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How can I have acne at thirty?!?

Alice,

I am a thirty-year-old woman. Recently I have experienced terrible acne on my chest, neck, upper back, and face. No matter what I do, the problem will not go away. Could it be serious? What should I do?

Dear Reader,

Thanks for popping this question! While acne (commonly referred to as breakouts, zits, pimples, and more) is often associated with the teenage years, acne affects people throughout their life cycle. In fact, adult acne is quite common — about half of those assigned female at birth and a quarter of those assigned male at birth experience adult acne. There are many contributing factors to the development of adult acne, including fluctuating hormone levels, acne rosacea, and stress; diet may also play a role. Additionally, medications such as lithium, corticosteroids, and anabolic steroids may also contribute to acne.

Fluctuating hormone levels as people age may contribute to adult acne. Typically, estrogen decreases and testosterone increases as women age. Testosterone directly leads to the production of oily skin, which increases pore size and creates a suitable environment for bacteria to multiply. When these bacteria multiply, it leads to an increase in whiteheads, blackheads, and cystic acne. In addition, hormone levels may be affected by starting or stopping birth control pills, undergoing menopause, or becoming pregnant. All of these events may contribute to a reduction in estrogen levels, which also leads to a buildup of oil in the skin. 

In regards to cortisol levels, it's typical to experience increased stress with age. However, increased stress may contribute to an imbalance of the androgens and hormones that regulate the skin. In response to stress, the human body produces an increased quantity of androgen, a type of hormone that stimulates oil glands and hair follicles to produce more oil, thereby leading to an increase in acne. Cortisol, which is known as the stress hormone, also increases the probability of developing adult acne. Higher rates of stress, which stimulate cortisol, coupled with an increase in testosterone as people age, promotes the production of oil on the skin and plugs up the glands, and can lead to adult acne popping up.

In addition, a few other, less common, factors may contribute to adult acne. First, although there isn't empirical evidence to link a specific diet to increased acne, some people have found that specific foods trigger their acne due to the inflammatory response certain foods cause. In this case, those individuals may find that avoiding those particular foods may help to clear up their skin. Another cause of pimples cropping up in thirtysomethings is a condition called acne rosacea. This condition causes redness and flushing of the face (which may become more pronounced when a person drinks hot beverages, alcohol, or eats spicy foods), pimples, dry skin, and reddish-purple streaks that look similar to broken blood vessels (called telangiectasias). However, this type of acne doesn't actually cause whiteheads or blackheads. Acne rosacea may be treated with antibiotics, whether pills, gels, lotions, or a combination of these products.

Reaching out to a health care provider may help you figure out the best way to regulate your acne. Given the number of options available over-the-counter and by prescription, they'll be able to best advise you on the cause of your adult acne, how to treat your skin and what types of products work best for you, and how to prevent your acne from getting worse. In more severe cases, a referral to a dermatologist (a doctor who treats hair, skin, and nails) may be necessary.

Best of luck breaking up with your breakouts!

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Last updated Dec 31, 2021
Originally published Apr 25, 2003

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