Please don't kill me for saying so, but up until a few years ago, I'd never found myself fixated on a breakout—mostly because they rarely, if ever happened to me. Only now that I'm in my early 30s am I beginning to understand the emotional agony that comes along with having a zit—a word I admittedly have trouble even saying out loud.

For years, I'd stash away acne treatment products that landed on my desk, keeping them on hand "just in case" but just knowing in the back of my head there would never be a legitimate need. Today, I'm the one begging my dermatologist for samples of super-strength blemish busters, slathering my trouble zones with any anti-acne masques I can get my hands on, and standing in front of the mirror in the living room on a Friday night, peering at my chin in complete disgust.

And it's not like my neuroses are unique: My boyfriend all
but refuses to leave the house when he breaks out. My best friend sees the inside of her dermatologist's office more often than she sees her parents, who live 20 minutes away. Another friend—an esthetician—totes around her lancets and pokes at her face as though it's a sport. And then there's my cousin, whose teenage acne is so out of hand, she's gone on Accutane three times now.

Despite the impression we were given by all those spot-treatment commercials we saw as kids, acne in real life isn't too easily discouraged, is it? I enlisted the help of some of the country's top dermatologists to help explain, but I can now tell you that before we understand the how? of adult acne, we must first address the why.

"Regardless of age, there are three main things that have to occur to cause an acne lesion: increased oil production, skin build-up (clogged pores), and inflammation caused by a normal bacterial inhabitant of our skin, called P.acnes," offered Dr. Ashley Magovern, DermStore's Medical Director. "So, whether you're in your twenties, thirties or forties, the fundamentals are the same. It's the reason that they're happening that's different."

While most dermatologists recognize stress and a poor diet as triggers for the perfect storm Dr. Magovern describes, they also agree that hormones are the main culprit when it comes to the acne we experience in adulthood.

"When we talk about adult acne, although it does affect both men and women, we are usually referring to female adult acne," says Dr. Rebecca Baxt, Assistant Professor of Clinical Dermatology at New York University. "I always tell my patients it's more common for boys to have acne as teenagers, and for girls to have acne when they are women. In boys and men, we cannot control the hormones, and this is why boys have acne worse when they are teenagers with hormone surges. Women's hormones change as they get older and many women have acne in their twenties, thirties, forties and fifties due to hormones." Adds Dr. Magovern: "As adult women, we all slowly lose estrogen over time. As this happens, the relative balance of testosterone shifts, and the testosterone can act unopposed and cause an increase in oil production. The oil gland can't get rid of the excess oil it's producing fast enough, and the pore becomes clogged, triggering a breakout."

So now you know why you're not immune to breakouts as a grandparent, even though you had the clearest of complexions in high school decades ago. But if you did struggle with acne in your youth and you can't help but wonder if the ghost of pimple past isn't resolutely reawakening old angst by re-appearing in the same spot over and over again, you might be onto something.

"The first cause of adult acne is left over from childhood acne— an occasional breakout or pimple that's triggered by hormones, a change in climate or oily skin," says Dr. Gary Goldfaden. "The location of the breakout is usually centralized in a particular area versus all over the face." And the hormonal acne that plagues women over the age of 30 pops up predictably, too. "Hormonal acne tends to occur along the jaw line, neck and chin," remarked Dr. Baxt.

Unlike hormonal acne, teen acne is wont to sprout up all over the face, and even on the chest and back. But there are several other key differences between the blemishes we suffered with in our teens and the ones we face as grown-ups.

"Adolescent acne usually occurs on a very oily face, while adult acne can actually occur on dry and sensitive skin," says Dr. Debra Jaliman, author of Skin Rules: Trade Secrets from a Top New York Dermatologist. "Further, adolescent acne manifests itself in the form of whiteheads, blackheads and pimples, whereas adult acne is often in the form of red bumps." Dr. Baxt concurs: "Adult acne tends to by cystic."

Then there's rosacea. Did you know that this skin condition—which affects 14 million people in the United States alone—is not only all but exclusive to adults, but a form of acne, too?

"Rosacea often begins with a red blotchy areas that generally form on the cheeks, nose, chin and forehead," Dr. Goldfaden says. "The skin in which rosacea occurs is very sensitive, while common childhood acne happens in tougher skin." And, like hormonal acne, rosacea brings with it a blemish all its own. "Small red bumps and red broken capillaries can form on the face, but unlike most childhood acne, blackheads do not form," he adds.

With all this in mind, you're probably now more confused than ever with regard to the proper treatment of adult acne. But while the answer isn't always simple, things will get much easier once you forget what you think you know about it. After all, haven't you been hearing your whole life that you've got to wage war against oil if you want to win the battle against acne? The experts agree: the sooner we discard this notion, the better our skin will become.

"Appropriate care in childhood acne is targeted to de-grease the skin and open the pores through exfoliation," Dr. Goldfaden pointed out. "Adult acne needs a lighter topical treatment since the skin is easily aggravated and very sensitive. Common acne treatments that are alcohol-based can cause added flare ups, and in most cases worsen the cause."

Dr. Magovern is of the same mentality. "Because of the estrogen shift, women's skin becomes drier with age," she explains. "Dry skin becomes irritated easily, and this can exacerbate acne. I see this all the time."

So what works? For starters, changing the way you cleanse your face.
"Adult women tend to be more likely to over-wash their face than teenagers," Dr. Magovern informed us. "Washing the face a lot will only take off the surface oil—it will not decrease the oil production in the hair follicle."

Oh, and cool it with the cabinet full of lotions, potions, serums and spot-treatments; being overzealous will only make things worse. "Product overload contributes to a damaged skin barrier and acne flare-ups," she asserts. "Gentle is better with acne."