There are very few things I am expert in; preventing and treating adult acne is one of them. Since the aging process is hard enough on a woman’s ego without acne, I’m sharing my top ten (and a half) ways to treat this nagging, unsightly, self-esteem-eroding problem.

For all the time, money, and attention I’ve poured into it, I can’t name a single relationship that’s given me less in return. Acne is like a selfish, bitchy neighbor I really don’t want in my life, but who keeps insisting on coming to my party. She is not welcome!

Let’s be real for a second: there are big, big problems in the world and adult acne is not one of them. But if you have it, you know that acne is a constant drain on the mental and emotional resources we need to face those big problems with confidence and fortitude. I hope these tips help you divert your resources to more important endeavors.

#1 Proactiv

Before you say “well, duh”, allow me to explain why this is at the top of my list.

The majority of the acne medications available at the drug store since we were in puberty contained one of two active ingredients: benzyl peroxide or salicylic acid. These are de rigueur medications for acne sufferers.

Proactiv is no different; these are the only active ingredients listed in their products for acne. As a result, I dismissed Proactiv for years as overpriced, overhyped, and preying upon desperate, pizza-faced teenagers and their parents, who were willing to shell out a heft sum every month for designer acne products when the exact same ingredients were available for a couple bucks at the local drug store. (Also, dermatologists never, ever recommend Proactiv. Maybe they’re afraid we won’t need them anymore!)

But about seven or eight years ago, I decided to give it a go and – weirdly, inexplicably – it worked! I followed the instructions to the letter (I’m a very cooperative acne patient) and, sure enough, my skin cleared up. I have no idea why Proactiv works better than the cheap, generic benzyl peroxide and salicylic acid creams available at the market, but it does.

Recommendation:

Try it! What do you have to lose? They offer a 30 day free trial, which is plenty of time to determine if this will work for you. Consider adding the Re-texturizing Toner to your kit. (It’s also available on Amazon.) If cost is an issue, keep in mind that the supply they provide you with is generous enough to last a few months, so it’s highly unlikely you’ll need a new shipment ever month. (My $40 kit lasts 4-5 months, so it ends up costing $8 to $10 per month.)

#2 Retin-A

“To my knowledge, (Retin-A) is the only drug for which there has been crystal-clear demonstration that it works on the molecular level,” said Dr. John J. Voorhees, the chairman of the dermatology department at the medical school of the University of Michigan. (Read more in this NY Times article.)

Anyone who has seen a dermatologist for acne has probably been put on Retin-A at some point in their life.

This product comes with a host of undesirable side-effects: redness, flakiness, sensitivity to sun and certain beauty products. For these reasons, grown women tend to shy away from using Retin-A to treat acne. But there’s a secret to Retin-A that I only learned about two years ago.

For years, I tried to combat the side-effects of Retin-A by mixing it with my moisturizer before applying it to my skin. WRONG. Retin-A wants to be applied on clean, dry skin and allowed to soak in completely before any moisturizer is added.

After washing my face and applying Proactiv Re-texturizing Toner, I wait 3-4 minutes for my skin to dry. (If I’m in a hurry, I’ll blow dry my face on the cool setting for about 30 seconds.) Then, I pat a teeny-tiny amount of Retin-A on the delicate skin around my eyes, a slightly less teeny-tiny amount on the rest of my face, and finally about half a pea-sized amount (which is about double the amount I apply to my face) on my neck and throat. I wait another 2-3 minutes before applying Proactiv Pore Targeting Treatment with benzyl peroxide. This has drastically minimized the side effects of Retin-A!

Recommendation:

Don’t walk, RUN to your dermatologists office. Even if you don’t have acne, Retin-A is something of a miracle drug and, if you have good insurance, is an inexpensive solution to both acne and wrinkles. I’ve had the best luck with Retin-A Micro, which has a concentration of 0.04%. As for generic vs. brand, I’ve seen zero difference other than the price. Tell your pharmacist you want whatever is cheapest.

#3 Antibiotics

Despite an overwhelming amount of evidence that antibiotics are overused and damaging to our immune systems, physicians just love prescribing antibiotics. Because they work, especially for acne that comes from the inside (as opposed to acne caused by some topical irritant or bacteria from outside our bodies.)

Other than the IV antibiotics I received while in labor with my third child six years ago, I haven’t taken any antibiotics. But after reaching a breaking point recently, I gave in. And – guess what? It’s working, so – for now – I’m sticking with it and hoping a decade or so of good behavior (and a religious reliance on Fire Cider) will work in my favor and minimize any damage I might be doing to my immune system.

If you’re adamantly opposed to treating acne with oral antibiotics (which I totally get), almost all of them are available in a topical version. There are a lot of them and I think I’ve tried them all. Many people get great results with these. I just don’t happen to be one of them. And keep in mind that studies have suggested many people have become resistant to topical antibiotics.

Recommendation:

Ask your dermatologist which antibiotic she recommends and what the potential side effects of each particular version are. I’m currently taking Solodyn and am pleased with the results so far.

#4 Accutane

Accutane, which is essentially oral Retin-A on steriods, is the nuclear weapon of acne treatments. For many people – especially people with deep, cystic acne – the effects of Accutane are permanent. They never have a blemish or pimple again!

But Accutane demands a high price from it’s patients. It’s so powerful that the FDA requires patients undergo regular blood tests to monitor their liver health. The FDA also requires female patients to be on birth control to prevent serious birth defects in the event she becomes pregnant while taking it. As if that weren’t enough, initially, the side effects of Accutane are worse than the acne itself. (Imagine having all the oil and lubrication in your body, including your joints, your hair, your eyes, your lips, your mouth, and the skin all over your body – not just your face – sucked completely dry and you’ll still be about 100 miles away from the awfulness that is Accutane.)

I have been treated with Accutane twice in my life and both courses resulted in flawlessly luminous skin for a couple years. But each time, my breakouts eventually returned.

Recommendation:

Weigh the costs and benefits and consider that the effects may only last 3-5 years before taking the Accutane plunge. For a more in-depth testimonial, read this article by the beautiful Molly Sims about her experience with Accutane.

#5 Spironolactone

Spironolactone is used primarily to treat excessive fluid build up, like the kind often experienced by patients with certain heart or liver conditions, or people with kidney disease. But off label, it’s frequently used to treat acne because it inhibits the production of the hormones that can cause acne (testosterone and aldosterone.)

Commonly prescribed as Aldactone, the most popular brand name, this drug has some fairly gnarly side-effects, as well, the most noticeable of which are it’s diuretic properties and lightheadedness due to lower blood pressure. Some women also experience a decreased sex drive since testosterone is important for getting women in the mood.

I was taking this medication to treat acne when I got married, but stopped when we decided to try and get pregnant. I started taking it again recently and have mixed feelings about this medication. For one thing, the initial adjustment period was unpleasant; I felt moody and hypersensitive, and I already have low blood pressure, so my energy was very low. I decided to stick it out and after about two weeks, the symptoms let up quite a bit. As for the acne, the results have been average. I saw fewer cysts, which was the desired and expected result, but they were definitely not gone altogether. Still, many women swear by this medication and most physicians agree that it takes three months of consistent use to get the full benefit, so I’m willing to try it a little longer.

Recommendation:

Spironolactone is worth a shot if you’re prone to hormone-induced breakouts (which typically show up on your chin and around your mouth). Some women also like it’s impact on fluid retention. Watch out for low sex drive, loss of energy, and PMS-like mood swings. The jury is still out for me as to whether the benefits outweigh the costs.

#6 Birth Control

Similar to Spironolactone, birth control pills are commonly prescribed to women as an off-label treatment for acne since so many of us experience hormone-induced breakouts. It’s effective, inexpensive, and millions of women with acne want to take it anyway, so from that perspective, birth control pills are a fabulous, two-birds-with-one-stone solution.

*A brief word to any traditional catholic readers: if you read my article, Why I’ll Give Up Two Things I Love For Lent, you already know there is some catholic dogma I don’t subscribe to. For some reasons that are far more important and complicated than acne, I don’t agree with the church’s position on contraception, generally, but that is a post for another time.

The pill has not agreed with me since my third child was born, so I don’t take it anymore. But for the years that I took birth control pills, my skin was clearer and I experienced fewer breakouts, so as a means of controlling acne, birth control pills have been helpful to me in the past and they are an extremely effective way to treat acne.

Recommendation:

You know your body! And I’m guessing you’ve been on the pill at some point in your life and know how your body responds to it. That said if you’re 40 or older and have’t been on the pill in a while, consider trying it again. For many women, this is a surefire way to keep breakouts under control.

#7 Chemical Peels

There are many chemical peels on the market (you can read about all of them here), but the two most commonly used to treat acne are AHA (alpha hydroxy) peels and BHA (beta hydroxy) peels. Both AHA and BHA peels are considered medium to superficial peels, depending on their concentration which range from moderately high to low. Using glycolic acid (AHA) or salicylic acid (BHA), peels exfoliate and shed the topmost layers of our skin to improve texture and help reduce the appearance of acne and acne scarring with repeated use.

AHA peels are considerably stronger, but not necessarily more effective than BHA peels with respect to treating acne. In both cases, you’ll feel a moderate to intense burning sensation on the skin after the chemical solution is applied. In AHA peels, this sensation stays the same during throughout the duration of the treatment. BHA peels grow gradually less intense with time and, after a few minutes, the sensation dissipates completely. AHA peels are washed off after a few minutes while BHA peels should be worn all day and not washed off until bedtime.

For the first few days after a chemical peel, your skin will be red and sensitive (more so if you’re using Retin-A). Depending on the type of peel and strength of the peel, your skin may be mildly scaly and you’ll start to notice fragments of flaking skin resembling eraser-shavings anywhere between one to five days after treatment. This period of flaking and peeling is very unpleasant and unattractive. I can’t tell you how many hours of my life have been spent removing flakes in order to get my skin smooth enough for a thin layer of makeup to go on top without looking like I poured flesh-colored paint on sandpaper. Once the flaking subsides, however, I usually enjoy a smooth complexion for a couple weeks with little to no breakouts.

BHA peels are relatively new to me and I prefer them over AHA peels for treating acne. Most recently, my skin was completely clear within one day of a BHA peel, which was somewhat miraculous considering I had four or five stubborn blemishes at the time. BHA peels are also less irritating than AHA peels and have a naturally-occurring anti-inflammatory agent.

Recommendation:

I highly recommend trying mild chemical peels to treat acne. The benefits can be fairly dramatic and worth enduring a few uncomely days to see them. Peels are also great for improving the texture of the skin and reducing fine lines and wrinkles. As an added bonus, if they’re administered by a dermatologist, they’re often covered (or partially covered) by insurance – a major advantage considering you might pay hundreds of dollars for a low concentration, less effective peel at at med spa.

#8 Red Light Therapy

Red Light Therapy – sometimes called Reverse Tanning – increases blood flow and stimulates tissue recovery by emitting red, low-light wavelengths through the skin. While considered a laser therapy, red light therapy is totally painless (unlike most laser treatments.) The benefits of red light therapy for chronic joint pain and tissue repair are well-documented, but recently, it’s becoming more popular for it’s anti-aging properties.

The purported benefits of red light therapy include activation of the lymphatic system that carries waste out of the body, increased circulation, increased collagen production, decreasing inflammation, and expedited healing of wounds. (Some physicians also recommend red light therapy for depression and fatigue.) Although red light therapy can kill bacteria, the primary benefit for acne prone skin is in it’s power to reduce inflammation in the skin.

I purchased the DPL LED Light Therapy System last January and absolutely love it. At the time, I wasn’t having acne flare-ups (this was pre-acupuncture. More on that in a moment.) I purchased it after reading about it’s impact on collagen production and decided the promises to provide anti-aging and acne fighting benefits were worth checking out. (There’s was a 90 day money-back guarantee policy at the time.) According to studies, a LOT of light therapy is required to see results, but when I’m using it regularly (10 minutes a day, once or twice a day), I definitely notice the impact is has on breakouts, when I have them, and the overall look of my complexion.

Recommendation:

Alone, red light therapy is probably not going to eliminate acne, but as a complimentary therapy, it’s hard to top. It soothes my skin post-peel and speeds-up my recovery process, reduces redness and inflammation, improves my overall skin tone, and helps blemishes heal more quickly. The more you use it, the better the results and the better your ROI, so if you’re someone with a drawer full of expensive skin treatments you gave up on, save your money and put it towards a year’s worth of chemical peels. But if you’re a compliant patient and willing to put in the time, it’s worth buying.

#9 Acupuncture

I know for a fact that acupuncture can have a dramatic impact on your complexion. Here’s why:

Last fall, I sought the help of acupuncture to address my chronic hip pain. I found a fabulous Chinese acupuncturist near my home through a friend whose daughter undergoes regular treatments for her rheumatoid arthritis and gets great relief. On my very first visit, after reading my qi, the woman administering my treatment determined that my hormones were imbalanced. She offered to balance my hormones and I agreed (because anything that gives me more balance can only be good, right?) I kid you not, the very next day, I had several new, deep, cystic pimples on my chin. As this breakout came on the heels of a long string of breakout-free months, I’m very confident that whatever she did to my hormones was showing up on my face in the form of ugly, red pimples. After two more treatments, my hip pain had not improved and neither had my acne, so I stopped going.

I could have (and maybe should have) shared my concerns with her. Maybe she could have returned my hormones to their previously unbalanced but blemish-free arrangement. I don’t know. But if acupuncture can CAUSE acne, then it stands to reason that it can solve it, too.

Recommendation:

Acupuncture has many wonderful health benefits. But it’s time consuming and most insurance plans don’t cover it (or only cover a portion of it), so it’s not cheap. If you have a laundry list of ailments to address, by all means, seek out acupuncture and let your care provider know you want your acne addressed while you’re in treatment.

#10 Differin

Differin has been getting some media attention since it was made available over the counter, recently, so I thought it worth including in this list. But it’s very similar to Retin-A – only not nearly as good, in my opinion – so I won’t spend a lot of time on this one.

Differin is the closest thing to Retin-A, for the least money, that you can buy without a prescription. For that reason, I’m glad the manufacturers have made this available over the counter.

Recommendation:

Differin is a distant second choice to Retin-A, so unless you don’t have insurance or can’t get a prescription for Retin-A for whatever reason, there’s no reason for you to settle for Differin; just use the real McCoy. But if you’re looking for an accessible, less potent alternative to Retin-A, Differin is a good product and can be used with benzoyl peroxide products for a winning combination of acne-fighting treatments.

#10-1/2 Fractional Laser Treatments

Be honest: did you skip ahead and are reading this first? I would have done the same thing.

Since fractional laser treatments are not approved to treat acne and the device I’m recommending is controversial in and of itself, I could only count this as half a tip. Also, I’m going to exercise my position as a blogger here, as opposed to a journalist, with the disclaimer that NONE of what I’m about to say has been evaluated by a professional physician. I am, however, a highly experienced patient, which I think counts for something.

Anyone who battles adult acne also battles acne scars. There are very few things we can do to minimize scarring (besides leaving pimples alone and most of us don’t have the cajones to be in public with an about-to-erupt whitehead on our faces. Although, a just-picked, oozy former pimple is not much better.) After nearly thirty years of acne, I have developed the unenviable orange-peel skin that results from repeated breakouts. To make matters worse, I used to get frequent cortisone injections in my more unyielding pimples which left a small depression behind after the pimple was gone. Diluting the cortisone can combat the dimpling, but I’ve made it a rule to use cortisone shots only as a last resort for “emergencies”. (A cortisone shot is still, however, the only true zit zapper available anywhere, ever, and they have proved incredibly useful to me on a number of occasions.)

I’ve been intrigued by Fraxel ever since I googled “Gwen Stefani, skin” after her first season as a judge on The Voice. But as convinced as I am that it’s the answer to my acne scarring, I have hesitated to pull the trigger and get the treatment for two reasons: one, it’s very expensive and two, I’m still getting acne, so until I can eliminate the source of the scars, why waste my money?

When I first learned about Tria Beauty Age-Defying Laser, the first fractional laser device approved by the FDA for at-home use, it sounded like a solution that made sense to me: a device that could help eliminate scarring and be used as needed for years to come for a fraction of the price. While hardly inexpensive – and potentially a huge waste of money that could otherwise have been put towards a genuine Fraxel treatment – it seemed like a gamble worth taking. And it has been.

Not only has this device improved the texture of my skin, it has also reduced my breakouts. I don’t understand the technical reasons why this might be the case and I won’t try to explain them. But I will happily share with you my experience and my amateur, non-professional theory about why it works.

First of all, this sh-t hurts. I won’t sugar coat it for you. The manufacturer recommends your first treatment be done at a trial-level of intensity that you’ll never repeat after the initial test. This level is slightly painful, but very tolerable.

The next level is the lowest level of treatment (i.e. the lowest possible level to use and still get some results). But the research on this subject is very, very clear: if you aren’t using the highest possible intensity setting, you’re not going to get results. This makes sense, given how conservative we know the FDA is, as I’m sure the highest level of the Tria is still considerably lower than the lowest level of Fraxel.

I have a pretty low pain tolerance. Because of that, I will downgrade my description of the third and highest intensity level from “quite painful” to “very, very uncomfortable”. The first few times I used it, I was only able to complete the treatment by the force of my will. Fortunately, it gets slightly more tolerable with each treatment.

What happens next is, similar to a chemical peel, the topmost layer of my skin sluffs off like pencil eraser-shavings the next morning, revealing a fresh, new layer of skin underneath. Overtime, after enough layers have been sluffed away, the scarring decreases and the overall texture starts to smooth out.

Recommendation:

As an acne treatment alone, I do not recommend this. The Tria at-home laser doesn’t treat acne. In fact, without the anti-inflammatory effects of the red light therapy, it could make it worse. But it is a useful way to improve skin tone and it has the same side effects (peeling) as many of the treatments I’ve listed, all of which are time-tested, proven ways to prevent and/or treat acne. So, for these reasons, as well as the fact that it has made my skin smoother and reduced that orange peel texture, I felt it was worth including.

So there you have it! My top ten and a half ways to treat adult acne. I hope these are helpful to you and I invite you to share your tips with me, too! The fight for clear skin may not be noble, but it’s one I’ll keep fighting until this selfish, bitchy neighbor stops coming to my party.

UPDATED 11/10/2017: Since this post was published in May 2017, I’ve come across a new, excellent source for all-things-acne. ThankYourSkin.com is a fabulous resource for anyone trying to have the healthiest, clearest complexion possible, including skincare products, masks for acne, wrinkles, and other common skin issues, and more. Be sure to check out their article on 92 Sneaky Causes of Acne No One is Telling You About.

Thanks for reading,