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Health Check: why do I still get zits?

Adult acne is very common and usually affects women women in their 20s, 30s and 40s. alri/Shutterstock

You may have battled blemishes in your teens, or made it through puberty and early adulthood with relatively clear skin, but it always feels particularly unlucky contending with zits in adulthood.

Adult acne usually affects women in their 20s, 30s and 40s, though men are certainly not immune. One study found 40% of women in their 20s, 25% of women in their 30s and 12% of women in their 40s suffer from clinical acne.

Acne is the most common skin disease globally. While some people get numerous pimples, blackheads and whiteheads over their face, chest and back, others may only have a few pimples now and then.

Adult-onset acne commonly flares around menstruation, and is most likely to appear around the jawline, and in those with darker skin types.


While hormonal factors play a key role in adult-onset acne, other factors such as family history, medications, make-up and certain hair-care products may also impact the skin.

Androgens are male hormones present in both men and women. Elevated levels of androgens over-stimulate the sebaceous glands (oil glands), causing them to produce excessive amounts of sebum (oil) and increased numbers of acne-causing bacteria (propionbacterium acnes) on the skin.

Fluctuations in hormone levels occur during ovulation, menstruation, pregnancy and menopause and can even be caused by certain oral contraceptive pills. Some types of oral contraceptives, on the other hand, can be helpful for the skin but if stopped later in life, the underlying acne may be unmasked.

If other symptoms – such as irregular or infrequent periods, or excessive facial or body hair – are present, hormonal blood tests may need to be taken. This will help determine if there are underlying medical conditions such as polycystic ovarian syndrome that are contributing to the acne problem.

Your treating dermatologist will then determine if hormonal therapies are necessary and safe for you.

Acne tends to run in families. If your parent battled acne at any point in their lives, it increases your risk of developing adult-onset acne.

Cleansers, moisturisers, make-up and hair care products can all impact negatively on the skin if not chosen carefully. Look for oil-free products that are marked “non-comedogenic” (meaning they don’t block pores) and ensure that all make-up and other creams are washed off thoroughly with a gentle, oil-free cleanser before you go to bed.

Popping zits can lead to problems such as scarring and discolouration. Jared eberhardt/Flickr, CC BY-SA

Try to avoiding oil-based haircare products. Select silicone-based products instead. Alternatively, only use these products on the ends of your hair and again, make sure you wash it off before bed.

Foods with a high glycemic index (GI) (refined carbohydrates) have also been blamed for the increasing incidence of acne. Though this remains controversial, there is certainly no harm in maintaining a well-balanced diet and minimising high-GI foods.


Many over-the-counter products are available to help control oily skin and mild acne including oil-free acne washes, cleansers and moisturisers. But those who experiencing more than just a few, rare pimples, should seek medical advice from a general practitioner or dermatologist.

Dermatologists will consider your skin colour, skin type, acne severity, complications, other conditions such as rosacea and pigmentation as well as pregnancy and breastfeeding before recommending an individualised treatment plan to suit you.

Topical retinoid (vitamin A-derived) creams or gels are often used as first-line treatment for all types of acne, including adult acne. These agents are also useful for pigmentation problems that may occur after acne has settled (post-inflammatory hyperpigmentation). This phenomenon is noted mostly in those with non-Caucasian skin.

Hormonal therapies, including certain types of oral contraceptives and anti-androgen medication, such as spironolactone and cyproterone acetate, can be used if required. These medications may have side effects and are not appropriate for all patients, so discussion with your treating dermatologist is critical to ensure the best treatment is chosen for you.

Six skin-care tips

1. Simplify your skin care regimen. Throw away the facial masks, essential oils, harsh scrubs and exfoliators and “magic serums”. Acne is not due to a build up of toxins or dirt on the skin and these products often do more harm than good.

2. Choose non-comedogenic products. Use a mild non-comedogenic cleanser twice per day with cool water and ensure make-up is washed off thoroughly before going to bed. Don’t forget oil-free hair products.

3. Less is more. It’s important to use only the recommended amount of medicated cream; more cream doesn’t mean it will work more quickly or give better results. In fact, over-use may result in irritated, dry skin.

4. Control the urge: refrain from “popping zits”. Picking and squeezing pimples may cause secondary infection, scarring and pigmentation problems.

5. It won’t happen overnight. No acne treatment will be an overnight miracle. But sticking to your treatment plan will give your the best chance of conquering post-pubescent spots.

6. Seek treatment advice from your dermatologist early. This will ensure you have the best information on how to control your acne and avoid complications.

While there is no “one treatment fits all” for acne, treatments have significantly improved over the years and in nearly every case, the acne can be controlled.

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