Why do I keep getting spots as an adult, and what can I do?

Breakouts that keep coming back in adulthood usually have several everyday causes at once: hormones that rise and fall around your period, stress, skin or hair products that make your skin greasy, touching your face, masks, sweat and some medicines. What you can do yourself is wash gently up to twice a day and after sweating, leave spots alone, choose products that do not clog pores, sleep enough and look after stress. If that does not help, see a dermatologist.

Many people think of spots as a teenage thing. The American Academy of Dermatology (AAD), the US body for skin doctors, says breakouts can continue into your 30s, 40s and 50s. Women tend to get them as adults more often than men, and some people get them for the first time as adults.

Why do I keep getting spots even though I'm an adult?

The UK's NHS explains that spots form when hair follicles become blocked with excess oil and dead skin cells. For adults, the AAD lists the common causes below, and often more than one applies to the same person.

Hormones that rise and fall

The AAD says changing hormone levels can lead to breakouts, especially in women: around periods, during pregnancy, in the years before and around menopause, and after starting or stopping some medicines that affect hormones. The NHS also lists hormone changes during periods, pregnancy and menopause. If your spots come in a pattern around your period, hormones may matter more than how you wash your face.

Stress

The AAD notes a link between stress and flare-ups, because under stress the body makes more of the hormones that stimulate the skin's oil glands. Year-end deadlines, exams or an ongoing worry are often the times people notice more spots.

Skin and hair products

Some creams, make-up, sunscreens, hair oils and styling gels make the skin greasy and can block pores. The NHS lists products you use on your skin or hair that make your skin greasy as one cause, and the AAD suggests choosing products labelled non-comedogenic, meaning they are made not to clog pores. If spots appear along your hairline, forehead or temples, look at your hair products too.

Touching and picking

The AAD says touching your face throughout the day can make breakouts flare, and picking, popping or squeezing spots makes them take longer to clear and raises the chance of scars. Small habits such as resting your chin on your hand at your desk are worth noticing.

Masks, sweat and friction

Wearing a mask for long periods can make the skin underneath more sensitive. The AAD says make-up under a mask is more likely to clog pores and lead to breakouts. Sweat that sits on the skin, under a mask, a helmet or tight clothing, is why the AAD and NHS suggest washing after sweating and wearing breathable clothes.

Some medicines and family history

The AAD says breakouts are a side effect of some medicines, and that a family history may make you more likely to get them. If spots started after a new medicine, do not stop it on your own; talk to the doctor or pharmacist who gave it to you.

I take good care of my face but still break out often. Is it related to gut health?

There is research looking at links between the gut and the skin, but nothing clear has been established, so it is not possible to say that frequent breakouts come from the gut. The AAD and NHS pages on what causes breakouts do not list gut health as a cause.

Good cleansing is only part of the picture

Several of the causes above have nothing to do with how clean your skin is, such as hormones, stress or medicines. Others come from doing too much. The AAD advises avoiding products that irritate the skin, including astringents, toners and exfoliants, and the NHS says scrubbing can irritate the skin and make spots worse.

Ask yourself:

• Am I washing more than twice a day, or scrubbing hard?
• Have I recently changed a cream, make-up, sunscreen or hair product?
• Do I remove all my make-up every night?
• Do my spots follow my period, or come with stressful times?
• Do I wear a mask or helmet for long hours?

If you suspect food

The AAD says some small studies found a link between certain foods, such as white bread, white rice, chips, pastries and sugary drinks, and breakouts, while other studies found no link, and more research is needed to know for sure. The AAD therefore suggests keeping a food diary to see whether any food or drink seems to come before a breakout. This shows your own pattern, rather than cutting out many foods at once without knowing whether they matter.

In the humid rainy season my skin gets oily and breaks out. How can I look after it from the inside?

Looking after your skin from the inside means sleeping enough at regular times, which the CDC puts at 7 hours or more for adults; looking after stress, which the AAD links with breakouts; and eating regular meals. Outside care for sweaty days comes at the end of this section. In the rainy season, humid air slows the evaporation of sweat, so skin feels oily and sticky for longer, and masks and clothes get damp easily from rain and sweat.

Sleep enough, at regular times

The US CDC recommends that adults aged 18 to 60 sleep 7 hours or more, going to bed and getting up at the same time each day. Short sleep often comes with busy, stressful periods, the same times many people notice more spots. If a racing mind keeps you awake, see Can't sleep because your mind won't stop thinking?

Look after stress

Because the AAD links stress with flare-ups, lightening the load where you can is part of looking after your skin: break big tasks into smaller ones, take short breaks, go for a walk, and talk to someone you trust. If stress is affecting your eating, sleep or work, talk to a doctor.

Eat regular meals

On rainy days many people order more fried food or sweets because going out is a hassle. No single food stops spots appearing, but regular meals with vegetables, fruit, rice and protein are the basis of overall health. If you suspect a particular food, use the food diary the AAD suggests.

Outside care on humid days

• Wash your face gently after sweating, as the AAD advises, rather than wiping sweat with your hand or sleeve.
• Change your mask as soon as it gets wet or dirty; the AAD notes a damp mask can irritate the skin.
• Wear loose, breathable clothes, especially when exercising or sweating, as the NHS suggests.
• If your hair is oily, the AAD suggests shampooing more often and keeping hair off your face.
• On very humid days, go lighter on heavy make-up and remove it fully before bed.

How should I look after my skin day to day if I break out often?

The NHS and AAD give similar day-to-day advice. The idea is to be gentle and avoid anything that irritates the skin further.

Why not squeeze spots?

The NHS says picking or squeezing spots can cause scars, and the AAD says it makes them last longer. Leaving them alone and caring for your skin gently is what skin doctors recommend.

Change one product at a time

If you want to try something new, change one product at a time and watch for a while. If you change several at once, you cannot tell what helped or what made things worse. Results vary from person to person, and for any product or cream containing a medicine, ask a pharmacist or doctor first.

I wear a mask all day and get spots. What can I do?

The AAD gives these tips for people who wear a mask for long periods:

• Wash with a mild, fragrance-free cleanser and use a moisturiser.
• Skip make-up under the mask, as it is more likely to clog pores. If you need it, use products labelled non-comedogenic.
• Avoid trying new, harsh products while you are wearing a mask, as your skin is more sensitive.
• Choose a mask that fits snugly but comfortably.
• Where you can take it off, take a 15-minute mask break every 4 hours.
• Wash a cloth mask after each wear, and throw away a disposable mask after one use.
• Change your mask as soon as it becomes wet or dirty, which happens often in the rainy season.

When should I see a doctor?

The NHS advises seeing a doctor if:

• self-care has not helped
• your spots are severe, for example large, painful lumps or spread over a wide area
• your spots are affecting how you feel about yourself or your daily life

The AAD says that if nothing you try helps, you should see a dermatologist, and notes that adult breakouts are sometimes a side effect of a medicine or a sign of another health problem that has not yet been found. If your spots started for the first time as an adult, or other changes in your body happened at the same time, tell the doctor. They can help find the cause and suggest care that suits you. Do not buy medicines to use on your own or stop medicines you already take without talking to a doctor or pharmacist.