You’ve long passed the days of first dates, getting your driver’s license and making the jump to varsity football. Maybe really long passed. But why hasn’t your face gotten the memo?
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“Acne is definitely normal for teenagers — more than 90 percent of teens get acne. The weirdos are the ones who don’t get it in their teenage years,” says dermatologist Alok Vij, MD. “But we’ve definitely seen over the past few decades that people don’t grow out of acne as quickly as they used to.”
So that means it’s persisting for men into the 20s and 30s. (Sorry, guys!)
Understanding the biology of acne
Acne is primarily a hormone-driven process, Dr. Vij explains.
“It’s excess activity of the male hormones, like testosterone, at the level of the hair follicle and the oil gland that leads to excess oil production, blockage of the hair follicles and then inflammation from overgrowth of bacteria in the area,” he says.
This process is still the same in adult acne, it’s just lasting even longer.
When you should seek a dermatologist’s help
Dr. Vij says there are a few reasons men should seek out help for acne:
OTCs aren’t helping. If you’ve tried an over-the-counter anti-acne medication and it’s not consistently helpful, you may need something stronger.
There’s scarring. “If you’re noticing any scarring at all, I think it’s important to go see a dermatologist as quickly as possible,” he says. “That’s your standard-issue sign that you need to be more aggressive with treatment.”
If you’re bothered by it. Whether it’s that you can’t figure out the pattern, or if you’re troubled by the breakouts, seek help. “Many people write off acne as just a few pimples, but we know that it has potentially lifelong psychosocial implications,” Dr. Vij notes.
“People who have had acne suffer — and some feel their suffering is just as bad as if they have a chronic medical condition, or in some cases, even cancer. Their quality of life gets that bad. And because acne can be a scarring process, that negative effect on someone’s life can be a lifelong thing.”
The most effective treatment options
Since acne is hormone-related, you can’t treat men who have breakouts the same way you do women. And vice versa.
In women, medications used to stabilize the level of hormones include birth control pills or a medicine called spironolactone, which basically blocks the effect of testosterone at the hair follicle.
“We don’t use those medications in men at all because — while you could put a man on birth control, he wouldn’t be happy about it,” Dr. Vij says.
What is used in men instead? There are three main strategies:
Topical medications. “We do use a lot of the same topical medications in men as in women,” Dr. Vij says. “And because men’s skin tends to be a little more oily than women’s skin, we can often be more aggressive and use stronger topical medications since their skin is a bit more robust.” These may include over-the-counter benzoyl peroxide or prescription retinoids.
Antibiotics. The tide is turning away from using antibiotics to fight acne. We’re realizing that “chronic courses” (that’s three months or longer) of antibiotics increase your risk of developing bacterial resistance to them. That becomes a problem when you get a severe infection, like a MRSA infection, and end up needing to be hospitalized and given IV antibiotics, Dr. Vij explains.
That’s why the American Academy of Dermatology recommends using the minimum amount of antibiotics for the shortest course possible.
Accutane. If someone’s acne doesn’t respond as well as it should to one course of oral antibiotics, typically isotretinoin — a medication that shrinks oil pores — will be recommended instead of more antibiotics.
2 common things that make men’s acne flare up
Last, Dr. Vij says it’s important to note that there two common pitfalls that lead to worsened breakouts in men.
Steroids. Using steroids like prednisone or dexamethasone for anti-inflammatory conditions or certain endocrine-type abnormalities can cause flare-ups, he notes. “But even worse are anabolic steroids that many athletes use to bulk up or make bigger gains at the gym,” Dr. Vij says. “Those definitely make acne flare.”
Greasy skin products. If you use hair care products that get onto your face — whether on your hair or your facial hair — you can plug your hair follicles and invite acne to rear its ugly head. (That includes you beard oils and waxes!)
“Now, more and more skincare companies are marketing new products specifically for men. Women always, I think, know to look for makeup and facial care products that say ‘non-comedogenic’ or not pore-clogging,” he says. “Men don’t necessarily look for the same thing. If you’re going to buy a new product, make sure it says it’s non-comedogenic.”