People tend to think of acne as a problem for the young, and there’s a good reason for that: Most of us start developing acne and often have our most severe acne during our teen years. Sadly, that doesn’t mean zits magically disappear the day you turn 20. Acne occurs frequently after the teenage years and at significantly higher rates in women compared with men.

Why do we get it?
Many of the same factors that cause acne in teens play a role in adult acne: pores getting clogged by oil, skin cells, and bacteria. Another factor that may explain the prevalence of adult acne in women is hormones; the kind of hormonal fluctuation that accompanies the menstrual cycle. As your period approaches, estrogen levels in the body dip, leaving your testosterone levels unchecked. Since testosterone, an androgen, can crank up your skin’s oil production, that also means a higher chance of clogged pores and big, angry pimples.

How is it different from teen acne?
The pattern of acne is usually different in adults than it is in teens. In teens, it’s usually on the forehead and cheeks. While in adults it tends to be mostly on the lower face, along the jawline and neck.

How can it be prevented?
While hormonal fluctuation may make women more prone to breakouts than men, it also gives them a few extra options for treatment. Studies have found that excess insulin from foods with a high glycemic index, like packaged foods as well as pasta, bread, and rice, may play a role in the effects of androgens (like oil-encouraging testosterone) on acne. Meanwhile, foods that are heavy in hormones, like dairy products, are often at the top of the list of things dermatologists recommend cutting out for clearer skin.

Milk naturally contains a great number of hormones. Consequently acne patients should cut down on dairy and eliminate straight-up milk altogether.

Chill out
Stress leads to increased cortisol levels. Like testosterone, cortisol is a hormone that can increase skin oiliness as well as inflammation. Not a good combo when you want to avoid being red in the face. Once upon a time our bodies produced cortisol only when we were in danger, but nowadays, it’s much more likely to flood your system in response to a looming deadline than in response to a predator in the underbrush. So when your acne starts acting up, take a minute to figure out whether there’s anything you’re freaking out over, then unload all of that skin-wrecking stress.

Think before you treat
Just because you had an acne regimen that worked in school doesn’t mean you should stick with it to treat your adult acne. Most acne solutions that are currently available were designed to treat teenage acne, and not many of them are designed to meet the special skin-care needs of adult women. Since your skin becomes less resilient with age, harsh acne treatments can exacerbate the problem with unwanted side effects, like itching, redness, flaking, and sensitivity. Day also warns that women of color are particularly prone to developing dark spots from acne treatments thanks to postinflammatory hyperpigmentation, or PIH.

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