Acne is supposed to end when you graduate high school, right? Wrong. Adult acne affects an estimated 15% of women and 5% of men — and for many patients, it's actually worse in their 20s, 30s, and 40s than it ever was as a teenager. Here's why it happens and what actually works.
Why Does Adult Acne Happen?
Acne at its core is caused by the same four factors at any age: excess sebum (oil) production, clogged pores, the bacteria Cutibacterium acnes, and inflammation. But what drives those factors can be very different in adults:
- Hormones — the most common driver in adult women. Androgens stimulate oil glands, causing breakouts especially around the jaw, chin, and neck. This often worsens before menstrual cycles, during perimenopause, or when coming on or off birth control.
- Stress — triggers the release of cortisol and androgens, both of which stimulate oil production. Chronic stress = chronic breakouts.
- Skincare and makeup products — comedogenic (pore-clogging) ingredients are everywhere. Many moisturizers, sunscreens, and foundations that seem benign are actually major acne triggers for sensitive skin.
- Dietary factors — high glycemic index foods and dairy have the strongest evidence for worsening acne, though the effect varies significantly by individual.
- Genetics — if your parents had adult acne, your risk is higher.
Types of Acne We Treat
Not all acne is the same. At Sergay Dermatology, we treat the full spectrum:
- Comedonal acne — blackheads and whiteheads caused by clogged pores without significant inflammation
- Inflammatory acne — red papules and pustules; the classic "pimple"
- Cystic acne — deep, painful nodules and cysts that don't come to a head. These are the most likely to scar and the hardest to treat with over-the-counter products
- Hormonal acne — concentrated along the jaw, chin, and neck; typically cyclical in women
- Acne mechanica — from friction (maskne, sports equipment, phone holding habits)
- Post-inflammatory hyperpigmentation — the dark marks that remain after acne heals
- Acne scarring — pitted or raised scars from previous breakouts
Treatment Options at Sergay Dermatology
The right treatment depends entirely on the type, severity, and suspected cause of your acne. Dr. Sergay takes a comprehensive approach that often combines multiple therapies:
- Topical retinoids (tretinoin, adapalene, tazarotene) — the cornerstone of acne treatment. They increase cell turnover, prevent comedone formation, and reduce post-acne marks. Prescription-strength retinoids are far more effective than anything OTC.
- Topical antibiotics + benzoyl peroxide — used in combination to reduce bacterial load and inflammation. Always combined with benzoyl peroxide to prevent antibiotic resistance.
- Oral antibiotics (doxycycline, minocycline) — for moderate-to-severe inflammatory acne. Typically used for 3–4 months while longer-term treatments take effect.
- Spironolactone — particularly effective for hormonal acne in women. Blocks androgen receptors to reduce oil production. A game-changer for many patients who've tried everything else.
- Oral contraceptives — certain formulations are FDA-approved for acne and can be highly effective for women with clearly hormonal patterns.
- Isotretinoin (Accutane) — the most powerful acne treatment available. We use it for moderate-to-severe cystic acne, acne that scars, or acne resistant to other treatments. When appropriate, it can produce permanent remission.
- Chemical peels — salicylic acid and glycolic peels to accelerate cell turnover, clear comedones, and improve post-acne marks.
- LaseMD Ultra — for improving the texture and tone after active acne is under control; particularly effective for post-inflammatory hyperpigmentation and mild scarring.
What About Over-the-Counter Products?
OTC products can help maintain clear skin once you've achieved control — but they're rarely enough to manage moderate-to-severe acne on their own. The concentrations of active ingredients (benzoyl peroxide, salicylic acid, adapalene) are lower than prescription equivalents, and many patients have tried them for months or years without meaningful improvement.
If you've been managing your acne with OTC products and aren't happy with the results, it's time to see a dermatologist. There's no need to suffer through years of ineffective treatment.
Preventing Scarring
The best time to prevent acne scarring is before it happens — by treating active acne aggressively and early. Cystic lesions that are allowed to persist for weeks or months are the ones most likely to scar. We'll also counsel you on never picking or squeezing acne, which dramatically increases the risk of permanent marks.
If you already have scarring from past breakouts, we have treatments for that too — including microneedling, chemical peels, and LaseMD Ultra.
