Adult acne comes in many shapes and sizes and may even change in character over time. Whether acne is in the form of small comedones or large nodules, all acne can be distressing, painful, and evoking of embarrassment, frustration, depression and anxiety. 

Fortunately, there are many safe and effective topical and oral medication treatments available for adult acne.

In my professional opinion, a personalized regimen is best as skin and acne types vary greatly as do the anticipated treatment responses.

Lifestyle Modifications to Prevent Acne

Mild Acne

For mild acne a great foundation to start with is a gentle skin cleanser with a pH of 5.5 – 7 (close to the pH of skin) mainstream soaps often have a pH of 9 – 10 which can irritate the skin and lead to dryness. If comedones or small papules aka black heads or small pimples are present on the skin, adding on a benzoyl peroxide wash, such as Panoxyl 10% wash as tolerated, or at least thrice weekly can be helpful. 

Diet 

Diet can also play a role. In the literature decreasing dairy, specifically milk intake and curbing high glycemic index food intake can decrease acne. 

Products

Of course less is more. But if you are seeking products to help cover up acne or scarring, selecting non comedogenic products is best. When acne lesions form or are healing, avoid skin picking as tempting as it may be as it will only delay healing and lead to increased scarring. 

When the above measures are not enough, the addition of a Retinoid therapy may be warranted. 

Similar to benzoyl peroxide washes, Retinoids can also be over drying and it takes some time for the skin to adapt to the regimen. I like to recommend topical retinoids as tolerated, at least thrice weekly to curb new lesions and to help prevent acne in persistent adult acne. 

Moderate to Severe Acne

In the instance of severe acne the above measures are also foundational, but a more aggressive regimen is necessary. In severe acne I like to recommend a topical antibiotic, such as Clindamycin. I tell patients the bottle looks like a bingo dauber, but instead of color it deposits a clear antibiotic solution on the skin and can be applied twice daily, especially to nodular or cystic lesions with purulent drainage. 

Oral antibiotics are sometimes prescribed, but this is not the safest practice, and of course the medications come with their own list of potential side effects including future antibiotic resistance patterning.