Acne is complicated. For starters, it’s a popular misconception that it’s just an awkward pimple-ridden phase you experience in middle school. But contrary to common belief, acne doesn’t discriminate against age or even skin type. So to get the full rundown on what causes acne, who is likely to suffer from it, how to identify the different types and how to treat it, we tapped Dermatologist Dr. Melissa K. Levin.

Teenage Acne
If you suffered from acne as a teenager, the breakouts you experienced then are much different than the kinds you would encounter as an adult. Dr. Levin explains, “Teens tend to break out primarily on their forehead, nose, chin, cheeks, chest, and back (locations on the body with a higher concentration of pores and oil glands) due to to the surge in hormones called androgens, which occurs during puberty.” She describes androgens as,  “The cause of excess sebum production (a waxy oily substance) that can clog pores and increased outbreaks. This can lead to anything from blackheads, whiteheads, papules, pustules, and for more severe causes, cysts and nodules.”

If you’re out of your teenage acne phase, but are still dealing with breakouts, treatment comes from identifying the cause and finding a solution to that specific type of acne. “In most adult acne cases, it tends to be present with cysts distributed along the chin and jawline,” says Dr. Levin. “Teenage skin is more resilient and has faster skin cell turnover than adult skin, so it responds more effectively to typical over-the-counter acne medications, such as salicylic acid and benzoyl peroxide” whereas “adult acne can have different causes and is usually more difficult to treat with over-the-counter options.”

Adult Acne
Dr. Levin says female adult acne is almost always caused by fluctuations in hormones. “Adult female hormonal acne can occur from your 20s through your 50s, due to the changing hormonal levels whether it’s from the natural changes, discontinuing oral birth control pills, pregnancy, post-pregnancy, and perimenopause,” among other things she explains. If you’re currently experiencing breakouts caused by changes in hormone levels, Dr. Levin recommends, “a gentle hydrating cleanser, an active topical medication, moisturizing, sunscreen and then adding one additional product at a time as long as the skin isn’t irritated. A couple of my favorite acne medications for adults in their 30s are Aczone and Differin Gel.” She describes Aczone as “a once-daily topical prescription gel, which is antimicrobial and anti-inflammatory and has proven to help treat not only deeper red painful pimples but also blackheads and whiteheads. Unlike other topical acne formulations, it does not cause dryness or irritation of the skin and it’s lightweight.” As for Differin Gel, she says, “it used to be a prescription, but is now a prescription-strength over-the-counter retinoid that not only normalizes skin cell turnover but also has anti-inflammatory properties to improve the skin texture and tone with regular use.” Not only does it help with acne, it’s also great for anti-aging and is a gentle option compared to other retinoids.

If you’re noticing your breakouts consist of cysts or tender lesions around the jawline and chin (also caused by fluctuating hormones), Dr. Levin recommends talking to your dermatologist about taking a birth control medication. “Not everyone is a candidate for birth control pills,” she says. While some might be looking to get pregnant or live a more natural, medication-free lifestyle, Dr. Levin also adds, “there are risk factors for smokers or family history of thrombosis which can increase your risk of blood clots.” If you and your dermatologist decide it’s right for you, “the effects of birth control medication takes time to see an effect — about three or four months to start seeing results,” explains Dr. Levin.

Another cause of adult breakouts could be comedonal acne caused by congestion and clogging of pores. Dr. Levin explains, “certain makeup, skin-care products, and hair products can cause chronic and regular clogging of the skin, which results in whiteheads and blackheads. For example, when these breakouts are concentrated only on the forehead, often times it is due to hair care products and styling practices.” If this sounds like something you are experiencing, consider incorporating deep-cleaning masks to detox your skin weekly and always washing your face before bed.

Stress
Another cause for adult acne can be stress. Although it isn’t a direct cause of new acne, Dr. Levin says “it can exacerbate or worsen” the problem. She explains, “Chronic stress induces the secretion of different neurotransmitters, inflammatory markers, hormones, and androgens” that can make existing acne so much worse.

Dr. Levin recommends another medication called spironolactone for stress and hormonal-related acne, which is a diuretic with anti-androgen effects that can counter the hormones that promote the development of acne. She says it’s commonly used as a blood-pressure medication and can only be used by females who are not currently pregnant. And just like birth control, spironolactone can take anywhere from two to four months to take effect. She also adds that some women find that acne has resolved even after discontinuing use of spironolactone. She explained that over time, fewer women deal with hormonal acne as they age, so Spironolactone is not necessarily a life long medication. This medication is recommended for women with cystic hormonal acne (not just stress-related) that is not controlled with topical medications.

Once you’ve been able to identify the cause of your adult acne, treating it can be much easier — and before you know it, just like your teenage years, acne will be just a thing of the past.

Stephanie Montes is a Los-Angeles based fashion, beauty and wellness writer. Her work has been featured on Elite Daily, Brides, Well + Good, Hello Giggles, The Zoe Report and more. She loves traveling, trying new beauty products, photography, and cuddling her two dogs and husband. Follow her on Instagram at @stephanie_montes.