Adult acne is a cruel joke of cosmic proportions. Sure, breaking out sucks when you're a teenager, but at least you’re somewhat united in it, as your friends will probably be suffering too. Plus, you can chalk it up to something of an awkward caterpillar phase — along with the mood swings, orthodontia, and questionable style choices.
Getting acne again in adulthood — or for the first time, if you made it through adolescence unscathed — feels especially unfair. You're supposed to have grown out of it by now... but you're really not alone. Some dermatologists have referred to the prevalence of adult acne as "an epidemic," and clinical trials ballpark the number of women who suffer from adult acne as anywhere between 12% and 41%.
Acne around the chin and jawline is particularly common in your late 20s and 30s, according to clinical facialist Kate Kerr. "It’s often hormonal, but not always. These types of breakouts don’t necessarily mean you have a hormonal imbalance, which is why blood tests may come back with normal results," she says. "However, your oil glands may have become sensitive to the levels of hormones you’re naturally producing. Mid-cycle, when your estrogen production dips and your testosterone levels don’t have anything to hold them back, you can expect to see more breakouts."
As you've probably already noticed, these breakouts aren't just annoying — they're painful, too. "Acne on the jawline can often turn nodular or cystic," says Kerr. "They sit deeper within the skin and create more inflammation closer to the nerves, which is why they're so sore." As she explains, while your acne might be triggered by hormones, it doesn’t necessarily mean you have an existing problem — it’s more that your sebum production takes any fluctuations as a cue to start whizzing into action. "Lifestyle factors such as stress, poor diet, and lack of sleep will all have an impact on our hormones," says Kerr. "Often with women in their 30s, it could be choosing to come off the pill or other hormonal contraception. It can take time for our hormones to balance after a long time on it."
As for treatment, picking and squeezing is not going to help. Because the acne lives under the skin, there's nothing to "pop," so to speak — but there is a lot of scarring that can occur if you're not careful. "If you exert any pressure on the surface, you can cause trauma underneath, leading to more breakouts, post-inflammatory pigmentation, and scarring," Kerr says. "Plus, your body will create more white blood cells as a response, which only further inflames the problem."
For that same reason, topical products won't get you far, either. "After proper clinical examination and assessment by a consultant dermatologist, drugs like spironolactone and Accutane can be helpful for deep, painful acne known as nodules and cysts," says dermatologist Dr. Anjali Mahto. "This is particularly the case if you have a lot of the breakouts and they’re persistent, and if they result in scarring or affect your mental health and self-esteem. Both medications have the potential for side effects and a thorough consultation to assess for suitability must take place first."
Accutane is fairly well-known (perhaps even infamous, at that), but spironolactone is a little more under-the-radar — but no less worth looking into. "It's actually an 'off-label' drug for acne," says Dr. Mahto. Originally designed to treat cardiac problems like hypertension, the reason it's beginning to see more use as an acne treatment is that it's an androgen blocker, which helps curb testosterone production and keep hormone levels more regular.
The best way to deal with this type of acne, to ensure minimal scarring and maximum results, would be to skip the over-the-counter topicals and swing by the dermatologist for a full skin exam. Unfortunately, hormonal acne can be incredibly stubborn, and doesn't react to most topicals the way standard breakouts do; you'll just dry out the skin without affecting the root of the problem underneath. So save the money you would've spent stocking up on salicylic acid creams at Sephora and put it toward getting yourself a prescription regimen instead. When you no longer have the persistent pain or redness of a series of cystic bumps throbbing under the skin, you'll be glad you did.