It starts with Clearasil, then moves on to stronger stuff: birth control pills, antibiotics, Retin-A, or the nuclear option, Accutane.
These days, there's an arsenal of treatments for that common adolescent scourge, acne vulgaris, and the beleaguered teenager may be forgiven for thinking that it will all go away when she hits adulthood.
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More and more women are battling breakouts along with their wrinkles these days, and while there is no cure for either, some promising treatments are on the horizon, from low-dose antibiotics to vitamins and light therapy.
Research by a joint team at the University of Pittsburgh and the University of California at Los Angeles has found that the "good" bacteria and "bad" bacteria found on people's skin and in their intestines can determine whether or not they have acne.
But don't expect a miracle cream just yet, said Huiying Li, one of the lead researchers in the study.
"We've still got years of work to do before anything appears on the market," she said. There are, at any one time, 40 million to 50 million people suffering from acne, and it's not clear why the number of adults are growing, said a report from the American Academy of Dermatology -- perhaps just more adults seeking treatment.
Adult acne affects 45 percent of women aged 21 to 30, 26 percent of women aged 31 to 40 and 12 percent of women aged 41 to 50, according to a Massachusetts General Hospital study in 2012.
For some women, it comes as a nasty surprise just when they're preparing to battle aging skin.
"Wrinkles and acne are the diabolical duo," said Suzan Obagi, assistant professor of dermatology at the University of Pittsburgh School of Medicine. Certain treatments present a special challenge with older skin, she said, which is thinner and drier and can respond poorly to the high concentrations of benzoyl peroxide teenagers slather all over their faces.
Obagi sees no shortage of older women patients "who are not going to outgrow this kind of acne," and, perhaps fittingly, she is turning to light as one of her options.
She uses CoolTouch, a laser emitting non-ultraviolet wavelengths that have been shown to reduce breakouts while smoothing fine wrinkles. The CoolTouch laser is applied in gentle pulses over the skin, penetrating deeply enough to shrink oil glands and decrease their capacity to produce acne without drying out the skin.
"You have to hit the acne where it lives and sometimes that requires careful targeting," Obagi said.
There are other light technologies that work on adult acne, including Isolaz, which merges broadband light and gentle vacuuming to remove pore blockages, and some blue light and red light therapies, distributing blue light over the skin's surface to target bacteria, and short wavelengths of red light to reduce inflammation. Since no ultraviolet radiation is involved, cancer and wrinkles aren't a risk.
These new light therapies are usually tried after medications are given a test run. Spironolactone, for example, blocks the effect of testosterone, a hormone that increases in women as they age and results in oilier skin, more facial hair growth and breakouts.
And there's tretinoin, the generic version of Retin-A, a derivative of vitamin A that helps with both acne and wrinkles, and isotretinoin, the generic version of Accutane. That pill's potentially severe side effects have been debated for years: While it causes birth defects in pregnant women, there is no direct scientific link to depression or suicide, and it is still considered the gold standard for severe acne treatment.
More recently, Dapsone, used to treat other skin disorders, including leprosy, has been shown to be effective as a topical antibacterial agent with anti-inflammatory properties, and Duac, another topical gel that combines benzoyl peroxide with an antibiotic called clindamycin.
For all the increasingly high-tech treatments out there, several recent studies have reinvigorated the debate about a very low-tech culprit -- diet, particularly carbohydrates and dairy products.
"I tell patients to cut out dairy, and some have reported an immediate improvement," Obagi said. "Sometimes, in the end, it's just about living in a healthy way -- and about eating fresh foods instead of chocolate."