Dr. Jaliman is a Board Certified Dermatologist, spokesperson for the American Academy of Dermatology, Assistant Professor at the Mount Sinai School of Medicine — where she has taught for over 25 years — and authoritative source in skincare. She has a private dermatology practice on Fifth Avenue in Manhattan.
When you’re already on the lookout for lines and wrinkles, acne can seem like an added insult – whether your struggle with the spots is a constant battle or a monthly skirmish. Why does acne still hang around when you’re well beyond the angst-ridden teen years? And what’s the best way to deal with it? We spoke with renowned dermatologist and adult acne expert Debra Jaliman, MD to find out.
In a nutshell:
1. Adult acne is very common and is frequently triggered by hormones, stress, and diet.
2. When choosing acne treatments, look for a mild cleanser, a treatment containing salicylic or glycolic acid, and spot/area treatment for specific problem patches. Retinol is a great nighttime treatment, since it has both anti-acne and anti-aging benefits.
3. Don’t use products designed for adolescents if you’re treating adult acne! They’ll often be too harsh and will over-dry your skin.
4. See a dermatologist right away if you have cysts (painful lumps underneath the skin) or scarring.
Read on for the full story.
Ayla: Acne is embarrassing at any age, especially when you think you should have outgrown it. Is it a common concern?
DR. JALIMAN: Adult acne is almost our entire practice! I’m particularly passionate about it because I’ve had it my whole life - I went straight from adolescent acne to adult acne. It’s very common. Our patients run the gamut from people like me (who have dealt with acne from the time they were adolescents straight through to adulthood) to people who had perfect skin as adolescents, then somehow ended up with adult acne.
We frequently see it in the lower part of the face - cysts on the chin, for example - and sometimes there’s a combination of rosacea and adult acne. In both cases, especially with rosacea, the key is to use gentler products so that you’re not inflaming or drying out the skin. In all cases, the important thing to know is that adult acne has to be treated very differently from adolescent acne - you’re dealing with much more sensitive skin, and you don’t want to dry the skin out too much.
Ayla: What causes of acne do you most frequently see? Do diet and stress levels play into it?
DR. JALIMAN: It’s often hormonally triggered, and lots of stress can certainly play into it. Diet can have a dramatic effect on acne, too. With patients who have struggled with acne for a long time and tried lots of treatments, you have to think out of the box, so we often combine topical treatments with suggested dietary changes. For instance:
• We’ve seen some new research that dairy can trigger acne, so sometimes we advise people to lay off the dairy (even if it’s organic and the cows aren’t treated with hormones) to see if that helps. It’s important to get enough calcium, but you can take a supplement during that time.
• There’s also evidence that high-glycemic foods - junk foods - can exacerbate acne.
Additionally, if a woman is struggling with acne and also getting irregular periods, and sometimes unwanted facial hair, polycystic ovarian syndrome could be the cause. Often I end up diagnosing it - in those cases, acne could be part of something much more serious.
Ayla: How do you recommend treating adult acne at home?
DR. JALIMAN: It begins with the way you wash your face. Washing is crucial; I like milder cleansers, because even gentler acne treatments can make the skin a little bit dry. Don’t use a drying cleanser, then a drying product - you’ll just be too dried out.
Note from Ayla: Naturopathica Aloe Cleansing Gel, Luzern Labs Pure Cleansing Gelee, and S5 Neutralise Cleanser are great choices for every day. If you need extra help, The Organic Pharmacy Peppermint Face Wash and Medik8 poreCleanse Gel are non-drying cleansers with acne-fighting and antibacterial properties. All are good choices for a natural anti-acne regimen.
The important thing is to avoid washing your face with your fingers: you might have bacteria under your nails that can spread to your face, and you won’t get enough exfoliation. So, along with a milder cleanser, I recommend using something like the Clarisonic face brush. It’s fantastic, and I like the blue brush head the best (it’s designed for delicate skin). If you don’t want to invest in a Clarisonic, you can just wash your face with cotton pads.
Then, I would just use one product designed specifically to treat acne. There are some adults with oilier skin, particularly in the T-zone - they can handle a bit more and treat the T-zone separately, for example. As a next step after washing, I would look for a mild exfoliant - either a salicylic acid pad or serum, or a toner with glycolic acid. If your skin feels irritated (particularly in the winter, when it’s windy), you can wash it off. I find that most of my patients can leave these types of treatments on their face in the spring and summer more easily.
Note from Ayla: Luzern Serum Control is an excellent all-over treatment with a natural form of salicylic acid. Our customers also like Ursa Major Essential Face Wipes, which contain the same key ingredient (willow bark extract) that's in Serum Control.
A lot of people will simply spot treat - but if you’re just doing that, you’re not treating the acne, you’re treating the spot. That acne will just appear in a different spot. So, if you need additional treatment, put it on the area where you’re breaking out. For example, if your breakouts are only on your chin, put a thin layer of treatment on your chin area.
Note from Ayla: Medik8 betaGel is the most effective non-toxic and natural acne treatment we've found (actually, it's the most effective spot treatment we've found, period). S5 Purity Serum is another non-toxic and natural acne treatment that works well over slightly larger areas. The Organic Pharmacy’s Blemish Gel is a natural acne treatment that's salicylic acid-free and can be used even if you’re pregnant.
Ayla: What types of ingredients should we look for in our adult acne product arsenal?
DR. JALIMAN: It’s very important to be careful about the products you use. You can certainly get over-the-counter products, but you want gentler ones, especially on your face. Frequently people will go to the drugstore or buy something they’ve seen on TV - products that are really designed for adolescents - and they’ll dry their skin out, ending up with peeling, dry skin. Then they’ll try to cover it up with makeup and it just becomes a mess.
Here are the ingredients I typically recommend:
• If you’re using salicylic acid, while an adolescent might use a 2% strength, an adult should only use 0.5%.
• If you’re using benzoyl peroxide, while an adolescent might use 5-10%, an adult should only use 2%.
• Another treatment that works well is Pyratine XR, which contains a growth factor from a plant - it’s very effective, particularly in cases where it’s an acne-rosacea combination. It rebalances the skin and takes the red out.
• For adult acne, I especially love retinol - I think it’s amazing because you get an antiaging effect from it and it’s anti-acne. You can either buy an over-the-counter product or go to a dermatologist for a prescription.
Note from Ayla: Luzern Force de Vie Nuit is a great retinol product from one of our favorite brands.
On the body, the best treatment is usually a wash containing benzoyl peroxide. The Clarisonic works well on the back, too. In our office, we often treat it with prescription products that have topical antibiotics, and sometimes we do back facials. You can use stronger products on your body than you can on your face; the skin on your body is a lot thicker.
Ayla: When do you recommend seeing a dermatologist about acne?
DR. JALIMAN: Usually, I suggest giving it 4 weeks of at-home treatment. If you don’t see any changes, consider seeing a dermatologist. But definitely see a dermatologist right away if you have cysts or scarring. You don’t need to come in all the time, but it will help you get started with the right treatment program.
Ayla: What’s the difference between a regular pimple and a cyst?
DR. JALIMAN: If you feel a big lump underneath your skin - frequently a painful lump - it’s a cyst. If it’s a pimple, sometimes it’s painful, sometimes it’s not, but it’s always at the surface of the skin. With cystic acne, you often get scarring and destruction deeper in the skin, and sometimes the scarring isn’t treatable. So I definitely recommend seeing a dermatologist right away in those cases. If you have cysts, you need something to treat them internally - a birth control pill, an antibiotic, or something else. Cysts are so deep that topicals won’t have much of an effect on them.
Ayla: What types of treatments do you use in your office?
DR. JALIMAN: We take a very comprehensive approach that varies from patient to patient depending on their need. We often use a combination of the following:
• Medical facials - a 1-hour treatment to clean the face
• Light peels
• Topical treatments
• Accutane (sometimes - it depends on the situation)
• Blue and red light treatments, and other lasers
Ayla: What about some of the new products that use light or heat to zap pimples at home?
DR. JALIMAN: In my practice, we use red lights and blue lights and find them to be very effective. But we tried the Zeno, and I don’t think it works that well. The TRIA’s interesting, though - people seem to like it, and I’ve heard from a lot of people that it does help.
Ayla: If you’re really acne-prone, can you use regular moisturizers or makeup on top of your treatment product?
DR. JALIMAN: The great thing is that there are really nice moisturizers you can use now that are non-comedogenic and contain things like hyaluronic acid. There are great cover-ups, too…in the old days, the only thing you could use was this one lotion that you shook up before putting it on your face, and it was horrible! You can find great foundations now - Armani makes a really nice one - that are appropriate for acne and offer a little bit of coverage.
Note from Ayla: We carry many moisturizers that are suitable for acne-prone skin. Luzern Labs Force de Vie Lotion and Force de Vie Micro-Gel are non-comedogenic. Other lightweight options include Hydra'Fluide from BioRecept, Antioxidant Gel and Manuka Cream from The Organic Pharmacy, Balance Fluid from S5, and Oil-Free Moisturiser from Elave.
Special note for pregnant or breastfeeding women: We generally recommend avoiding retinol and salicylic acid if you're pregnant or breastfeeding. If acne is a concern for you, you can treat problem areas with The Organic Pharmacy's Blemish Gel.
About Dr. Jaliman: Debra is a Board Certified Dermatologist, spokesperson for the American Academy of Dermatology, and Assistant Professor at the Mount Sinai School of Medicine. She treats actors, models, and newscasters at her private practice in Manhattan, where she is always at the forefront of the latest skincare news, clinical updates, and emerging trends. An authoritative source in dermatology, Dr. Jaliman is frequently quoted in top print publications and featured on national TV shows including 20/20, Dateline, CBS News, NBC News, FOX News, and BBC News. Learn more about Dr. Jaliman’s impressive background here.
Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.