Just about everyone has some acne as teenagers. Sometimes it lasts much longer than that. Even grown men can have it. But there are treatments, even for severe acne decades after you finished high school.
For most people, changes in hormone levels trigger acne. These hormones create oils that can lead to clogged pores, which sometimes let bacteria grow. Both of these problems cause breakouts.
Men whose fathers had severe acne are more likely to have it, too. Some medications such as lithium, which treats bipolar disorder, and corticosteroids like prednisone can also bring on acne.
The Male Breakout
Men often get acne on the face and back.
Sweating can make it worse. Breakouts on the back often happen in hot weather or after exercising. They're harder to control than the kind on your face. But fewer people see your back.
Some men get shaving bumps that look like acne, but ingrown hairs or shaving mistakes are the real cause.
Keep your skin clean. Many cleansers are available. In general, avoid products with beads in them, because they can irritate your skin. Wash twice a day.
If these products don’t help, a dermatologist can prescribe several other treatments:
- Antibiotics taken orally or rubbed into the skin help control bacteria.
- Vitamin A derivatives, known as retinoids, help unclog pores and keep them unclogged.
- Anti-inflammatory medications known as corticosteroids can be injected directly into an inflamed cyst or pustule by a doctor to subdue severe eruptions.
One word of caution: Some supplements designed to quell acne can actually cause other problems. “If you take too much zinc to treat acne, it can cause anemia,” says David Rahimi, MD, a privately practicing dermatologist in Los Angeles. “It can bring your white cell count down and lead to severe infection. Too much vitamin A in the form of Accutane can cause a host of problems, from liver toxicity to hair loss — all sorts of problems.” He says these products should be used moderately, if at all, and preferably under a doctor’s supervision.
Use a fresh washcloth that's gentle on your skin.
When you shave, use a clean razor every time. You might want to use an over-the-counter product with benzoyl peroxide, retinol, or salicylic acid. Your doctor can prescribe an antibiotic foam that you can mix with your shaving cream to help prevent breakouts.
If shaving bumps are a problem for you, try an electric razor, and don’t shave too closely.
When you shower, use a cleansing brush with an extension to wash hard-to-reach areas on your back. A sonic cleansing system with a changeable brush head is another option.
Benzoyl peroxide or salicylic acid products can help control acne on your back. You don’t need a prescription for them. But go easy, because these can be drying.
A white cotton T-shirt is the best thing to have closest to your skin.
If you’ve tried at-home treatments for 4-8 weeks and your acne won’t go away, it may be time to see a dermatologist.
At your appointment, your dermatologist will check your skin and recommend a treatment plan. You might need a prescription for antibiotics, prescription-strength benzoyl peroxide or salicylic acid, or a type of drug called retinoids.
If your acne is severe, your dermatologist may consider a drug called isotretinoin. Women who plan to get pregnant must avoid this drug, because it can cause birth defects. But men don't need to take extra precautions to avoid getting their partner pregnant.
There are also high-tech options. One of them is a laser skin treatment, and another is light therapy combined with vacuum therapy. These can be expensive, and your insurance may not cover them, so check first.
Other Acne Problems
Anabolic steroids, used by athletes and bodybuilders to build muscle mass, are one well-known cause of acne in men. Studies indicate that about one-third of men who use steroids get acne, and about 50% of the men who get it develop a severe form known as cystic acne.
“With some patients, I can tell from the kind of acne they have that they are using anabolic steroids,” says Jeffrey Dover, MD, a dermatologist at Skin Care Physicians of Chestnut Hill in Massachusetts. “The acne usually is on the back and on the chest, but it can be anywhere. Treating them involves getting them to acknowledge that they’re taking these performance-enhancing drugs. It is very difficult to treat because it’s intensely resistant to typical treatments.”
Such acne usually goes away gradually if the man stops taking the steroids.
Men also can develop an acne-like disorder known as folliculitis, Rahimi tells WebMD. Frequently, this comes from the tiny nicks caused by shaving too closely. Bacteria enter the follicles and cause infection.
“One way to distinguish a follicular pimple from acne is that with a follicular pimple, you often can see the hair shaft at the center of the lesion,” Rahimi says. “The pimples sometimes contain pus, and they may crust over or become surrounded by an area that’s red and inflamed. The infection may itch or be somewhat tender, but it usually isn’t painful.” But deep folliculitis, which affects the entire hair follicle, can cause large, painful, pus-filled bumps that may leave scars, he says.
Folliculitis is more common among Hispanic and African-American people, Rahimi says, because their hair tends to curl up under the skin and cause a pocket of infection. The best treatment is to switch to an electric shaver.
“The electric shaver doesn’t give as close a shave as a blade, but it causes fewer problems with irritation and inflammation around the hair follicle,” he says. “Also, I have [men with folliculitis] use salicylic acid or glycolic acid to unclog the pores, and then Retin-A once a week. The key is to use different medicines from different families to control bacteria, clear the pores, and bring inflammation down.”
Another type of facial inflammation known as rosacea is sometimes confused with acne because it produces small pimples and redness across the nose and cheeks. “Acne rosacea,” as it’s known, involves the follicles but is not caused by sebum or oil. Although the cause is not known, some dermatologists believe the condition is caused or aggravated by common mites known as Demodex folliculorum, which live in follicles and are found in far greater numbers in people with rosacea. Treatment for rosacea differs from treatment for typical acne vulgaris.
Treatments for acne, as well as for rosacea, have improved in recent decades, and they continue to get better, dermatologists say. Christopher B. Harmon, MD, a dermatologist with Total Skin and Beauty Dermatology Center in Birmingham, AL, predicts an even clearer future for men’s faces: “In 10 years, we’ll have new topicals and new oral agents, and more innovations involving the use of oral vitamin A derivatives,” he says.