Q:

I'm 25 years old and still get occasional breakouts. Is this normal? What can I do to make it stop?

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Answers (14)

EXPERT
Dr. Lawrence Osman, MD (Dermatologist) answered

Many people still break out past their teen years, and many others start breaking out in their 20s even though they had clear skin as a teen. There are many options available to treat your acne, including prescription and over-the-counter (OTC) creams, medications taken by mouth, lasers, chemical peels, and for severe cases, Accutane. Accutane is the most effective treatment available, but it's not meant for everyone and it has its risk--so it's not always the best choice. The best treatment for you depends on many factors, including the type of acne you have.

Most patients with mild to moderate acne are best treated with prescription creams alone or a combination of creams, pills and peels. Current guidelines suggest that all patients other than those with cystic and scarring acne should first start treatment using a retinoid. Retinoids are a class of topical medication that are derived from vitamin A, and include Retin-A, Differin, Ziana and Tazorac (all of which are available with a prescription). Retinol is a retinoid that's available without a prescription, but it's much less powerful than its prescription counterparts.

While using a retinoid may be all that you need to treat mild acne, you may want to combine it with a cleanser to help unclog pores. Just make sure that your cleanser is mild and gentle, as retinoids can cause skin irritation.

 

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Anonymous commented
What if you are allergic to retinol? What other options are out there?
lauragunn commented
Also it is important to change your pillowcase frequently.. It can make a huge difference in complexion.
ka50b commented
my grandma is 59 and she still as breakouts but she looks younger than my mom. i use an apricot scrub from walmart just keep up on washing you face every day and it should be under control
EXPERT
Daniela Ferri (Licensed Esthetician, Acne Specialist) answered
There's a very good possibility that you're current skin care and makeup routine contains pore clogging ingredients.  In my experience, when someone in their mid 20s start to experience an acne problem they didn't really have in high school, or is ongoing and just won't go away after adolescence, there are normally three explanations.  

One, the start of new skin care routines in anticipation of "getting older" involving many clogging moisturizers and makeup.

Two, introduction of birth control in college or later, for actual birth control purposes or hormonal problems associated with conditions such as PMDD or PCOS.  

Three, new stress from starting out on a career, which is a different type of stress than even occurs in college.

It can be possible to tell the causes of a breakout by the placement of the blemishes.  For instance, when the breakout is concentrated along the jawline by the ears, that's often hair styling product or foundation. Along the cheekbones can be impactions caused by certain red and yellow dyes in blush irritating pores. Bronzer is noTORious for causing breakouts, especially pressed. Cleansers that are too harsh, scrubs that are too scratchy and moisturizers and makeup that contain pore-clogging ingredients always make everything worse, whether it's oil overproduction from hormones to food sensitivities to irritating medications, prescription or over the counter.

If you'd be interested, we can do a personalized skin care evaluation by email, where we talk in-depth about your routine, habits, breakout placement and what to do about all this.  It includes a full evaluation sent to you by email and a sample packet of product sent to your home or work.  Please email me at skin911@daniela.com. 
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Anonymous commented
Danielle: My face is breaking out under my skin, what would be the cause of this kind of break out? I'm 26 & I've had moderate-severe acne breakouts as a young child starting at age ten (when I started puberty) and throughout my pregnancy at 19. After I had my daughter my skin seemed to clear up alot! I'd just have the occasional zit appear from time to time but now, I'm starting to notice bumps under my skin that don't come to the surface! They are still an annoyance because although you cannot see them w my make-up on, it's very embarrassing when my fiancé rubs his hand along my cheeks in the shower and says why is your skin so bumpy now? :( iv tried every otc product they sell, Ive even went as far as ordering proactive...alot of money down the drain & I'm stuck with this problem still! My doctor says a prescription wouldnt be necessary because my acne isnt severe enough to merit one & to wait it out and it should go away....its been years!! can you please help!! -kris
EXPERT
Daniela Ferri commented
What you're describing happens to most of my clientele ! :D Notice how the breakouts under your skin are colorless and when you squeeze them squiggly stuff comes out? I call these "oil balloons". lol These are what are called "closed comedones". They're basically a mixture of oils, dead skin cells and certain waxes the skin makes, which are all the same components of blackheads. However, what's happening here is that instead of pores remaining open and filling with these materials to make regular blackheads, the mouths of the pores are closing in as the skin either gets dehydrated from harsh cleansers and lack of a good toner, or what usually happens at the jawline and chin is an accumulation of pore-clogging materials from foundation, powder, bronzer or hair styling product. Most often it's from very pore-clogging makeup gathering there by the end of the day because of gravity. Having said that, when these closed comedones extend all the way up the jawline so that the entire lower half of the face is covered with them, this is an indication that there is a severe hormonal imbalance. However, if there are no mood swings, no excess hair in the "beard area" or decollete, and no history of very irregular periods, then hormonal imbalance is unlikely. Chances are much greater the problem is pore clogging. This would also be the reason it's all of a sudden come up after years of being clear, and why nothing has been working. Any good that could or has resulted from anything you've been using ends up thwarted by pore clogging materials, which can not only be in makeup, but most moisturizers out there have them, and even some brands of Benzoyl Peroxide! Even the generic version of retin-a cream is pore clogging! Since each person's skin is different, it's better to deal with each person's skin individually. The best way I can do that is by a personalized consultation. Please contact me from my profile here so I can tell you how. :)
EXPERT
Jillian Wright (Clinical Aesthetician & Spa Owner) answered
Break-outs can happen at any age given hormonal changes, environmental stressors, pollution, touching your face (bringing bacteria to the surface), emotional stress, diet, lack of sleep.  Depending on your lifestyle and when and why you are experiencing the break outs is half the battle in correcting them.  Often times, when you play skincare detective and keep a mental journal as to why you might be breaking out, you can figure it out and change that habit or even your skincare routine.  Make sure you cleanse day and night with the appropriate cleanser.  It doesn't need to be medicated or have AHA, just a good all purpose cleanser that will not strip your skin. Beta Green Tea Cleanser by Rhonda Allison or her Citrus Gel Cleanser are both wonderful options.  You need to exfoliate 2x a week, use a good moisturizer with spf and an effective repairing and/or rejuvenating moisturizer for night.  They even have amazing moisturizers for congested and oily skin on the market.  An excellent spf for acneic skin is Elta MD UV Clear spf 46.  It's a client favorite here at the spa. 
There are many ingredients on the market that are very harsh for the skin and unnecessary.  If you figure out your skins needs and your lifestyle habits, you can figure out how to take great care of your skin to ensure its health over time.
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EXPERT
Daniela Ferri (Licensed Esthetician, Acne Specialist) answered
Spironolactone is a wonder drug, seriously!  However, it has to be temporary, it cannot be used for very long term. You still may need a long term solution, mainly connected to why you're breaking out to begin with. Acne has many causes and multiple solutions.  I must say, though, I do often recommend Spironolactone.  :)
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Kim commented
Hello, i'm 20 and having break-outs these days which makes me feel embaras. I had a clear skin before but started to have a break outs first on my right cheek then on the chin and then on my left cheek. What should i do? Is aloe vera effective to remove scars and redness?Thanks.
EXPERT
Daniela Ferri commented
THe answer above about recommending Spironolactone which was written on March 7th, 2013 was in response to a question that now appears below this answer. I have since learned that it's not really as good an option as I thought, and should only be used by acne sufferers who have acne because of severe hormone imbalances and conditions such as PCOS. To Kim : It sounds like your breakouts are due to either pore clogging materials or pore irritating dyes in your blush, or pore clogging materials in your hand or body lotion, which you would be able to tell by the pattern of the breakouts if they correspond to where you lean on your hands or fists. Most blushes out there can cause breakouts to those with enough oil production in their skin - try a pure line of loose mineral blush instead. If it's your hands, I recommend VaniCream Lite Lotion instead of regular hand or body lotion.
EXPERT
Daniela Ferri (Licensed Esthetician, Acne Specialist) answered
It shouldn't be more than a year or two, after which better skin care and hormone balancing, whether through more carefully chosen birth control or alternative medicine, will be able to take over.  It isn't necessarily a good indicator of imbalance because it works just as well for someone who simply produces too much oil without a hormone problem.  However, dead skin cell build up will actually cause an acne condition in someone who genetically produces a great deal of oil, so if the skin is exfoliated appropriately, oil is controlled without stripping the skin, and diet is healthful, acne should be able to be kept under control.  So, at the very least, Spironolactone can be used to give the skin a break from the various inflammatory consequences of oil overproduction that has not responded well to most acne clearing regimens, whether it's because of hormones or genetics.
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EXPERT
Daniela Ferri (Licensed Esthetician, Acne Specialist) answered
I'd say if Spiro helps, it can mean you have a hormonal problem to begin with, but it does mean you produce too much oil in your skin.  You would need a definitive diagnosis to determine why that is, then take measures to treat it - Spiro treats the symptom, it doesn't get rid of the problem.  So, if you don't have any significant imbalances, it may be that you genetically produce too much oil, in which case the answer really is a good skin care routine. Spironolactone has many side effects.  Anything that has that many side effects has to have an alternative waiting in the wings in case you can't handle them.  So, it's hard to say how long is too long, but it is indeed not a permanent solution.
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EXPERT
Dr. Charles Bollmann, M.D. (Ob/Gyn, Fellow Amer. Academy Cosmetic Surgery, Founding Member Amer. Holistic Medical Assn.) answered
See all the above answers, but if you are female you might want to try a low progesterone combined oral contraceptive that contains estrogen. Many women have increased androgen production which can contribute to the acne, due to a lack of the enzyme esterase, which converts androsteinedione to estrogen. 

A birth control pill that contains estrogen will help this by decreasing the production of androsteindione, and decrease the acne production. It might take 3-6 months before you see an effect from this.
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EXPERT
Daniela Ferri commented
Is there a blood test that might show the lack of this enzyme?
EXPERT
Dr. Charles Bollmann, M.D. commented
My mistake, I meant the enzyme aromatase, not esterase. I am not aware of a blood test. Mostly the diagnosis is made clinically.
buzzlove answered
I have been taking prescription Spironolactone for a month now and its been amazing.  Still get a few here and there, but much better now;)  I'm 25...(and my airheaded sisters in law have all clear skin!  one even made it through childbirth and still has perfect skin!)  
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buzzlove commented
how short term does Spironolactone have to be? I guess if Spiro helps your acne problem, you can tell that you have a hormonal acne problem?
Anonymous answered
I would try moderate and more natural approaches before you resort to harsh treatments that could have side effects and clear your acne but lead to other skin problems. I am in the same position and am using EVE Lom's Dynaspot and taking L-Lysine vitamins. Both have worked significantly well. 
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Anonymous answered
I'm 27 and have been breaking out a week or so before my period. Then it'll clear up. Not fun, but hormonal. 
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EXPERT
Daniela Ferri commented
Breakouts before one's period, or any other hormonal cause like stress, can actually be curtailed, simply because the only difference between a time of greater male hormone, which is what causes the breakouts, and any other time, is an increase in oil production. That means if your skin care routine is completely non pore clogging and hydrating so pores flow better, and your diet is non-inflammatory, you actually will breakout far less before your period, if at all. :)
DiamondsAndPearls answered
No chemicals just use Aztec Indian Healing Clay (you can find it at natural stores or online) and organic raw apple cider vinegar to mix it. This stuff has done AMAZING wonders for my skin and I've unfortunantly wasted hundreds of dollars on the so called "professional" stuff and endless other stuff. Buy this, it works in just a few days sucking all the bad stuff out of your face. Research it.

Good luck xoxo
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ashleetyra89 answered
Im 25 and I have severe acne that started a few months ago, I had a babya a yr ago and my periods recently stopped. Im not pregnant nor on contraception. .do I have to go to a dermatologist to get prescriptions? I cant afford a dermatologist so thats why I was hoping for a alternative. 
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