Mandy Epley has been an aesthetician for 15-plus years, first in New York and currently in New Orleans. Between the two cities and performing an estimated tens of thousands of facials, she’s seen a major uptick in one specific skin-care issue: adult acne.
“In my opinion, it’s because we eat out a lot more, we have more demanding jobs and we read too much online about what to do with our skin. And then we apply too much skin care,” she says.
“It’s a bad cycle.”
Elmer, NJ dermatologist Ingrid Warmuth, MD shares that sentiment: “Adult acne is something a large amount of my patients struggle with on a daily basis. Unfortunately, I find that women have more of an issue treating hormonal acne than men, due to changes in testosterone levels as they age, gynecological issues like polycystic ovary syndrome [PCOS] and pregnancy.”
And the stats don’t lie: According to the Journal of the American Academy of Dermatology, 54 percent of women 25 and over have some form of facial acne—something New York dermatologist Ritu Saini, MD sees a lot, adding that if she had to blame one culprit, she would single out stress, with a side of hormones. “People have more fast-paced lifestyles now, and more stress is related to more cortisol, which exacerbates breakouts, especially in those predisposed to hormonal acne.”
The Big Debate
Aestheticians and derms don’t always agree on the best way to treat acne. Here’s what the experts recommend for their patients and clients:
“When I am treating adult acne, I first do a thorough consultation on the client’s diet, supplements and medications, as well as which products they are currently using. I then do a deep pore-cleansing treatment, and every three weeks I have them do a series of three chemical peels. Then, I decide from there what is best going forward, as everything is personally customized. When we have calmed everything down, I do a series of microneedling treatments. I also suggest keeping a food journal, and I will always try whatever at-home skin-care regimen I recommend for them.” —New Orleans aesthetician Mandy Epley
“Acne goes by so many names—adult acne, acne rosacea, rosacea, adult-onset acne, and granulomatous rosacea—so, depending on whether there is just redness, or redness and bumps, or just bumps, I will tailor a prescription-strength program to address the components of the patients’ concerns. There is a long list of things in a diet that can exasperate acne and rosacea, and by identifying the particular triggers for a particular patient, you can minimize outbreaks. However, I’ve found the most effective treatments are a combination of prescription medications, in addition to trigger avoidance. —Eagan, MN dermatologist Charles Crutchfield, MD
“I believe diet and the right home care are the two main factors in making skin better. It is important to always thoroughly cleanse the skin—preparing a clean slate by sloughing off surface dryness is 50 percent of the success of any acne treatment. I also like working in treatment serums that are nurturing and supportive. Most people with adult acne are surface-dry, and getting rid of that dry, dead cell buildup is super important, as it holds congestion. Keeping skin hydrated is essential to speeding up its recovery and achieving healthy skin.” —Celebrity aesthetician Nerida Joy
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Frappuccino and the Flare-Up
Vienna, VA dermatologist Brenda Dintiman, MD doesn’t think hormonally triggered acne is necessarily new, but she does blame what she refers to as the “Starbucks phenomenon” for some of our modern-day skin issues. “With many people drinking daily cappuccinos, and even Frappuccinos, there seems to be a rise in the type of acne that occurs around the mouth, and even rosacea,” she says. “After 20 years of saying diet doesn’t matter, I now tell patients to avoid dairy and eat a low-glycemic diet to avoid triggering hormonal acne.”
The Off-Label Super Pill
Almost everyone we interviewed for this story said the same thing: Spironolactone is effective, especially when it comes to treating hormonal acne.
“Spironolactone—a mild blood-pressure medicine that is prescribed off-label for acne—has been great for some of my clients, as it suppresses androgens, or the male sex hormone,” Epley explains. “But, if you don’t have the overactive hormone, I haven’t seen it help much.” Dr. Warmuth is also a fan. “Treating hormonal acne takes a little thinking outside the box. I typically recommend oral spironolactone medication,” she says, but stresses that not everyone is a candidate.
“After a simple blood test to check potassium levels and rule out pregnancy, I usually trial this medication for a few weeks or months, and then have a follow-up evaluation to see how the patient is responding. For the most part, taking a daily pill is easier for adults to fit into their routine. Then add on a gentle glycolic or alphahydroxy acid face wash once a day with a topical tretinoin at night and they’re set.”
The Clear-Skin Tool Kit
Post-Acne Protocol: A constant doctor-favorite, CeraVé’s Resurfacing Retinol Serum ($20) targets post-acne marks and large pores—all while brightening, improving the skin’s barrier and boosting hydration.
Device Strategy: Compatible with all Clarisonic devices, the line’s long-awaited Acne Cleansing Brush Head ($29) is clinically proven to reduce the appearance of blemishes and prevent future breakouts.
Hydrate + Treat: Powered by medical-grade and active ingredients like salicylic and hyaluronic acids, Oxygenetix Acne Control Hydro-Matrix ($99) reduces inflammation and calms even the most sensitive skin.
Retinol, Revised: When Altreno launched is 2018, derms were thrilled. According to the manufacturer—they’re the masterminds behind Retin-A—the Rx is the first and only tretinoin lotion “designed with women in mind“ (i.e., it’s perfect for adult acne).
The Latest Launch: West Palm Beach, FL dermatologist Kenneth Beer, MD says the 2020 debut of Arazlo is “welcome in his practice,“ as the formula lessens irritability commonly found with retinoids.
Pregnancy Pick: When a patient is pregnant and acne or rosacea is an issue, Dr. Warmuth’s pick is a one-two punch: Generic Clindamycin 1% Lotion and Finacea Gel or Foam, coupled with a gentle cleanser. “But no retinoids of course!“