in women and girls. (Androgen can increase oil production and cause stubborn breakouts.) The medication is known as spironolactone.
• Isotretinoin: This oral derivative of vitamin A is prescribed for moderate or severe, disfiguring acne that hasn’t responded to other treatments. The medication can have serious side effects, including birth defects. It shouldn’t be taken by women who are pregnant or plan to be. Brand names of this medication include:
  • Absorica^®
  • Amnesteem^®
  • Claravis^®
  • Myorisan^®
  • Zenatane

Topical and oral medications are the first line of defense against acne. But your dermatologist may recommend other treatments to help improve your skin.

Lasers and light treatments: Laser and light treatments are typically done in a doctor’s office. You can also buy at-home laser devices. These treatments typically don’t resolve acne on their own. But they can be part of an effective acne-fighting regimen. There are several light therapy treatments, including:

• Visible light devices
• At-home LED devices
• Infrared
• Photodynamic therapy (in which a solution is applied to skin, and then a special light or laser is used)
• Photopneumatic therapy, which combines light therapy with vacuuming to help clear clogged pores

(You can buy OTC medical-grade light therapy devices that help fight acne at the Optum Store. Shop products now.)

Chemical peels: To perform a peel, a dermatologist applies an acid solution to remove top layers of skin.

Acne surgery: During this in-office procedure, a doctor uses a special tool to gently remove comedones (whiteheads and blackheads) or cysts.

Steroid injections: For people with inflammatory acne, a steroid injection can treat the swelling. Because steroids can cause skin thinning and discoloration, this might not be an ideal long-term solution.

Yes. If you get pregnant, you may need to switch up your acne treatment. Some treatments may cause birth defects. Other treatments have less definitive warnings, but doctors recommend stopping them to be on the safe side. Discuss your options with your doctor.

Definitely avoid these treatments:

• Isotretinoin (known by the brand names Absorica, Amnesteem, Claravis, Myorisan, Sotret and Zenatane)
• Spironolactone (known as Aldactone^®)
• Tazarotene (known by the brand names Avage^®, Fabior^®, Tazorac^® and Zorac^®)

Doctors recommend that you also stop:

• Adapalene (applied topically and known by the brand name Differin)
• Tretinoin (a topical retinoid, also known as Retin-A)

Avoid being too rough on your skin when you wash your face or shower. Scrubbing skin or washing too frequently can actually cause more breakouts. Try these tips:

• Wash in the morning and evening, and after working out. Sweat can make acne worse. Don’t forget to change sweaty yoga pants, too, because you can get pimples on your buttocks.
• Use a gentle liquid cleanser.
• Don’t use abrasive scrubs or loofahs.
• Avoid alcohol-based cleansers, toners and treatments.
• Try not to touch your face.
• Don’t pop or pick a zit. This is a bad habit that can lead to scarring.
• Avoid the sun and use sunscreen. UV rays can darken skin, and some treatments make you more light-sensitive.
• Shampoo your hair regularly: Oil in your hair can produce breakouts around the hairline and on your scalp and neck. Hair products can clog pores and cause breakouts.

Acne scars and hyperpigmentation can be distressing. Hyperpigmentation occurs when a pimple heals but a dark spot remains. It’s more common in people with dark skin. A variety of treatments can improve the appearance of hyperpigmentation and acne scars.

• Sunscreen: It can keep scars and pigmented spots from getting darker. Be sure to apply sunscreen every morning.
• Lightening topical solutions: Products that contain 2% hydroquinone, glycolic acid, azelaic acid, kojic acid, retinoids and vitamin C are known to lighten skin and slow pigmentation.
• Steroid injections: If acne leaves raised scars, steroid injections can help shrink them.
• Peels: Treatments that take off top layers of skin can be helpful for hyperpigmentation.
• Laser treatments and pulsed light therapy: Lasers remove the thin top layers of skin with a beam of light to improve the surface appearance. The laser heats the underlying skin, which stimulates the growth of collagen fibers. That helps make skin smoother. Pulsed light therapy helps make acne scars less visible without damaging the outer layer of skin.
• Fillers: Injectable skin fillers can temporarily plump up acne pockmarks. But the treatment must be repeated to maintain results.
• Microneedling: A device with “needles” on it is rolled over the skin to encourage the production of collagen. This treatment can improve the appearance of acne scars, according to a 2020 review study in Dermatologic Surgery.
• Dermabrasion: This treatment is for more severe acne scars and involves “sanding” off the top layer of skin. The goal is to remove surface scars and make deeper ones less obvious.
• Surgery: A surgeon can cut out individual scars and repair the wound with a skin graft or stitches. Another option is to loosen the fibers that are pulling on the skin by using a needle underneath the skin.

Amy B. Lewis, MD, board certified dermatologist in private practice, New York City

Rajani Katta, MD, board certified dermatologist in private practice in Houston

Teens and acne: American Academy of Dermatology (n.d.): “Skin Conditions by the Numbers”
Androgens: Cleveland Clinic (n.d.): “Acne”
Acne in 40s stat: Johns Hopkins Medicine (2018): “Acne in Adolescents and Young Adults”
Milk and acne: American Academy of Dermatology (n.d.): “Can the Right Diet Get Rid of Acne?”
Acne treatments: Mayo Clinic (n.d.): “Acne”
Microneedling: Dermatologic Surgery (2020): “Microneedling as a Treatment for Acne Scarring: A Systematic Review”