8 Common Acne Questions Dermatologists Answer

Acne has no expiration date and can appear in adulthood, not just during adolescence.  (Photo: Getty Images)

Acne has no expiration date and can appear in adulthood, not just during adolescence. (Photo: Getty Images)

When you think of acne, chances are you picture a young teenager in middle school or high school — and you’re not wrong. Acne tends to appear during puberty and is often seen as a rite of passage into adulthood.

But acne has no expiration date and you can have pimples in your 20s and even in your 50s. “It’s a myth that acne is the problem of young people,” Dr. Elaine Kung, founder of Future Bright Dermatology and assistant professor of dermatology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. “I’ve seen acne in people from 8 to 80 years old.”

Here’s why acne can appear at any age, how certain foods and stress play a role in acne, and how best to treat it.

#1: What Causes Acne?

Pimples form for a variety of reasons. But the most common culprit is excess oil production that, along with dead skin cells, clogs pores, according to the Mayo Clinic. This can create an ideal environment for acne-causing bacteria to grow, causing inflammation and infection.

That’s why standard treatment for mild to moderate acne usually includes a one-two punch: benzoyl peroxide and/or a prescription antibiotic, which kills acne-causing bacteria, and a topical prescription retinoid (such as Retin- A) or salicylic acid (usually in the form of a face wash), which removes oil and dead skin cells to unclog pores.

Hormones play a role in excess oil production leading to breakouts. As you transition from puberty to adulthood, Kung explains, excess androgen levels and hormonal fluctuations increase oil secretions, making hair follicles, also known as follicles, more prone to blockage and inflammation.

Your genetics can also determine how much oil your body’s sebaceous glands secrete and how easily hair follicles clog. In other words, if your parents had acne-prone skin when they were younger, chances are you will too.

Your skin care habits are another factor. Dr. Melanie Kingsley, an associate professor of dermatology at Indiana University School of Medicine and a dermatologist at Indiana University Health, tells Yahoo Life that you can significantly reduce your risk of breakouts by washing your face twice a day — morning and night.

“Don’t wake up with all those oils on your face from bedtime and go about your day or put on makeup without washing your face first,” she says. Likewise, before you go to bed, says Kingsley, you want to remove dirt and oil that could clog pores overnight.

Kung explains that exposure to air pollution and high humidity can trigger inflammatory acne breakouts. Even touching external objects like your phone and then your face can be enough to clog your pores if your hands are dirty. With the COVID-19 pandemic, there’s also the “mask” issue, as sweat and dirt from face masks touch the bottom of your face for long periods of time, causing acne.

Bottom line: There are many factors that can cause acne. “There is never a single factor that people can eliminate to cure themselves of acne,” notes Kung.

#2: How long does it take for a pimple to appear on your skin?

On average, a pimple takes about two to six weeks to raise its head to the surface of the skin. However, “everyone is unique in how their skin is sensitive to breakouts, oil, and dirt,” says Kingsley. “Some people will tell you they never wash their face and they’re perfectly fine. Others go one night without washing their face and wake up with a pimple in the morning.”

No. 3: Is adult acne more difficult to treat than teenage acne?

Acne is not just a teenage problem – adults can develop acne at any stage of their lives. In fact, the American Academy of Dermatology reports that adult acne is on the rise and affects 15% of adult women.

Kingsley says some adult patients who see her for acne say they never had it as teenagers. If you fall into this category, the most likely reason is due to hormonal changes. For example, some women entering menopause may develop acne due to the drop in estrogen and rise in testosterone levels. “I have a lot of patients in their 30s, 40s, 50s with acne who never thought they’d have to fight acne in adulthood, but it’s a lifelong problem for a lot of people,” says Kingsley.

Dealing with acne at any age is frustrating. However, whether adult acne is more difficult to treat is up for debate. On the one hand, both experts say adults may be more compliant and motivated than teenagers to follow a daily skin care routine. In addition, Kingsley says that adults with persistent cystic or hormonal acne may be prescribed medications such as spironolactone, which helps block the hormones that cause acne.

However, Kung points out that if a lack of good skin hygiene and lifestyle choices — such as smoking, poor diet, lack of sleep — are the reason behind breakouts, it may be harder to break those habits because the adults tend to be more set in their ways.

#4: Does pizza or chocolate cause pimples?

The role of diet in acne has been hotly debated for years. While some can consume fried foods and chocolate without breaking out, others may notice a pattern of acne development after eating certain foods. In general, Kung says, the health of your skin reflects your overall health. Eating foods that are high in sugar (especially white sugar), processed or fatty can increase your risk of inflammatory acne.

Kingsley says that while eating a lot of pizza or chocolate isn’t ideal for your health in general, one culprit to watch out for is dairy. There is some evidence that dairy products such as cow’s milk and cheese promote inflammation and can affect acne. “Kids who drink a lot of milk or cheese tend to have worse breakouts because the foods are very inflammatory,” says Kingsley.

No. 5: Can stress make acne worse?

It’s not just a coincidence that breakouts occur when you’re under stress. Research shows that stress can trigger acne breakouts. Kung explains that during stressful events, such as a work deadline or financial problems, the body releases corticotropin-releasing hormone (CRH) and inflammatory cytokines to deal with the stressor. CRH promotes the production of an oily substance called sebum, which can clog pores and cause pimples.

Stress can have an indirect effect on acne as well. When people are stressed, priorities can change, putting things like a skin care routine and other healthy habits like a balanced diet and good sleep on the back burner. “They’re so stressed that they don’t wash their face as much or stick to their routine that they spend more time studying or meeting their deadline,” says Kingsley.

No. 6: Does putting toothpaste on a pimple make it go away?

Toothpaste is a popular home remedy for acne. Kung says the appeal stems from the fact that the toothpaste has ingredients like calcium carbonate that dry the skin and shrink the pimple. However, she warns that the toothpaste has abrasive ingredients that remove plaque, such as silica, which can irritate the skin. Silicon can also worsen acne inflammation, making your face redder and more noticeable.

Instead, Kingsley recommends wearing a face mask with sulfur or benzoyl peroxide and going to bed with it. Masks will help absorb excess oil and dry out dead skin cells that clog pores.

No. 7: Does tanning help clear up pimples?

Sunshine and drier weather can help with many inflammatory health conditions, so it’s no surprise that it can also help clear up some inflammatory acne, says Kingsley. However, she does not recommend going to a tanning bed or lying in the sun without sunscreen to get rid of some pimples, as the risks outweigh the small benefits. “There are so many melanomas and skin cancers that come from patients who go to tanning beds, so I wouldn’t advocate using it to treat your acne,” she says.

An alternative to tanning is red light therapy for acne, which is offered in dermatology offices. Red light therapy works under the skin to repair the tissue. It also has an anti-inflammatory effect to reduce redness. Another option Kingsley recommends is Isolaz, an FDA-approved light-based treatment that works like a vacuum to clear pores and then sends broadband light into the pores to shrink the sebaceous glands.

#8: Can exfoliation help get rid of pimples?

While chemical exfoliation, such as from acids, can help remove dead skin cells and oils that can clog pores, it’s important not to overdo it. “Exfoliating too much, using too many topical medications, or over-the-counter salicylic acid or benzoyl peroxide make your skin so irritated that acne gets worse,” says Kingsley.

The same goes for applying too much prescription retinoids. “A lot of people use Retin-A products, and that’s very irritating because while it dries out the pores and shrinks the oil glands, it also dries out the skin, which causes peeling, redness, and dermatitis just from that drug.” says Kingsley.

If you over-exfoliated or applied too much product, Kingsley says, it’s best to reset and go back to basics. She suggests starting with a gentle cleanser and not exfoliating more than once a week. For retinoids, you don’t want to use more than a pea-sized amount for the entire face, says Kingsley, who adds that you should apply a retinoid every other day or every third night for the first two weeks to see if the skin tolerates it. You can also mix it with an oil-free moisturizer to reduce any irritation until your skin gets used to it.

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