Here’s why you struggle with adult acne, and how to get rid of it

You might think of acne as a teenage problem, but if you’re still suffering from breakouts, you’re not alone. More than half of women over 25 have some facial acne, according to the Journal of American Academy of Dermatology. Whether it’s the occasional zit or severe, cystic lesions adult acne is increasing in women in their 20s, 30s, 40s and even 50s.

So what do you do? For starters, the same rules apply as high school — don’t pop your zits. Even, and especially, if they are whiteheads. “If you manipulate the acne, there’s a much higher rate of leaving a scar,” warns Dr. Elizabeth Hale of CompleteSkinMD.

Here’s how you can take control of the situation.

Manage Your Stress

One major culprit of breakouts is stress. Dr. Jessica Weiser of New York Dermatology Group says that similar to teenage acne, which stems from a surge of hormones triggering oil glands to overact, adult acne has a lot to do with hormones, too. “We’re seeing a lot more stress, a lot more intensity from stress hormones, which can also contribute to later onset acne,” she explains. The stress hormone cortisol, for example, causes glands in the skin to produce more oil which results in breakouts.

But unless you’re a yogi eliminating stress all together is near impossible.

“Try to find activities that lower stress, because stress increases cortisol,” Dr. Hale says. “Whether it’s exercise, yoga, meditation or sleeping well, anything that can decrease your stress level can have a great effect on your skin.”

Keep Your Skin Clean

A key to clear skin is to keep your face as clean as you can. Cleanse your face in the morning, evening and after the gym. Dr. Hale even says it’s important to clean off makeup before sweating at the gym.

“Your pores open up and if you have makeup on, it just seeps into the pores and triggers breakouts,” she explains. Her suggestion: use cleansing wipes before and after working out, especially the ones with salicylic acid if you’re acne prone. She likes Neutrogena Oil-Free Cleansing Wipes in Grapefruit.

Dr. Weiser also adds that if you’re prone to dry skin, use micellar water instead. (We like, Garnier SkinActive Micellar Foaming Cleanser). “It doesn’t strip natural oils, so it’s a gentle way of cleaning the skin without washing,” she explains.

Make sure to keep anything that touches your face clean, too. That means wiping down your cell phone each night, washing your pillow cases regularly and keeping your hair out of your face.

Don’t Overwash

While you should be keeping your skin clean, be careful not to over do it. If you wash your face more than two times a day, you risk stripping your skin of its natural oils, which can lead to even more oil production to compensate for it. Ultimately it could lead to dry skin with breakouts — the worst of both worlds.

Watch What You Eat

Unfortunately, the old adage that sweets are bad for your skin is probably true. Dr. Weiser says, “Personally, I feel like sugar is the biggest dietary trigger of acne. It’s very pro-inflammatory — it triggers a lot of redness and inflammation.”

Some studies also point to other triggers such as refined carbs (pasta, white bread, processed foods) which spike your blood sugar, and dairy products which are high in hormones (milk, cheese, yogurt).

And in case you haven’t guessed it already, yes, drinking water is key for great skin — it hydrates and helps flush out toxins.

Rule Out Rosacea

Another type of adult acne is acne rosacea. “Rosacea is a common inflammatory skin condition where someone has sensitive skin and tends to get red in the central face and tends to flush and blush frequently,” Dr. Hale explains. “But in addition to redness, they also get pimples, papules and pustules.” Unlike hormonal acne, which typically occurs on the jawline and neck, acne rosacea breakouts take place where people flush, like the nose and cheeks.

Related article: Skincare tips: How to improve your complexion while you sleep

Treat the Occasional Breakout

For occasional breakouts, both Dr. Hale and Dr. Weiser recommend using mild skincare products in conjunction with over-the-counter salicylic acid or retinol treatments. SkinCeuticals Retinol 0.5 is recommended for first-time retinol users. Dr. Weiser says using a gentle exfoliant a few times a week can help turn over fresh skin cells and prevent pores from clogging.

“Using things like clarifying masks, like charcoal or clay-based, or exfoliating masks like lactic acid-based products can help give a nice, gentle turnover,” she says. She recommends the Colbert MD Intensify Facial Discs, Drunk Elephant T.L.C. Framboos Glycolic Night Serum for oilier skin and La Roche Posay Toleriane as a gentle, everyday moisturizer. Dr. Hale likes lightweight moisturizers by Kiehl’s, Neutrogena, and Paula’s Choice.

If your zit is an urgent matter — say, you’re getting married, for example — you can pop into a dermatologist’s office for a cortisone shot to zap it away.

Check Your Birth Control

It’s also worth checking if your birth control method might be affecting your skin. Dr. Weiser says that as hormonal IUDs with progesterone, and other progesterone-based birth control methods become more popular, birth control pills with estrogen, which protects against breakouts, have declined in popularity. Progesterone can cause breakouts for some women, and Dr. Weiser says many women don’t realize that their IUDs change their hormonal balance.

“Progesterone is the hormone that peaks the week before your period and it triggers oil glands, so it produces more oil and sebum,” she explains. “We are seeing more acne in that phase, so if you have progesterone all the time, it’s almost as if your body is a ‘week before your period’ phase all the time.” But that doesn’t mean you need to take out your IUD. Oral medication spironolactone can help regulate your hormones and calm oil gland production, says Dr. Weiser.

Get Tough When the Problem Persists

If you have moderate, frequent breakouts, it’s time to see a dermatologist for topical retinoids —a vitamin A derivative, which helps increase cellular turnover and improve skin — like tretinoin or adapalene. Dr. Weiser says your doctor might also prescribe topical antibiotics like clindamycin or erythromycin instead of or in addition to the retinoids.

Retinoids also help stimulate collagen production, and fight fine lines and wrinkles. A bonus for adult acne suffers.

Dr. Hale also suggests seeing a dermatologist for laser and light therapy that can shrink sebum glands such as blue light LED treatments, photodynamic therapy or smoothbeam lasers. A dermatologist can also prescribe an acne peel.

Consider Accutane For Severe Acne

If you’re suffering from severe, chronic acne that scars easily, you might want to consider Accutane. Dr. Weiser says though it has its drawbacks, “It gives you a shot of never having acne again. Seventy-five percent are cured.”

But make sure you visit a board-certified dermatologist who will provide proper monitoring, as Accutane has side effects of severe sun sensitivity, a risk of fetal malformation and depression and mood issues. She says, “It’s typically a last resort option, but it is for people who need a very effective and helpful medication.”

This article originally appeared on MarthaStewart.com.