Adult female acne and anti-aging skin care is a Holy Grail topic. That’s because adult acne is common in women and tends to show up at about the same time as crow’s feet! Fortunately, key products, ingredients and treatment strategy overlap for these two tenacious complexion issues. Understanding the driving factors in adult female acne and the causes of premature skin aging will help you to mindfully build a skin care routine that works, and that you can depend on for decades.
I kept my facial complexion relatively acne-free, and leveraged the best advances in anti-aging skin care as I have aged. I started in my late 20s when I entered dermatology training. Now in my 60s, I can honestly say that I am happy with how my skin has aged. I’m going to explain what makes a great skin care routine to fight acne and skin aging together, one you can use for decades to come. This is information almost every woman needs to know! Dermatologist and Skin Wellness Expert Dr. Cynthia Bailey
Start by understanding the causes and unique skin issues associated with adult female acne and premature skin aging.
What causes adult female acne (AFA)?
The causes of adult female acne include:
- Genetics, if acne runs in your family, you are more likely to suffer with it.
- Hormones, most women have worsening of their acne in the PMS part of their menstrual cycle.
- Androgen (male) hormones (including hormone imbalances in conditions such as Poly Cystic Ovary Syndrome) cause increased sebum output and sebaceous gland activity. Enhanced sebaceous gland receptor sensitivity and conversion of other hormones into androgen hormones in the pore itself may also play a role.
- Increased presence of the acne causing bacteria called P. acnes (now called C. acnes).
- Follicular hyper keratinization, which is the medical term for clogged and plugged pores. These can be microscopic plugs, macroscopic plugs such as blackheads, and even small closed cysts.
- A change in the actual chemistry of sebum lipid composition.
- Inflammation in the skin.
Acne in adult women is common. It is also more common for adults with acne to be women, though men can suffer acne too. Adult female acne occurs after the teen years, typically after the age of 25 and can extend well over 50. It can even last after menopause.
What does adult female acne look like on your skin?
- All areas of the face can be involved. Originally, we believed that the lower third of the face was mostly at risk. This is the skin around the mouth and along the jaw. This is no longer believed to be true. Many women with adult female acne have it on all areas of their face.
- Pimples and inflammatory cysts are classic. Blackheads and microcysts (closed over blackheads) are also present, though perhaps less so than in classic teen acne vulgaris.
- There may be increased sebum, but many women with adult female acne don’t feel their skin is excessively oily.
- Adult female acne is associated with skin barrier weakness and increased transepidermal water loss. This means that using a moisturizer to help preserve skin hydration is also an important aspect of healing.
- Dark marks, called post inflammatory hyperpigmentation (PIH) and scars are common, present in 20% of women with adult female acne.
- There may be pimples on the chest and back
- Typically, the acne is worse during the PMS part of a woman's menstrual cycle, sometimes during pregnancy and when progestin-only birth control is used.
The causes of skin aging
Most of skin aging is due to UV sun exposure and not actually age! It's true. UV rays trigger a cascade of events within skin that result in:
- loss of collagen and elastin,
- skin thinning of both the epidermis and dermis,
- roughening of skin texture,
- irregular pigment including age/sun spots,
- crepey skin texture,
- fine lines and wrinkles that grow into deep lines and course wrinkles.
If you doubt that UV alone is responsible for most of skin aging, compare sun protected skin to sun exposed skin. A great place to do this is the abdominal or buttocks skin, or even the inner arm skin near the armpit. Compare the look and feel of this skin to the chronically sun exposed skin on the face, sides or back of the neck or outer surface of the forearm and back of the hands. The difference is always striking.
Free radicals cause skin to age and most free radicals in skin happen during UV exposure. Free radicals are chemical species that damage skin DNA and important structures.
Antioxidants in your skin neutralize free radicals. Loading skin with antioxidants, both from a healthy diet and with antioxidant rich skin care will slow skin aging.
To be fair, a small amount of free radicals are formed in skin from the normal metabolic activities of your skin during your lifetime. It means that even if you stay fully sun protected, there will be some free radical destruction in your skin during your life. The magnitude, however, is much smaller than that coming from UV exposure.
Six-step skin care for adult female acne and anti-aging skin care treatment.
Step 1: Treat the acne causing bacteria called P. acne (C. acnes)
The most effective way to do this using skin care is with medicated benzoyl peroxide. This non-prescription ingredient controls this bacterium better than prescription antibiotics, which have led to bacterial resistance and put you at risk for gram-negative folliculitis (a skin infection that resembles acne). I usually recommend that my patients apply benzoyl peroxide twice daily to prevent new breakouts where the skin is prone to pimples. One can also spot treat pimples after they occur with benzoyl peroxide.
Step 2: Fight blackheads and follicular hyperkeratinization (plugs in your pores that lead to pimples)
To do this, we use keratolytics. Keratolytics are ingredients that break up clumps of dead skin cells. Medicated keratolytics include salicylic acid and benzoyl peroxide. Add glycolic acid and retinol for even greater results.
These later two keratolytic ingredients (glycolic acid and retinol) begin the fight against the signs of skin aging while also helping to control acne.
Step 3: Use products that fight collagen loss to counter premature skin aging.
The best proven collagen boosting ingredients to incorporate into your skin care routine are a retinoid (retinol being the best to use without a prescription) and glycolic acid. Glycolic acid and retinoids have over 4 decades of rigorous scientific study proving their unsurpassed ability to stimulate collagen renewal to fight fine lines and wrinkles.
Glycolic acid and retinol also help to correct uneven skin pigment, fight age spots and help to restore the living layer of skin called the epidermis. And, they brighten dull skin fast for almost instant gratification. The catch is that these ingredients need to be formulated in high concentration pharmaceutical grade products such as mine.
Step 4: Apply the best antioxidant skin care product.
It is important to load and reload your skin’s critical antioxidant reserve. This helps fight free radical induced skin aging and inflammation simultaneously. Green tea antioxidants have the best data to support their benefit. Green tea polyphenol antioxidants, in high concentration and pure form, also reduce sebum production and acne lesions. It is another wonderful overlap between acne and anti-aging skin care!
Step 5: Use a moisturizer that hydrates skin to protect skin barrier.
Weakened skin barrier is a known consequence of both adult female acne and aging skin. Weakened skin barrier also results in product intolerance, skin dryness and sensitivity. It is essential that you 'dial in' the right skin hydration for your skin by using a moisturizer that will not clog pores. You need to apply the moisturizer after skin cleansing, which is typically done twice daily.
Step 6: Wear a broad-spectrum zinc oxide sunscreen on exposed facial skin daily.
UV exposure is known to contribute to adult female acne and certainly leads to premature skin aging. Getting serious about your sun protection is a key to success with your adult female acne and anti-aging skin care treatment strategy. Sun protect the skin on your chest, back and neck too.
Putting together the best skin care routine to fight adult female acne and skin aging:
Your skin care routine is done twice daily in layered fashion. This allows you to apply key actives for best absorption, use ingredients that might otherwise inactivate each other if formulated into the same container, and maximize results. The most effective skin care routines are Complete and include products that Cleanse, Correct, Hydrate and Protect skin. Some products will achieve two steps, such as a medicated acne cleanser which may both 'Cleanse' skin and 'Correct' acne.
I've done the work selecting professional-grade products for you with my Adult Female Acne and Anti-Aging Skin Care Kit.
You can also create your own routine using the information below.
Here is what the ideal routine looks like:
Cleanse your skin well. When treating acne, I like to use a medicated cleanser to Correct acne with a keratolytic. My top choice acne cleanser ingredient is salicylic acid (which is the best ingredient to penetrate into oily blocked pores). I like to combine it with 10% glycolic acid. Salicylic acid comes in a range from 0.5 to a max of 2%. Oily complexions and those struggling with blackheads do best with a full 2%. Salicylic acid powerfully penetrates into oily pores. Options include:Foaming Acne Treatment Cleanser with 2% salicylic acid and 10% glycolic acid.
Less oily complexions may do better with my Triple Action Cleanser that contains 0.5% salicylic acid and 10% glycolic acid paired with gentle eco-friendly beads to exfoliate and polish skin.
Both cleansers are pH balanced.
Extremely oily complexions benefit from a second cleansing step with a toner, ideally one with more salicylic acid and glycolic acid as in my Acne Treatment Pads. Again, I recommend the 10% glycolic acid for age-fighting benefits. These pads are uniquely designed for oily skin struggling with clogged pores.
Sensitive skin and less oily complexions may do better with my Naturally Hydrating Pore Minimizing Toner, which tones pores with witch hazel and is tolerated by all complexion types.
After Cleansing, continue to Correct the causes of adult female acne and premature skin aging by layering the following:
This is a non-drying benzoyl peroxide with the right concentration to treat bacteria without irritating your skin making it the best benzoyl peroxide choice for treating adult female acne.
Alternatively, you can just spot treat pimples with benzoyl peroxide.
Hydrate skin by applying a non-comedogenic moisturizer such as my Daily Face Cream for All Skin Types.
This light textured cream formula is fortified with glycerin, ceramides, squalane and antioxidants, making it the ideal dermatologist-recommended moisturizer for adult female acne.
If you don’t have sensitive skin, the hydrating cream in my Glycolic Acid Anti-Wrinkle Face Cream could multi-task to Correct and Hydrate; it provides 15 or 20% glycolic acid for more age-fighting benefits in a moisturizing base. (Sensitive complexions may not tolerate this level of glycolic acid.)
Protect skin from UV damage using only the best SPF 30+ broad-spectrum zinc oxide sunscreen. I rely on my Sheer Strength Pure Physical Sunscreens and alternate between my Matte Tinted, Invisible and Spray depending on my activities. I refresh my sun protection with my SPF Refresh Powder to ensure that UV rays never start the premature skin aging cascade on my skin.
Makeup, if used, is applied on top.
What is the best makeup for adult female acne and to help fight skin aging?
I always prefer mineral makeup for its added UV and visible light protection, and the brilliant hypoallergenic nature of pure mineral powders. A good mineral makeup should be made without fluff or fillers. The mineral powders can help block visible light that can also contribute to skin pigment problems. Powders can also fight oily shine thought out the day.
If you are in the sun and need to reapply your sunscreen over makeup, the easiest way is to use a sunscreen powder such as my Sheer Strength Pure Physical SPF 50 Refresh.
This SPF Sunscreen Powder contains over 3.2% iron oxide to also block visible light that contributes to pigment problems such as the hyperpigmented acne scars of adult female acne.
It also helps absorb oily shine and soften complexion flaws throughout the day.
Cleanse your skin as in the morning.
Oily complexions sometimes benefit from a first oil cleanse and my top choice oil is grapeseed oil. The concept here is that like dissolves like, meaning the day’s oil, product, dirt and debris are best removed with oil! - Dermatologist Dr. Cynthia Bailey
Follow this step with your cleanser, and you can apply your toner or the Acne Treatment Pads if needed.
Correct the causes of acne and skin aging with retinol. This night product is key in the fight against collagen loss. Always start with lower retinol levels, such as my 5X (0.5%) Retinol Anti-Wrinkle Night Cream, and work up to the full 10X (1%) Retinol Night Cream as tolerated. You may need to start every third night and work to nightly. Anytime your skin becomes irritated for any reason, take a break and resume once your skin barrier has returned to normal.
Retinol Night Cream is the single best ingredient to fight both adult female acne and skin aging. I always use a retinoid when I treat women for this combination of skin challenges.
Hydrate: Apply a good non-comedogenic moisturizer on top of the retinol such as the Daily Moisturizing Face Cream. Eventually, you may be able to apply the Glycolic Acid Anti-Wrinkle Night Cream on top of retinol for double the benefit! This is what I do and my complexion is technically ‘sensitive’, so it is possible.
I love using retinoids and glycolic together - that was a game changing move for me! Lorski
What other treatments are beneficial to improve both adult female acne and skin aging?
- Azelaic acid has been shown to help adult acne. Typically, 15-20% strength is needed. I don’t find that enough people benefit from this ingredient and it can be irritating. I prefer the routine and ingredients listed above.
- Chemical peels and microdermabrasion treatments can help improve both acne and the signs of skin aging. Discuss your skin care routine with your skin care professional and/or doctor before undergoing procedures such as these.
- Laser and light procedures can help with skin aging and scarring. None are really effective against acne though. Discuss your skin care routine with your doctor before you undergo these procedures.
- Your lifestyle choices can also support clear skin and slow skin aging.
Lifestyle choices have a huge impact on your complexion when it comes to acne and skin aging. - Dermatologist and Skin Wellness Expert Dr. Cynthia Bailey
What are the biggest lifestyle choices that cause premature skin aging beyond sun exposure?
Skin aging is worsened with physiologic conditions that lead to overall metabolic inflammation. You know what they are because you don't feel great when they happen. They include:
- lack of sleep,
- high glycemic diet (meaning foods with a lot of sugar or refined carbs),
- alcohol, and
Interestingly, these same conditions trigger adult female acne! Here again, there is overlap with both skin care and lifestyle when it comes to controlling acne and skin aging. I think this is really good news!
Five lifestyle choices that cause acne:
We know that stress alters sebum production and also leads to inflammation that leads to skin aging.
Has been tied to both acne and premature skin aging.
3. Sleep deprivation
Inadequate sleep is known to worsen acne and also makes skin look old, leads to stress and metabolic inflammation that destroys skin vitality.
4. UV exposure
The sun's UV rays lead to both worsening of adult female acne and skin aging.
5. Diet has huge impacts on both adult female acne and premature skin aging.
High glycemic foods lead to acne and also glycation of skin structures that results in skin aging. Dairy foods are known to predispose the pores to developing acne.
Both acne and premature skin aging are aided with healthy dietary choices such as lots of fresh produce, nutrition dense lean protein, complex carbs such as whole grains, legumes (beans) and healthy fats. - Dr. Bailey
Even your gut microbiome impacts your risk of acne. Eating healthy probiotic rich foods and whole foods that promote healthy gut microbes will help fight acne. Basically, these are two skin problems where the adage “you are what you eat” plays out in a big way.
Certain medicines may increase adult female acne including:
- Serotonin reuptake inhibitors
- Progestin contraceptives
If you are on any of these, discuss them with your prescribing physician in the context of acne.
Supplements linked to acne:
- Muscle building supplements have also been found to cause acne.
- Iodine as in kelp or seaweed supplements has been linked to acne.
- Whey protein powders have also been linked to acne.
- vitamin B-type complexes such as B6 and B12.
The bottom line with adult female acne and anti-aging skin care treatment
The overlap of skin care ingredients into a simple skin care routine gives you great opportunity to tackle them at the same time. Clinical grade products get the best results.
- Use a Complete Skin Care Routine that addresses the key causes and helps to prevent dryness. Tackle clogged pores, acne causing bacteria, skin hydration, antioxidant recharge, sun protection and collagen renewal in one simple layered routine and see clear, bright, youthful skin.
Leverage your lifestyle choices to support healthy skin and overall wellness, it goes a long way to help you clear adult female acne and slow skin aging. Plus, you will feel as vibrant as your skin looks.
Start with your skin care routine and tackle the easiest lifestyle issues first. In my personal life, this is the approach I’ve carried out for over 3 decades and I know it works.
See my Adult Female Acne and Anti-Aging Skin Care Kit for the best products to fight both of these skin problems.
Bagatin E, Freitas THP, Rivitti-Machado MC, et al. Adult female acne: a guide to clinical practice [published correction appears in An Bras Dermatol. 2019 Mar-Apr;94(2):255. Machado MCR [corrected to Rivitti-Machado MC]]. An Bras Dermatol. 2019;94(1):62-75. doi:10.1590/abd1806-4841.20198203
Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT, Callender VD. Understanding the burden of adult female acne. J Clin Aesthet Dermatol. 2014;7(2):22-30.
Zeichner JA, Baldwin HE, Cook-Bolden FE, Eichenfield LF, Fallon-Friedlander S, Rodriguez DA. Emerging Issues in Adult Female Acne. J Clin Aesthet Dermatol. 2017;10(1):37-46.
Zamil DH, Perez-Sanchez A, Katta R. Acne related to dietary supplements. Dermatol Online J. 2020:26(8):2.
Kazandjieva J, Tsankov N. Drug-induced acne. Clin Dermatol. 2017;35:156-162.
Cengiz FP, Cevirgen Cemil B, Emiroglu N, Gulsel Bahali A, Onsun N. Acne located on the trunk, whey protein supplementation: Is there any association? Health Promot Perspect. 2017;7:106-108.
Nichols JA, Katiyar SK. Skin photoprotection by natural polyphenols: anti-inflammatory, antioxidant and DNA repair mechanisms. Arch Dermatol Res. 2010;302(2):71-83. doi:10.1007/s00403-009-1001-3
Varani James et. al., Vitamin A Antagonizes Decreased Cell Growth and Elevated Collagen-Degrading Matrix Metalloproteinases and Stimulates Collagen Accumulation in Naturally Aged Human Skin, J Invest Dermatol 114:480-486, 2000
Lee YB, Byun EJ, Kim HS. Potential Role of the Microbiome in Acne: A Comprehensive Review. J Clin Med. 2019;8(7):987. Published 2019 Jul 7. doi:10.3390/jcm8070987
DiNardo Joseph, et. al., Clinical and Histological Effects of Glycolic Acid at Different Concentrations and pH Levels, Dermatolol Surg, 1996;22:421-424