I’ve struggled with acne for as long as I can remember. From my teenage years into adulthood, it’s been a persistent issue. I’ve tried nearly everything: Proactiv during its heyday, prescribed topical creams like Clindoxyl and Differin, red light and blue light therapies, oral antibiotics like Minocycline, and even two full rounds of Accutane. Three, if you count the few weeks I tried before stopping out of fear of the side effects. Despite all of it, acne has remained a constant, unwanted companion.
I always thought my acne would eventually go away – I’m still waiting. That was wishful thinking.
Just recently, I had a bizarre breakout on my neck and chest that was more like a mix of eczema and acne. WTF! When will this end? It left me feeling discouraged and hopeless that I would always have acne.
I kept trying to blame myself. Was it something I was eating? An allergy I didn’t know about? Hormones? I just wanted answers and a way to feel in control of my health again.
Why do adults still get acne?
To get answers, I spoke with dermatologist Dr. Annie Liu, MD FRCPC FAAD, Co-Founder & CEO of DermCafé. According to Dr. Liu, the biology of acne is similar at all ages (clogged pores, oil production, inflammation, and bacteria), but adult acne has unique triggers. “In teens, it’s primarily hormonal surges during puberty,” she says. “In adults, it’s often hormonal fluctuations, stress, skincare or cosmetic products, and chronic low-grade inflammation.”
Adult acne shows up in women around the jawline and chin, and can be persistent and inflammatory. Hormonal changes, such as those that occur before your period or during perimenopause, can spike androgens like testosterone, which increases sebum (oil) production. PCOS (polycystic ovary syndrome) is another common hormonal condition that can lead to adult acne, especially in women.
What is inflammaging and how do you avoid it?
Can skincare products cause breakouts?
Yes, what you use on your face can contribute to acne. Plus, hair products or even the fabric from your pillow (or the detergent you use to wash your linens) can cause pimples and skin reactions.
“This is often referred to as acne cosmetica,” Dr. Liu explains. Pimple triggers are often thick, fragranced creams, coconut oil, lanolin, and anything without the label “non-comedogenic.” (That means it won’t clog pores or cause acne.)
I’ve learned the hard way that using stronger, more aggressive treatments doesn’t always mean better results. I broke out with eczema when I used Differin (a prescribed topical acne treatment, which comes in cream and gel forms, and contains adapalene, a type of retinoid). Because it’s a drying formula designed to speed up cell turnover and clear clogged pores, it can also strip the skin barrier, especially if your skin is already sensitive. The eczema showed up behind my ears, on my face, and on my chest. It was the worst of both worlds – breakouts and inflamed, itchy, flaky skin. Brutal.
“Acne and eczema may seem like opposites – one oily and inflamed, the other dry and irritated, but they’re both rooted in inflammation and barrier dysfunction,” Joy McCarthy, holistic nutritionist and founder of Hello Joyous, tells me. “If your skin barrier is compromised, it becomes more reactive.”
She recommends focusing on natural, barrier-supporting ingredients, think rosehip oil, calendula, and chamomile, especially for those dealing with both breakouts and skin sensitivity. “When the skin is inflamed, less is more,” McCarthy says, adding that diet and lifestyle changes, along with gentle, plant-based skincare, can go a long way in calming both acne and eczema-prone skin.
And if you need more targeted support, medi spa treatments can be a great complement to your routine. “Depending on the stage of your acne, whether you’re experiencing active breakouts, healing, or in maintenance mode, customized treatments can make a big difference,” says Yolanda Balatbat, Nurse Injector at TMB Cosmetic. “Blue light therapy can kill acne-causing bacteria and reduce inflammation, while treatments like microneedling with PRP can help smooth texture and reduce scarring.” (PRP stands for platelet-rich plasma, which comes from the patient’s own blood.)
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The emotional effects of having skin issues
Acne isn’t just skin-deep. Adult acne can cause feelings of anxiety, self-consciousness. For me, it made me feel like I was somehow failing at being an adult. I’ve cancelled plans, avoided photos, and second-guessed my self-worth.
“It’s OK to feel frustrated,” says Dr. Liu. “Acne is a medical condition, not a reflection of hygiene nor self-care.”
And once you seek help and get the results you want, Dr. Liu says, “When patients’ appearances improve, their confidence improves, too.”
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Why does it take so long to see a dermatologist in Canada?
Dermatologists can help. But from my experience, the wait time for a doctor referral can be a test of patience. I got an appointment four months after I saw my own doctor. According to the Canadian Dermatology Association, most patients wait six months or longer for an appointment. This is partly due to a shortage of dermatologists in Canada. There are only around 2.8 per 100,000 Canadians. That number is even lower in rural areas.
If you need acne help – stat – you could try online platforms, like DermCafé. You can meet with a dermatologist virtually in about a week, I’m told. And you don’t need a referral or have to pay out of pocket. DermCafé provides the same provincially covered dermatology services as regular in-person appointments. That means that your video appointments with DermCafé Dermatologists for medical concerns can be covered by provincial healthcare.
A virtual derm can be helpful for common skin issues like acne, eczema and rosacea, but for skin checks (moles and other serious skin concerns), you’ll want to do that in person.
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How do gut health and hormones contribute to acne?
There’s a link between gut health and liver function with acne, says McCarthy. “When the gut’s out of balance, it can lead to systemic inflammation in the body that often shows up on the skin. Your liver is responsible for detoxifying hormones. If detox pathways are sluggish, the skin might take over – and that can mean more breakouts.”
Dr. Liu echoes this, explaining that hormonal shifts – including menstruation, perimenopause, menopause and other hormonal conditions like PCOS – can disrupt the delicate balance of hormones that regulate oil production in the skin.
“When hormones shift, even just a little, it can throw your skin off,” Dr. Liu explains. “For example, when levels of testosterone – a type of androgen – rise, it signals your skin to produce more oil. And more oil means a higher chance of clogged pores and breakouts.” That’s why many people notice flare-ups during times like before their period, after coming off birth control, or during perimenopause.
As adults, our hormones fluctuate. Things like coming off birth control, chronic stress and perimenopause (which can start as early as your late 30s or early 40s, not just in your 50s!), all impact estrogen and androgen levels. McCarthy says a holistic approach, like supporting gut health, lowering stress, and simplifying your skincare routine, can help break the acnegenic cycle. And by simplifying, she means sticking to the basics: a gentle cleanser, a targeted serum if needed, a moisturizer, and always SPF. Less truly can be more when your skin is inflamed or reactive.
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What’s helped my adult acne
I’ve started a gentle, non-stripping skincare routine. Prioritizing sleep. I now limit my dairy and sugar intake. And, importantly, I talked to a dermatologist.
I’ve started sticking to a gentle, non-stripping skincare routine, no more harsh exfoliants or five-step systems. I also aimed to drink at least two litres of water a day and for eight hours of sleep each night (no more scrolling until midnight). I’ve cut back on dairy and sugar, which I noticed were triggering breakouts for me, too. And, most importantly, I finally talked to a dermatologist.
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At-home treatments to try
This gentle, soap-free face wash purifies skin without stripping it, making it ideal for oily and acne-prone skin. It uses thermal spring water to calm inflammation, and zinc PCA to help with excess oil. La Roche-Posay Effaclar Purifying Foaming Gel, $30 at laroche-posay.ca
