As an adolescent, I somehow managed to elude those pesky pimples that plagued most of my high school classmates. Even as a 20-something stressing over law school finals, I was blemish free. But then, in my 30s, it happened. Plain as the nose on my face, I suddenly had pimples—and lots of them. Had they been hovering all these years waiting to strike?

Or are the 30s just another time in a woman's life when an acne outbreak is to be expected?

"Experiencing acne in your 30s is very common," says Jill Evenson, ND, a physician in Jamesville, Wisconsin, "even if it's the first time you ever suffer from breakouts." Fortunately, this postadolescent skin problem can be treated and prevented naturally—without the use of harsh, over-the-counter pimple creams. Read on to learn how to say bye-bye to blemishes for good.

Causes of adult acne
"Hormone levels are often the cause of acne in women in their 30s," says Hilary Andrews, ND, professor of microbiology and public health at the National College of Naturopathic Medicine in Portland, Oregon. As women age, she explains, they sometimes become more androgenic, meaning they produce more male hormones, such as dihydrotestosterone (DHT), the active form of testosterone. DHT is thought to stimulate the production of oil in the skin, which leads to clogged pores and inflammation, known as acne. Stress also tends to cause hormonal shake-ups; to cope with tension and anxiety, your body increases its production of cortisol and testosterone. "And when those hormones go up, you're bound to get acne," Andrews says.

Acne is also a major symptom of polycystic ovarian syndrome (PCOS), a condition increasing in today's female population, says Andrews. Women with PCOS produce excess levels of androgens, or male hormones, especially DHT. Symptoms of PCOS, in addition to acne, include lack of a menstrual period, male-pattern hair growth, and blood sugar imbalances.

Poor bowel health, such as frequent constipation, can also cause adult-onset acne, according to Mary Bove, ND, a physician in Brattleboro, Vermont, and author of Herbs for Women's Health (Keats, 1997). If you don't have at least one regular bowel movement daily, you may have a sluggish liver, she says. Because your liver plays a vital role in how your body rids itself of toxins, an ill-functioning liver needs help from other organs, and "your skin becomes the avenue for detoxification," says Bove.

Healing from the inside out
To treat adult acne naturally, you first need to know the underlying cause. If elevated male hormones are the culprit, targeting the testosterone in the body before it's converted to DHT will help improve your skin. Two supplements well suited for the job are zinc (50 mg per day with food) and saw palmetto (Serenoa repens; 160 mg, twice daily), as both inhibit the conversion of testosterone to DHT, says Andrews. Some simple changes in your diet can also make a difference. Andrews suggests increasing your protein intake, especially with free-range, organic beef, chicken, and turkey, because protein helps prevent DHT conversion.

If you suspect a sluggish liver (evidenced by irregular bowel movements and frequent constipation), choose foods and supplements that restore liver as well as gut health because this will aid the body's ability to detoxify and make your organs more efficient. Bove suggests hempseed and flaxseed oils because they're good sources of omega-3 and omega-6 fatty acids, which contribute to a healthy stomach by decreasing inflammation.

Don't squeeze it! It doesn't matter what blemishes look like. Whiteheads, blackheads, and inflamed cysts are all blocked pores, says Robert Brodell, MD, a dermatologist in Warren, Ohio. All of these lesions are classified as acne. But whatever you do—however tempted you may become—never pick at or squeeze a pimple. Picking helps spread the infection to other areas of your skin, says Brodell. Squeezing will only release half the bacteria; the other half goes deeper into your skin and may result in a pit, cyst, or scar. —K.R.

To help detoxify your system, bulk up on fiber, including legumes and whole grains. Bove recommends 15 to 20 grams of fiber a day (a 1/2 cup serving of kidney beans contains 4.5 grams of fiber), but if you're often constipated you should up that amount to 30 grams daily. "In addition, leafy green vegetables aid digestion, and cruciferous veggies, such as broccoli, cauliflower, kale, and cabbage, help normalize hormone levels," Bove says. She suggests avoiding hydrogenated fats, dairy (unless it's organic, because conventionally raised animals are fed hormones, which ultimately may affect your levels as well), refined sugars, and alcohol; all can aggravate the gut and hamper digestion.

Also helpful are milk thistle (Silybum marianum; 400 mg per day), an antioxidant that's effective at repairing the liver, and vitamin A (10,000 IU per day), which helps regulate the skin's oil production. (Vitamin A in very high doses can be toxic; do not exceed this recommendation unless under the supervision of a health care practitioner.)

Applying aloe cream or gel can also cool and soothe the skin during painful breakouts and help reduce scarring.

Topical treatments
Internal treatments could take months to work, so in the meantime some topical remedies will help soothe your skin. Traditionally, breakouts are treated on the surface with antibiotic creams, such as benzoyl peroxide. But anyone who's smeared that stuff on her face knows how drying it can be—not an attractive option, considering your skin naturally loses moisture as you age. Luckily, there are some alternatives. Andrews suggests bentonite clay, a gray-green sedimentary clay made from volcanic ash. "Mix it with water and apply it like a mud facial," she says. "It draws oil out of pores and gives a mineral bath to the skin. It's very cooling and good for inflammation."

Applying aloe cream or gel (Aloe vera or Aloe barbadensis) can also soothe the skin during painful breakouts. "It cools the skin as well as helps reduce scarring," says Karta Purkh Singh Khalsa, RH, American Herbalists Guild member and author of Herbal Defense (Warner, 1997).

Be patient
Anyone who suffers from adult-onset acne should be aware that healing can take time. "Don't expect results overnight," says Andrews. "I tell my patients to take the number of years they've been suffering from acne and multiply that number by two. That's the number of months it'll take to clear your skin."

As for my own acne, I found that pinpointing the problem was the first step toward healthier skin. A cross-country move, accompanied by oodles of stress, made going to the gym a thing of the past, and pizza and fries were often the cuisine du jour. But I soon discovered that navigating myself back to a healthy lifestyle, which meant lacing up my running shoes on a regular basis and opting for colorful salads, was all I needed to recapture that clear skin of my youth.

Monkton, Maryland-based freelance writer Kelli Rosen vows always to make time to sweat and to never again consider a chocolate bar and chips an adequate meal.