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I'm a 61-year-old woman who has hardly had a pimple my whole life, til now. Lately, I've been getting these huge, what I call, under-grounders. They hurt like the dickens but never come to a head. They appear around my mouth, near my nose or on my forehead. What is going on?

-- Jane

A pimple occurs when sebum -- the lubricant that naturally moisturizes our skin and hair -- is trapped under dead skin cells and debris in a hair follicle, according to the Mayo Clinic. Typically, sebum rises to the surface, where it is able to condition the skin. If it gets trapped, it creates an ideal circumstance for bacteria to grow. What Jane calls "under-grounders" are actually pockets of sebum and bacteria that are trapped further down along the hair shaft, deep within the follicle.

Adult acne is common -- about 30 percent of women and 20 percent of men between the ages of 20 and 60 have breakouts, according to WebMD. So why would a person develop acne later in life? Very often, it's related to hormones.

"When adult women experience acne outbreaks, hormones are usually the primary culprit," dermatologist Dr. Diane S. Berson said in an interview with Medical News Daily. "Hormonal acne can be particularly frustrating because it may not respond to the same over-the-counter treatments that worked for some women during their teenage years."

At 61, menopause, hormonal treatments or a growing ratio of androgen (male) hormones like testosterone may be contributing to the sudden emergence of acne, according to an explainer by the American Academy of Dermatology. Research shows that testosterone, for example, causes increased production of sebum by the sebaceous gland.

Other causes of adult acne can be medication related -- some psychotropic medications, like lithium, or steroids or hormonal medications can contribute to acne breakouts, according to the Mayo Clinic.

The best course of action may be to talk to a doctor about having your hormone levels checked and to speak with a dermatologist about proper skincare. Since many acne medications and special soaps are geared towards teenage skin, which is thicker and less dry, picking the right skin care regimen for an adult requires greater care.

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