Women's Health special issue. Credit: Julia Yellow for The Washington Post. (Julia Yellow for The Washington Post)

Pimples are a scourge of teenage years, right? But anyone who has looked in the mirror and found an unwelcome zit in their 20s, 30s or even later can tell you that clear skin isn’t always one of adulthood’s privileges.

A stray pimple — or ongoing breakouts — aren't unusual for adult women, says Nada Elbuluk, a dermatologist and assistant professor at NYU Langone Health. For many, they're the norm. A 2008 study found that more than 50 percent of women in their 20s, 35 percent of women in their 30s, 26 percent of women in their 40s and 15 percent of women in their 50s reported experiencing acne. That's more than men — thanks in part, says Elbuluk, to hormones that influence oil production in women. (Teenage boys are more likely to experience acne than teenage girls.)

Acne occurs when hair follicles get blocked by dead skin cells or oil. Bacteria thrive in clogged pores and when inflammation results, normally calm skin can erupt into cysts, pimples and blackheads. Stress, hormonal irregularities, pregnancy, menopause, genetics and some dietary factors can spur breakouts. Other times, they just happen. "It's often very frustrating," says Elbuluk. "There's not really any way to predict."

Though adult acne can be a holdover from the teen years, it often differs from the breakouts on teenage faces. Teens tend to get acne in their "T zone" (across the forehead, nose and upper chin); adults usually get it in what dermatologists call the "U zone" (around the cheeks, mouth and chin).

The hormonal acne that women get tends to cluster around the chin and jaw line. And while teens tend to get inflamed whitehead-type zits, adult women are more likely to experience bumps under the skin. It’s unclear what accounts for this difference. The menstrual cycle can cause acne, but so can hormonal imbalances.

Women with acne have plenty of treatment options, including over-the-counter benzoyl peroxide and salicylic acid, prescription options such as topical creams, oral antibiotics and birth control pills, and procedures such as chemical peels.

But think twice before heading to your medicine cabinet for a "natural" remedy, Elbuluk says. "I've had patients who have tried lemon juice, apple cider vinegar or various oils," she says. "But there's no scientific data behind a lot of that stuff." Other purported remedies, such as an iPhone app that claimed to heal acne but was smacked down by the Federal Trade Commission as essentially snake oil in 2012, don't do anything at all.

Elbuluk recommends you visit a board-certified dermatologist instead of turning your face into a science experiment. “Even a natural-seeming product can cause irritation to the skin,” she says. Dermatologists can usually help find a treatment you can afford, she adds, and if the visit reveals an underlying health issue, your entire body may thank you.

And don’t think you’re in the clear once you hit menopause: Some post-menopausal women get acne, too.

Learn more: aad.org/public/diseases/acne-and-rosacea/adult-acne.

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