Answers on How to Treat Adult Acne
"Hello Dr. Bailey,
I'm impressed by your blog. I'm just finishing my last year of emergency medicine residency training and recently moved from Chicago to Charleston SC.
I've always had acne-prone skin with mild acne as a teenager and then bouts of breakouts as an adult. I just turned 40, Charleston is hot and humid...and my skin is going crazy. Mostly the problem is on my chin, and a little around the nose/t-zone. I have excellent hygiene practices, rarely use foundation, use a zinc/titanium sunblock (as I have had issues with chemical sunblocks) but nothing about my skin care, other than my move, has changed.
I'm guessing that the acne might be a combination of several years of bad eating, the heat and the humidity and hormonal changes involved in turning 40 but I really don't know. Here's what I've been doing to try to clear up my acne flare: I've recently purchased a Clarisonic and have used it for 2 weeks. I believe it is helping a little and I love it either way. I've started slowly re-introducing Retin-a to my skin care routine to treat the acne, but I've noticed it makes my skin peel. I don't mind that too much except that my make-up/concealer looks horrible over peeling skin. I try to exfoliate but by the end of the day my blemishes look cracked and peeled. It is embarrassing but I feel like I need to cover them.
My questions: First: do you recommend the Acne Treatment Kit or the Anti-Aging Skin Care Kit? Second: what make-up do you recommend for acne-prone skin that peels a bit from my regimen?
Your story is similar to that of so many women who continue to struggle with acne beyond the teen years.
The challenge is that your skin’s needs change with each decade.
Most traditional, acne products are designed to fit the needs of teen skin and treat the most common form of acne called acne vulgaris.
Traditional acne treatment products don’t always fit your complexion after adolescence, which is why the skin care routine I use to treat adult acne is often different than the routine for teen acne.
What skin care products do I use in my dermatology practice to treat facial acne in an adult woman?
It's a five-step process that ranges from confirmation of the diagnosis to treatment, and then, observation. Here is my approach broken into steps:
Step 1: I always start by trying to determine if the pimples are due to the most common form of acne called acne vulgaris.
There are other reasons to have pimples and the treatments are different.
Here is a post I wrote that summarizes the most common reasons for acne other than acne vulgaris:
Another important skin problem to consider based on the acne being on your chin and around your nose is perioral dermatitis (it’s not always limited to the perioral skin around the mouth, and thus, its name is a misnomer).
Step 2: I almost always treat the Pityrosporum yeast because it often plays some role.
Click here for a post I wrote explaining Pityrosporum folliculitis, the type of acne caused by this yeast.
The bottom line is that I add Calming Zinc Soap once a day to the skin care routine.
Step 3: I create a comprehensive skin care routine to treat the causes and consequences of adult acne.
Usually I employ RetinA (Tretinoin), which is a retinoid, meaning that it is in the vitamin A family. It's my favorite prescription adult acne treatment because it:
- Helps lighten and get rid of acne scars;
- Helps to unclog pores;
- Is a great acne treatment medicine; and
- Is the best anti-aging cream to treat wrinkles.
I double-check to be certain that my patient is using the product correctly, too, as there are some tricks to minimizing irritation with Tretinoin.
Click here to see my tips and instructions for Tretinoin.
For people who don't want to use a prescription, I start them on my Retinol Cream. Retinol is vitamin A, and thus, very similar to tretinoin. It is available without prescription and yet serves to unclog pores and fight the signs of skin-aging.
If there is skin peeling from retinoid usage, then treatment options include:
- Using a lower strength or mixing it with a bland skin moisturizer until the skin adjusts.
- Backing down on how often the cream is applied. Meaning, instead of nightly use, we back down to to once or twice a week. Once the skin is tolerating that application schedule, we slowly move up as the skin tolerates.
- Taking away other products that can be potential irritants like cleansers and acne medicines.
Often, this means washing with a pH balanced gentle skin cleanser like my Extremely Gentle Foaming Facial Cleanser alternating with Calming Zinc.
If, for some reason, a patient can't use a retinoid, or wants additional active ingredients, then I use my Glycolic Acid Facial Skin Care Kit.
Glycolic acid helps to keep pores clean to fight acne. It also lightens marks from acne and is great anti-aging skin care.
My skin care regimen usually also includes Green Tea Antioxidant Skin Therapy.
I have my patients apply it twice a day right after washing. It helps to ease the redness and inflammation of acne and allow skin to better tolerate retinoid, glycolic acid and other acne treatment products.
It also hydrates and plump crepey skin because it contains a high concentration of hyaluronic acid.
Step 4: I often also try to add an acne fighting medicine that kills the acne causing bacteria called P. acnes.
Options include either a benzoyl peroxide (which can be a spot treatment) or Cleocin Lotion.
The Cleocin is less likely to irritate sensitive skin but requires a prescription, is an antibiotic, and the P. acnes germ has demonstrated resistance to this antibiotic.
Thus, the best choice is benzoyl peroxide at the low concentration of 2.5%, which is below the threshold for skin irritation on most complexion types.
This is the level in my Benzoyl Peroxide 2.5% Acne Treatment Cream.
I make sure all the other products used in the skin care routine are non-irritating and oil free so that the skin can tolerate the acne treating products.
Daily Moisturizing Face Cream for Normal to Oily Skin to help balance skin moisture on those areas of the face that are drier.
We chose a sunscreen that is oil-free and applied every day to prevent hyperpigmentation from healing acne lesions.
Sun protection is extra important because of the Tretinoin or Retinol use, which can increase skin sun sensitivity. It's also a key anti-aging skin care step in any complete anti-aging skin care routine.
For those who wear makeup, my Pressed Mineral Makeup is the perfect makeup for adult acne because it's oil free and covers beautifully.
Complete skin care involves the 4 key steps of Cleanse, Correct, Hydrate and Protect.
The ideal complete skin care routine for adult acne might look like this:
|Cleanse with the Extremely Gentle Foaming Facial Cleanser. Consider using the Clarisonic Brush to deeply clean your pores. Your acne-treating products will work better and your skin will look better, too.|
|Correct by applying Green Tea Antioxidant Skin Therapy to load antioxidants into inflamed skin to help sooth redness. Then, apply additional acne-fighting products such as the Glycolic Acid Face Cream, Benzoyl Peroxide Treatment Cream or your prescription medicines such as Cleocin Lotion.|
|Balance skin moisture and prevent dryness by applying a moisturizer such as my Daily Face Cream on those areas where your skin tends towards dryness.|
|Always protect your skin from UV damage, wrinkles and hyperpigmentation by applying a broad spectrum SPF 30+ sunscreen daily. Apply makeup if desired.|
Using Calming Zinc or the Glycolic Acid Cleanser.
|With Green Tea Antioxidant Skin Therapy or the Retinol Cream (which also has the green tea antioxidants plus retinol). Or, apply the Green Tea followed by any prescriptions like Cleocin. Alternatively, you can just apply your Glycolic Acid Face Cream as a night cream. It doubles as a moisturizer and will take care of the last skin care step, Hydrate.|
|With your Daily Face Cream, or other moisturizer if you are not using the Glycolic Acid Face Cream, or another product that doubles as a moisturizer such as Tretinoin cream.|
Step 5: I give it time to work before changing things around.
In my dermatotolgy practice, I always allow a skin-care routine to work for about two months before deciding if we are on the right track. This is especially true with acne, which improves slowly. We need to be patient. If I'm not entirely satisfied with the skin-clearing by two months, then I may consider other, additional diagnosis that can cause facial pimples such as:
- Staph. aureus super-infection of the pimples; or
- A gram negative infection.
Thanks for sending in a great question about a tough complexion problem. I hope that my answer helps give you some additional new ideas on how I approach an adult patient with pimples in my dermatology practice.
Cynthia Bailey MD, Dermatologist
Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.