Still breaking out? Here’s what your skin is trying to tell you.

By Pretty Proven

Over the last few months, I’ve been asking myself – why do I keep getting breakouts of acne?! I didn’t have acne like this as a pubescent teenager. So why, in my late 30’s, am I suddenly breaking out like it’s 2006? 

As it turns out, I’m not alone. Acne is very common, especially in your 20s when it affects around 50% of women. It becomes slightly less common with age, dropping to around 35% in your 30s and 26% in your 40s.

Let’s get something straight -  adult acne differs from teenage acne. Teenage acne typically appears on the T-zone (forehead, nose and chin) and back and chest and can be a mix of whiteheads, blackheads and inflamed pimples.

In comparison, adult acne tends to be more concentrated along the jawline, chin and mouth. It’s typically triggered by stress and fluctuating hormones and tends be present as deeper, more inflammatory and painful cysts. Sound familiar?

Before we dive in too deep, let’s go back to the basics. What causes adult acne? 

Adult acne isn’t just about “dirty skin” or bad hygiene, it’s mainly driven by what’s happening under the surface.

At its core, acne forms when three key things happen at the same time:

1. Excess oil production Your skin naturally produces oil (called sebum) to keep itself hydrated. In adults, this oil production is often influenced by hormones - especially fluctuations in androgens (like testosterone). Too much oil creates the perfect environment for breakouts. 

2. Clogged pores Dead skin cells don’t always shed properly. When they mix with excess oil, they can block your pores - kind of like a traffic jam under the skin. 

   
   

3. Bacteria + inflammation There’s a type of bacteria that naturally lives on your skin. When it gets trapped in clogged pores, it multiplies and triggers inflammation - leading to red, swollen pimples.

Adult acne often has deeper triggers compared to teenage acne. Common root causes include:

• Hormonal fluctuations - including those associated with the menstrual cycle, pregnancy, and perimenopause.

• Chronic stress - elevated cortisol increases sebum production, which can trigger and worsen breakouts.

• Certain medications - some contraceptives can contribute to acne, particularly progestogen-only pills and combined oral contraceptive pills containing higher-androgenic progestogens such as levonorgestrel. If you suspect your contraception is affecting your skin, speak to your GP about alternatives.

• Comedogenic or acnegenic skincare and makeup - products that block pores or trigger inflammation can perpetuate breakouts regardless of other treatments.

• Lifestyle and occupational factors - including regular exposure to grease or oils, hot and humid environments, steam, and chlorinated water

• Genetics -  a family history of acne can increase your predisposition, regardless of skincare habits.

Adult acne isn’t caused by one single thing - it’s usually the result of hormones + oil + clogged pores + inflammation working together.

That’s why treating it effectively often requires addressing the root cause, not just the surface symptoms.

The invisible symptom of acne: emotional distress  

It’s important to acknowledge that acne should be considered a chronic condition with a significant psychological impact that should not be underestimated. 

In fact, research indicates that the emotional distress associated with acne is not always proportional to its clinical severity, meaning even mild acne can cause significant psychological distress. 

In one study, 88% of patients reported embarrassment/self-consciousness due to acne which is consistent across the literature. 

This study went on to highlight the negative impact of reported embarrassment/self-consciousness on daily activities, influence on choice of clothes, effects on social and leisure activities, work, study and relationships. 

Acne scarring: What’s really happening below the surface

Acne doesn’t always end when the breakout disappears - and for many people, the real frustration begins after the skin clears.

Scarring is a direct result of inflammation within the skin. When a blemish becomes inflamed - particularly if it’s picked, squeezed, or left untreated - the skin’s repair process can become disrupted. This can damage collagen, the structural protein that keeps skin smooth and firm, leading to visible changes in texture.

The majority of acne scars are what we call atrophic scars, meaning there has been a loss of collagen during healing. These include:

• Ice-pick scars – deep, narrow, and puncture-like 

• Boxcar scars – wider with sharp, defined edges 

• Rolling scars – broader with a softer, uneven appearance 

Less commonly, the skin can go in the opposite direction - producing too much collagen which leads to raised scars such as hypertrophic or keloid scars.

Not all marks left behind are true scars.  

Many people experience post-inflammatory hyperpigmentation (PIH) - those lingering dark spots or patches that appear after a breakout heals. Unlike scarring, PIH doesn’t involve permanent structural damage to the skin.

Instead, it’s caused by excess pigment production triggered by inflammation. The good news? These marks often fade over time - though it can take several months.

One of the biggest misconceptions about acne is that treatment is only about stopping breakouts.

In reality, effective acne management is also about preventing long-term damage.

Because once scarring or pigmentation develops, it becomes significantly more complex to treat.

Acne Treatment: What can you do today? 

When it comes to treating acne, the goal isn’t just to clear what’s already there - it’s to get control, prevent new breakouts, and minimise long-term scarring. Let’s start with the basics (this matters more than you think). 

Before reaching for treatments, your foundation needs to be right. Keep your routine simple and consistent:

• Cleanse (morning and night) 

• Moisturise (yes—even acne-prone skin needs hydration) 

• Sunscreen (daily, no exceptions)

Here are a few more small habits that make a big difference: 

• Choose non-comedogenic (non-pore-clogging) products. 

• Avoid picking or squeezing (this is one of the biggest causes of scarring). 

• Change pillowcases and sheets regularly (at least weekly). 

• Shower after sweating or exercise. 

• If you work in a greasy environment (e.g. kitchens), cleanse skin and hair promptly. 

• Avoid tight clothing or friction (especially for body acne). 

• If wearing face masks regularly, take breaks where possible.

For Mild Acne: Where to start

If your acne is mild (limited areas, mostly blackheads, whiteheads, and small pimples), you can begin with over-the-counter pharmacy treatments. You can find these on the shelves of the skincare section of your local pharmacy.

Start with one active ingredient at a time:

Benzoyl Peroxide (e.g. Benzac® Gel or Wash) 

• How it works: Kills bacteria on the skin, reducing inflammation and unblocking pores.

• Pretty Proven Tip: Benzoyl Peroxide is available as a gel or facewash - we recommend starting with the 5% facewash. 

Start with once daily use and let it sit on the skin for 1-2 minutes before rinsing. If tolerated, you can increase to twice a day. Continue for at least 6 weeks for full effect.

This product can cause bleaching of towels and fabrics - so use your old ones!

Salicylic Acid (e.g. The Ordinary 2% Salicylic Acid serum)

• How it works: Exfoliates dead skin, reduces excess oil and reduces inflammation of skin.

• Pretty Proven Tip: If you’re new to salicylic acid, start with a cleanser rather than a leave-on product - it gives you the benefit of less irritation while your skin adjusts.

Azelaic Acid (e.g Azclear Medicated Lotion)

• How it works: Targets bacteria, reduces inflammation, and helps normalise skin cell turnover. 

• Pretty Proven tip: Unlike some other actives, it’s gentle enough for sensitive skin and has the added benefit of fading the dark marks that acne lesions can leave behind

Niacinamide (e.g The Ordinary Niacinamide 10% + 1% Zinc Serum)

• How it works: Reduces excess oil production and inflammation of the skin. May also reduce hyperpigmentation of skin caused by resolved acne lesions. 

• Pretty Proven Tip: Look for products containing 5 - 10% niacinamide for acne management. Concentrations above 10% are more likely to cause temporary flushing or irritation, particularly for sensitive skin types.

Consistency matters more than intensity give products at least 6 weeks to work.

If you’re not achieving control of your breakouts after 6 weeks with a single topical treatment you can consider adding another topical agent to use in combination with your existing treatment of choice.

Adapalene Gel 0.1%* 

• How it works: Topical retinoids promote removal of keratin plugs (clogged pores), preventing re-blocking of pores and suppressing inflammation.

• Pretty Proven Tip: Topical retinoids should be introduced gradually because they can irritate the skin initially. This product is available behind the counter at the pharmacy and requires consultation with a pharmacist before use.

What About Breakouts Right Now?

While you’re waiting for the full effect of your chosen treatment you can manage active pimples with pimple patches.

Hydrocolloid Patches: These are the most common type and are best for surface-level pimples (like whiteheads). Hydrocolloid patches: 

• absorb oil and pus 

• protect the skin from bacteria 

• help prevent picking 

• support faster healing.

Medicated Patches: Contain added ingredients like salicylic acid or niacinamide. Medicated patches: 

• help reduce inflammation 

• gently exfoliate 

• target the breakout while protecting it.

The key takeaway here is that pimple patches can be a helpful tool, particularly for preventing picking and managing surface-level breakouts but they are not a treatment for deeper or persistent acne.

What if nothing is working?

If you’ve tried the options we’ve discussed above but you’re still not in control of your acne, it may be time to see your local general practitioner or specialist dermatologist. 

When to see a doctor: 

• Your acne symptoms that are not improving or resolving after 6 weeks despite treatment with topical treatments.

• Acne has led to scarring (even mild acne can scar).

• Over-the-counter topical treatments have not been tolerated (e.g. caused sensitivity or allergic reactions).

• You have a family history of acne scarring.

• You’re experiencing significant psychosocial effects due to your acne.

If you’re experiencing persistent mild acne or moderate to severe acne your general practitioner or dermatologist can prescribe you stronger topical treatments other oral agents to improve acne and prevent scarring. 

These may include: 

• oral and topical antibiotics (e.g. clindamycin, doxycycline, minocycline, erythromycin) 

• topical retinoids (e.g. Isotretinoin)

• oral retinoids (tretinoin)  

• combined oral contraceptive pill 

• anti-androgens (e.g. spironolactone).

If you want more in-depth information about these, and other acne treatments, check out our Adult Acne Quick Reference Guide. As always, if you have any questions about acne feel free to email us at info@prettyproven.com. We’re here for you!

Disclaimer: 

The information contained in this article is intended for general educational purposes only. It does not constitute medical advice, diagnosis, or treatment, and should not be used as a substitute for professional medical guidance tailored to your individual circumstances.

The resources used to develop this article are drawn from Australian best practice, consensus-driven guidelines, and are intended to provide you with accurate, evidence-based information.

While every effort has been made to ensure the accuracy of the information provided, Pretty Proven does not accept any liability for loss, harm, or damage arising - directly or indirectly - from the use of or reliance on the content within this article.

Knowledge is power. Use it wisely, and always in partnership with the professionals who know you best.

References

1. Acne [published 2020 Dec]. In: Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited; accessed {insert access date}. https://www.tg.org.au

2. Australian Medicines Handbook (online). Adelaide: Australian Medicines Handbook Pty Ltd; [year] [month]. Available from: https://amhonline.amh.net.au/

3. Hazarika, N. Archana, M. The psychological Impact of Acne Vulgaris. Indian J Dermatol. 2016 Sept-Oct;61(5):515-520.