Zits at my age? Why?

After our teenage years, we think that the days of dealing with acne are behind us—but that's not always the case. While adult acne is much less common than adolescent acne, I see a lot of patients struggling with skin blemishes as adults. Most men outgrow acne in their 20s, but adult acne affects 12 percent of females at age 25 and 5 percent of women at age 45.

So what causes acne in adult women? As you may have guessed, hormonal shifts often play a role. Hormonal acne typically appears at the jawline or chin. A woman might experience breakouts around the same time every month coordinating with her menstrual cycle. Other hormonal issues that can cause blemishes are pregnancy, menopause and changes in contraception.

There are other factors that can cause flares in an acne-prone individual. Stress can increase cortisol levels, which can worsen acne. Also, foods that are sugary or have a high glycemic index can flare acne in some people. Some studies have shown a connection between drinking skim milk and having acne.

Certain hair and skin products can clog pores and contribute to acne. If acne seems worse under hair bangs, consider switching hair products. Read the labels on all your skin care products. Make sure that you see one of the following terms on every container:

• non-comedogenic
• oil-free
• won't clog pores

These products are the least likely to cause acne, and you want to make sure your moisturizer, cleanser, sunscreen and all other skin care products contain one of these terms.

Adult onset acne is generally very inflammatory, making it frustrating for patients. It often can't be managed in the same way as adolescent acne. The deep inflammatory acne "cysts" can be painful and take several weeks to resolve.

Talk to your health care provider about the best options for your adult acne. While topical medications can be very effective in treating more superficial acne, other medications are often needed for the deeper acne lesions. Often oral antibiotics are used. Other options include hormone-regulating medications such as an oral contraceptive or a blood pressure medicine that lowers free testosterone called spironolactone. For severe cases of inflammatory acne or acne that has failed multiple treatments, a course of isotretinoin may be indicated.