Adult acne: what works and what does not

Acne does not always end with adolescence. Around a quarter of women and one in ten men in their thirties still have breakouts, often along the jawline and chin. The good news is that adult acne responds well to treatment once you stop trying products at random and follow a plan.

What is actually happening

Acne forms when pores become blocked by dead skin cells and oil, bacteria multiply inside them and the surrounding skin becomes inflamed. Hormones, stress, some medicines, comedogenic cosmetics and, in a smaller way, diet all influence how much oil is produced and how easily pores block. It is not caused by dirt, and scrubbing makes it worse.

Start with the basics

Wash twice a day with a gentle, non-foaming cleanser and lukewarm water. Choose moisturisers and sunscreen labelled non-comedogenic. Remove make-up before sleeping. Change pillowcases weekly and stop touching or picking, which spreads bacteria and causes scarring. These steps alone will not clear moderate acne, but every treatment works better on a calm skin barrier.

Treatments with good evidence

Topical retinoids such as adapalene are the backbone of acne treatment; they unblock pores and prevent new lesions. Expect dryness for the first weeks and improvement after two to three months, and always use sunscreen. Benzoyl peroxide kills bacteria without creating resistance and pairs well with retinoids. Azelaic acid helps pigmentation left behind by old spots and is safe in pregnancy. For inflamed acne, a dermatologist may add a short course of oral antibiotics, always combined with a topical to limit resistance. For women whose acne flares with their cycle, hormonal treatments can be very effective. Severe or scarring acne is treated with oral isotretinoin under specialist supervision, with strict pregnancy prevention.

What has weak evidence

Toothpaste, lemon juice and harsh alcohol toners irritate rather than treat. Expensive "detox" products have no effect on pores. Chemical peels and laser can help in clinic as additions, not replacements.

Diet

High-glycaemic diets and, in some people, large amounts of skimmed milk are associated with worse acne. A balanced diet with whole grains and vegetables is sensible; eliminating entire food groups is not.

When to see a dermatologist

Book if acne is leaving marks or scars, if over-the-counter products have not helped after three months, or if it is affecting your confidence. Photographs uploaded before a video consultation let the doctor assess severity and start treatment the same day.