Sudden acne outbreak

October 22, 2014 7:51 AM

I've managed to reach my mid-30s with no acne and suddenly it's AcneTown all over my face. Can you help me clear it up?

I've never had acne anywhere on my body. Since the beginning of summer, I've started developing a combination of deep, cystic pimples on my chin along with little red pimples on the rest of my face that eventually explode into goo. Nothing has changed in my life beyond a bit more stress than usual, so I'm assuming this is some mid-30s hormonal thing. I'm a lady.

Here's what I've done to combat it so far, without much luck:

I rarely wear makeup.

I don't use soap on my face. I'll rinse my face morning/evening with warm water and a washcloth for gentle exfoliation. Every few days, I'll use a little Cetaphil cleanser.

I have naturally dry, red, Irish skin, so I moisturize a few times a day. I use Eucerin Anti-Redness in the evenings, and Neutrogena Rapid Repair in the mornings.

I've tried a couple different salicylic acid creams which I put on the pimples when they pop up.

I wash my sheets and pillow case regularly.

My diet is pretty good and hasn't changed. Nothing has changed, really - I take the same vitamins and live in the same place and use the same laundry detergent, etc.

I live in Minnesota, and our climate can be awful for skin, but since this started prior to the summer, I don't think this is a drier-weather thing.

About once a week, I have a public job that involves being on camera and generally looking my best, so I'd like to kick this if I can. Do you have suggestions for clearing this up? Products you use? Lifestyle changes you made? Is a dermatologist appointment necessary? I feel like I may be overreacting since this is so new to me, but I'd like to hear what you have. Thanks!

posted by Laura Macbeth to Clothing, Beauty, & Fashion (28 answers total)

A dermatologist may not even be necessary. When I suffered from acne, I asked my regular physician for a prescription. She prescribed Benzaclin (which may or may not be the generic name, it's been years) and it worked like a charm.
posted by Enchanting Grasshopper at 8:03 AM on October 22, 2014

Nothing has changed in my life beyond a bit more stress than usual, so I'm assuming this is some mid-30s hormonal thing. I'm a lady.

I'm a man so I am dealing with (obviously) a slightly different biology than you are, but I have had, and continue to have, adult-onset acne. It comes and mostly goes. Here's what I have learned:

Weight-gain causes an acne outbreak. Generally speaking, a higher BMI will affect your endocrine system, and certain hormones make you more prone to acne outbreaks. I lost weight earlier this year and my skin problems vanish.

Stress will cause an acne outbreak. Generally speaking, increased stress affects hormones in your body, and also impacts the effectiveness of your immune system. This can cause acne.

Blood-sugar spikes affect acne. Once again, in my experience (my doctor confirmed this), if you are eating food that causes blood sugar spikes, it will affect your acne, especially with the interplay between stress, hormones, and your immune system. For me, eating anything with refined flour (bread, bagels) and sugar (chocolate, candy, soft drinks, Starbucks fraps) will cause an outbreak.

I do notice a spike in acne after eating a bagel, and it lasts for a few days. So I have learned to avoid carbs (and this includes sugars). Losing weight also helped.

Interestingly, a pharmacist once recommended Aspergillus supplements to combat acne, and this helped. Your gut bacteria play a role in the ecology of your skin.

On top of that, winter can be a bad time for acne. The air is cold and dry, which can dry out and damage one's skin, making one more susceptible to acne. One remedy is to moisturize your skin frequently.
posted by Nevin at 8:06 AM on October 22, 2014

What is your diet like? Sugar and carbs can be the problem.
posted by DeltaForce at 8:07 AM on October 22, 2014

This does sound like a hormonal thing, have you had any other physical changes? Gone off/on birth control? I would probably recommend getting in to see your gp, and even getting a referral to an endocrinologist. Sudden acne after a lifetime of no acne seems like a larger systemic change, something you may want to get checked out.
posted by nanook at 8:08 AM on October 22, 2014

I would talk to your doctor about birth control. I had sudden, cystic acne out of nowhere at the age of 24, and tried to many over-the-counter and prescription products until my OBGYN wrote me a 'script for birth control. It was a miracle from day one -- I just recently went off and the whole three years I was on it, I had one cyst. It was so, so worth it and it resulted in an extremely dramatic immediate improvement when nothing else worked.
posted by queens86 at 8:09 AM on October 22, 2014

My diet is pretty good - I'm vegetarian and cook from home most days. Not a lot of grains or crabs, and rarely any sugar. Occasional junk food, but not much. I'm thin and exercise regularly. Thanks for the answers so far.

No specific hormonal changes besides just getting older. The birth control is an idea, though - my doctor recommended it for some other hormonal symptoms (change in periods), so this may be the route I go.
posted by Laura Macbeth at 8:09 AM on October 22, 2014

If you have something particularly important coming up and have some cystic acne popping up, a dermatologist can inject them with cortisone to clear them up super quick (like if you're going in front of HD cameras or something). Usually cystic acne is hormonal and mid 30s is about the time for it to ramp up.

This stuff seems to be more gentle on my face than regular salicylic acid creams. You shake it up and put a dot on your zit with a Q tip.
posted by hollygoheavy at 8:09 AM on October 22, 2014

Oh, and I was also told by a derm that sudden acne, especially on the cheeks and jaw (mine all kept popping up on the same cheek) is almost always hormonal. The other drug that was recommended to me for this type of acne (although I haven't tried it) was spironolactone, which is an antihypertensive that is used off-label for acne. If my acne comes back, that is what I'm going on.
posted by queens86 at 8:11 AM on October 22, 2014

I have the dry, red, Irish skin (sigh) and I was diagnosed with rosacea about ten years ago, and got cystic chin acne, at least 2 spots monthly, with pms. I went through the gamut of antibiotics and topical prescription creams from the derm and nothing really helped me personally (friends of mine have seen results from either treatment).

I found out I have Celiac disease a few months ago, and since I've made those changes, my skin is the nicest it's ever been. I no longer have to moisturize 2x a day and it's CLEAR. Even during pms. In addition to cutting gluten, corn, and dairy, I needed to supplement with magnesium and B vitamins beyond what's in a typical multivitamin.

It's amazing to have nice skin that doesn't hurt, but for me, it was just the tip of the iceburg. I had to treat my skin from the inside. Good luck, memail me if you want more info.
posted by Lardmitten at 8:12 AM on October 22, 2014

Make sure you're using an oil-free/"oily skin" moisturizer even though you have dry skin. I know it's counterintuitive, but take heart in the fact that it is a "moisturizer", it just works via non-oily alternatives. Oily moisturizers can block pores and make things worse. I recommend Neutrogena Oil Free Moisture, which is also hypoallergenic.

Something to at least try: try laying off hot/spicy/peppery food and alcohol for a week. In
Ayurvedic medicine, these are "heating", and an imbalance can suddenly affect your health (especially skin) in new ways.
posted by Quisp Lover at 8:14 AM on October 22, 2014

Since you note a change in periods and prior consideration of birth control, it makes sense that hormones are an issue here.

But if you're not ready to go that route, a really good probiotic can help. Sounds like you eat well, but it's amazing how many things can damage good flora; a healthy gut can do wonders for your skin.
posted by whoiam at 8:21 AM on October 22, 2014

This is a medical condition. There may be a simple lifestyle change needed. There may be more to it (e.g., you have rocasea and the rest of your problems flow from that.)

See a dermatologist. If you cannot see a derm, see your usual doctor.
posted by Lesser Shrew at 8:41 AM on October 22, 2014

I went through the same thing in my early thirties. After trying a series of topical antibiotics prescribed by my PCP, I saw a dermatologist. He prescribed a couple of similar things (Ziana and something else) which dried out my skin but didn't help much with the acne. I went back, and he prescribed Tretinoin (generic Retin-A). That stuff worked. Nuked it from orbit within a few weeks. I've stayed on it for several months. I have the occasional zit, but it's nothing like it was.

He also suggested that I switch from soap to a glycerin bar soap called Purpose. It's by Johnson & Johnson, and works well. Bonus, it has a nice, old-fashioned smell that I really like.
posted by Flipping_Hades_Terwilliger at 8:53 AM on October 22, 2014

This sounds like my skin.

Yes, birth control will probably help.

In the dry northern winter, skin gets dry and has a hard time sloughing off naturally, and that is the cause of my non-cystic acne. You'll need a very thick, heavy duty, maybe even grandma style moisturizer to soften it all up regularly and then exfoliate (with mild acids or with scrubs) as much as your skin will tolerate. I also use straight up oils and cold creams too.

You can also ask your regular doctor for Retin A. It's supercharged vitamin A and helps skin turn over more quickly. It made all the difference for me and is also anti aging. You will really need lots of moisturizer because it's very drying. For redness find moisturizers and serums with some vitamin c.
posted by littlewater at 8:55 AM on October 22, 2014

This happened to me when I was 28 and 29. I was under extreme stress. I cannot take hormonal birth control, so my dermatologist prescribed me a low-dose antibiotic, which helped. I also went in semi-regularly for cortisone shots for the biggest ones - I would get ones that were the size of a quarter, and they hurt like heck.

The biggest change happened when I dumped my abusive boyfriend, though - my adult onset cystic pimples disappeared when my stress dissipated. So in addition to checking out medication, have you thought about some de-stressing activities like yoga or meditation?
posted by sockermom at 9:01 AM on October 22, 2014

I've tried a couple different salicylic acid creams which I put on the pimples when they pop up.

You need to add benzoyl peroxide to your routine. Use a salicylic acid toner or face wash (instead of a heavier cream-based form) and then follow up with a benzoyl peroxide ointment on the areas prone to breakout.

The active ingredients serve two different functions. Salicylic acid cleans gunk out of your pores (and thus is best for blackheads and other clogged pores) and benzoyl peroxide kills the acne bacteria (and thus is best for whiteheads and those painful red pimples under the surface).

Use them in that order (salicylic acid first, benzoyl peroxide second) for best results as the salicylic acid will clear the way of oil and dirt so that the benzoyl peroxide can better penetrate the affected pores. Do this every day up to twice a day (morning and night) as a preventative measure instead of waiting until you already have pimples.
posted by Jacqueline at 9:14 AM on October 22, 2014

Zinc oxide cream (or even Desitin). Better to use at night but a very thin application can be covered with a tint during the day. It's amazing on cysts, reduces them in a day, and you can be somewhat preventative with it. Zinc also super calms the redness and irritation.
posted by lawliet at 9:41 AM on October 22, 2014

Paula's Choice makes great acne products: get the 2% BHA lotion (or cream if you have dry skin), and the 2.5% benzoyl peroxide, and her sunscreen if you don't already have one you love to wear every day. You need to start slow (so maybe just start with the BHA on night one, and wait a few days before you add the benzoyl peroxide) and wear sunscreen every day without fail or your skin will get burnt (because the products make your skin more sensitive and slough off layers). So start with that once a day, wear sunscreen during the day, try not to touch your face. Over time you can use more and use it twice daily (in the morning under makeup/sunscreen and at night).

Those two products combined with DIM (diindolymethane) have largely cleared my face (I am in my 30's and have never had great skin fwiw). DIM helps your body clear out excess estrogen, it's a nutrient from cruciferous vegetables. You can find usage suggestions online. I take 4 Estrosmart capsules a day and that seems to be the right amount for me (you can find DIM in other products or on its own).

Nthing stress reduction/self care as well. Many find cutting dairy, wheat, and sugar helps too.
posted by lafemma at 10:10 AM on October 22, 2014

Another Irish-skinned person, here, who has similar problems appear in my mid-30s, initially diagnosed as rosacea. What it ultimately was driving the symptoms, though, was respiratory allergies. The flare-ups usually involved the addition of spring and fall pollen to the constant allergen of dog fur, with extra stress bringing out extra problems.

It took several trips to different clinics to get it pinned down. Initial prick tests didn't turn up anything, but higher doses injected directly help narrow things down to some very specific pollens and danders. A daily nose spray and seasonal doses of over-the-counter allergy meds have improved things immensely. And keeping moisturized in the dry months. And vacuuming up the pet fur as much as possible.
posted by bendybendy at 10:29 AM on October 22, 2014

Great suggestions. I have a game plan.

I ordered the Paula's Choice items mentioned - the BHA lotion and benzoyl peroxide.

I'm also going to do a little experiment with my diet to see if going Whole30 for a bit will help. I've done this before and had terrific results before.

I do have seasonal allergies and take an OTC antihistamine and prescription nasal spray, so I'll be better about being consistent taking these.

If these changes don't help, my next step is the dermatologist and also my PCP to discuss birth control.

Thanks for all the help!
posted by Laura Macbeth at 10:58 AM on October 22, 2014

I had clear skin except for the occasional PMS hormonal zit or two but nothing drastic. Then came my early 20s and my face practically erupted like Mt. St. Helens. I switched my make-up to mineral (Alima Pure) and I washed and switched out my pillowcase as often as possible. I stopped wearing make-up unless I absolutely had to and I stopped eating out at restaurants including quitting sushi/soy. I cut down on sugar intake to almost nonexistant unless naturally occurring such as fruits. I completely cut out bread/rice/grains and most of my carbs come from either beans or sweet potatoes. The sweet potatoes have vitamin A which is helpful for skin. Also, probiotics are supposed to help repopulate your internal flora with healthy bacteria that boosts healthy skin in my experience. Lots of water and tea, no soda/alcohol/smoking. Yoga, walking, jogging, meditation and simplifying my life to be the least stress possible that was in my control.

Besides diet and lifestyle changes, immediately what helped was using coconut oil as make-up remover and occasionally exfoliating with a water/baking soda mix about once or twice a week. After washing my face I would alternate nightly between applying witch hazel or coconut oil. Slathering coconut oil on my face daily for as long as possible is what finally curtailed the massive cystic pimples I was getting in a matter of weeks. From there it was just rebuilding and exfoliating the skin. Also, to help soothe the redness and irritation, making a mask out of avocado is fantastic too. It's cooling and I use about half an avocado, mash it as well as you can and then clump it on your face until it dries. About an hour or two, once you wash it off, your face will feel AMAZING. Good luck, skin issues always suck. But whatever you course of action you choose, start slow and don't add too many things at once because there's an acclimation period that it will get worse before it gets better and you might have to give it about 3 months to determine what is working or not working for your skin.
posted by lunastellasol at 11:00 AM on October 22, 2014

You should head over to https://www.reddit.com/r/SkincareAddiction/ and read through the beginner's routine and also do a search for hormonal acne.
posted by LoonyLovegood at 11:01 AM on October 22, 2014

I am also the skin-type you describe and I get flare ups around my jawline. My never-fail answer to the problem is Burt's Bees Tomato Toner. I have no idea why it works so well. I put it on before bed and within a week or two of consistent use, the acne is gone. It's expensive, but it smells divine and is relatively "natural" -- I really think it's worth trying before you go to a hormonal birth control or a prescription cream/wash.
posted by RingerChopChop at 11:02 AM on October 22, 2014

Also -- I found using mineral make-up improved my skin, as well as trading in all lotion-type moisturizers for coconut oil.
posted by RingerChopChop at 11:04 AM on October 22, 2014

Jacqueline's advice about salacylic acid and benzoyl peroxide is spot-on. The BP may dry your skin out a bit so I wouldn't use it more than once a day. Also note that it can bleach your pillowcases if you use it at night.
posted by radioamy at 11:08 AM on October 22, 2014

Beware of coconut oil, for some people it's extremely comedogenic and causes acne problems.

Also, get in the habit of wiping your phone handset down with rubbing alcohol and changing your pillowcase frequently. These items can harbor all kinds of bacteria and you may be redepositing them on your face. Also, in case you haven't used benzoyl peroxide, be aware that it can bleach towels and pillowcases.
posted by quince at 11:14 AM on October 22, 2014

I find pro-activ actually works quite well if you use it as instructed.

I would add that there are a number of medical conditions, mostly related to hormones and your reproductive system, that can result in adult acne including some which are quite unpleasant. Please see your actual doctor, not just a dermatologist.
posted by jacquilynne at 12:02 PM on October 22, 2014

Unfortunately I have had acne since about 12 but it was just forehead spots before I started birth control at 16, then I had horrible cystic acne on my chin and jaw line. I recently switched to a hormone free coil and I have clear skin for the first time in 15 years, the cysts have gone completely! I think a lot of acne is hormone related and stress plays into that as it can upset the balance. Birth control could make the issue worse so make sure your ready for that but it could fix it, I found the local sexual health clinic infinitely more helpful than my GP as they had more in depth knowledge of how these things work. If you do go the birth control route make sure you give it a few months at least before deciding if you want to continue as there can be a lengthy transition period, there definitely was for me.

N'thing what lunastellasol said about the coconut oil, I always thought that because I had greasy skin I needed to strip the living daylights out of it. Since I stopped washing my face with harsh cleansers my skin has been so much happier and much less greasy, I use jojoba oil a lot as coconut oil is too heavy unless my skin is particularly dry. As a bonus I haven't come across any make-up that oils can't remove!
posted by Peetree at 12:05 PM on October 22, 2014