The typical customer of the "clean" cosmetics company Beautycounter is in her 30s, and historically anti-aging has been her biggest concern. But when the nearly six-year-old company introduced a set of acne-control products in August, the line quickly became Beautycounter's top skin care seller.
Michael McGeever, the company's chief merchandising and product officer, wasn't surprised. After all, Beautycounter's 35,000 consultants (think the Avon sales model) had long been clamoring for pimple solutions for themselves and their clients.
"The assumption is that acne is no longer an issue for adult women," McGeever said. "But they were telling us that's not true."
Indeed. A 2018 review of studies in the journal Clinical, Cosmetic and Investigational Dermatology reported a significant increase in adult acne (which overwhelmingly occurs in women), although there is little consensus yet as to just how precipitous the rise is. Dr. Whitney Bowe, a dermatologist in New York and a member of the American Academy of Dermatology's acne working group, used the term "epidemic proportions."
In Bowe's practice, she said, the fraction of adult female patients with acne jumped from "significant" five years ago to "half of them" three years ago. Today, it's nearly all of them — to the point that the rare woman without acne is notable. "That feels like more the exception these days," Bowe said.
Not surprisingly, beauty companies have taken notice, introducing blemish products designed for grown-ups. Net-a-Porter's skin care offerings (of which acne-related products are the "vast majority") grew 90 percent in the last year; there was triple-digit growth before that, said Newby Hands, the site's global beauty director.
Doctors don't yet fully understand what's causing the recent breakout of, well, breakouts. They think the red angry bumps and pus pimples they usually see on adult women — almost universally in so-called surgical-mask distribution (the lower third of the face) — can be blamed on multiple things. Environmental factors such as stress can send oil glands into overdrive, while high glycemic diets have been associated with acne. (So have skim milk and whey protein, although studies on the latter have been done only with men.)
Hormones are another factor. Birth control pills are being prescribed ever younger and more frequently, so when women stop taking them, sometimes 20 years later, it's the first time the oil glands are subject to the normal cyclical changes of hormones.
"We theorize that the skin is going through a new puberty," said Dr. Joshua Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital. (Why are pimples on the lower third of the face? The current hypothesis is that, as with male pattern baldness, it's a hormone sensitivity issue.)
Finally, the sheer number of products women pile on may be to blame for "pomade acne," so named for pimple-causing hair ointments but now used to refer to breakouts from any occlusive product. Too many acne treatments can cause inflammation, which itself can cause pore blockage.
Also at issue is what Zeichner called "21-step skin care routines," which may or may not be effective. Combining various products may inactivate the hero ingredients in each, and using the wrong things "can certainly cause an acne flare," he said.
Some things to try
Zeichner, who sees double the number of adult female acne patients now compared with five years ago, suggested that after cleansing, any more than three steps in the morning or evening is "too much." His preferred regimen is serum and sunscreen in the morning, moisturizer and a therapeutic product in the evening.
He also advised giving products a monthlong trial to see results. No active ingredient works instantly unless it's a hydrator or a plumper, which are only temporary benefits.
When choosing products, respect the skin barrier. In adult acne sufferers, the skin is often dry and sensitive, and unable to tolerate the same treatments (or the same levels of ingredients) as robust teenage oily skin. If you're using a leave-on product with a potential irritant — such as the common zit treatments benzoyl peroxide or salicylic acid — avoid using a cleanser with irritants. (A rule of thumb: ones labeled "acne-fighting" or "pore-refining.")
Another challenge in healing adult acne is that because of collagen breakdown from aging, the skin is weaker than that of teenagers. Sarah Chapman, a facialist in London whose clients include Meghan Markle, said blemishes can take, in her experience, four to 10 times as long to disappear.
"Women in their 40s are coming to see me, saying, 'I've still got this mark three weeks later,' " she said. Pimple poppers: Consider yourselves warned.
To speed the healing process, Chapman created SOS spot stickers, or thin translucent patches that deliver salicylic acid to the site of the pimple while keeping bacteria — and the wearer's fingers — away.
Chapman's offering, packaged in a handbag-friendly white leather carrying case with a mirror, is one of a fast-growing new type of treatment: acne patches, which can be medicated (as Chapman's are) or unmedicated.
What good is an unmedicated patch? It is designed to suck out fluids, which flattens the pimple and reduces redness. These patches are also known as hydrocolloid dressings, which for decades could be found on the pharmacy's wound-treatment shelf, just not in any format you'd want to put on your face, let alone wear in public.
The stickers-as-blemish-remedy have also long existed in Asia, which is where Ju Rhyu, a founder of the acne sticker startup Hero Cosmetics, stumbled upon them in 2012. Rhyu, then 32, was working in Korea for Samsung and suffering from chin zits that occasionally looked like "big red beacons."
She quickly became obsessed with the patches — "I thought, 'Why am I first discovering them in my 30s?' " she said — testing some 40 kinds to determine optimum size, stickiness and absorption powers. Rhyu's own unmedicated Mighty Patch ($12.99 for 36) was introduced in September 2017 and quickly picked up by retailers such as Madewell and Neiman Marcus. The company will reach seven-figure sales this year, she said.
Rhyu said she initially was surprised by the age of her customers, some of whom are in their 50s and 60s.
"There's never a good time to have a pimple," she said.