Adult Acne: Causes, Treatments & Prevention

• Adult acne can persist from adolescence or present for the first time in your 20s, 30s or 40s.
• Adult acne is primarily caused by hormonal fluctuations and is far more common among women than men. 
• Other factors such as stress, medications and cosmetics, can trigger or worsen adult acne symptoms.
• Effective treatments for adult acne include over-the-counter medications,  prescription medications, and natural home remedies.

Acne is a skin condition that occurs when pores become blocked by oil or dead skin. While acne is most common among teenagers, it also affects adults. Women, in particular, are prone to adult acne, with data showing that 85% of adult acne sufferers are female.

While some cases of adult acne persist from adolescence, others manifest for the first time in the 20s, 30s and 40s. This is called adult-onset acne. Either way, adult acne can be frustrating, painful and embarrassing. Fortunately, there are various solutions including over-the-counter and prescription medications to effectively treat adult acne. Preventative measures such as daily skincare can also keep breakouts at bay.

What is adult acne?

Like all forms of acne, adult acne is a chronic skin condition. It is characterized by multiple blemishes on the skin which occur when pores become clogged with excess oil (called sebum), dead skin cells, dirt or bacteria. 

Adult acne can occur in many forms, including:

• Blackheads
• Whiteheads
• Pustules
• Papules
• Nodules
• Cysts

Whiteheads and blackheads are mild forms of acne, which are non-inflammatory and not painful. However, pustules, papules, nodules and cysts are inflammatory blemishes that form deep beneath the skin. These blemishes can be extremely painful and can result in scarring if not treated properly.

Adult acne vs teenage acne

While the symptoms of adult acne range in severity, most cases are mild compared to adolescent forms. Adult acne also tends to present gradually in contrast to teenage acne, which occurs quickly and aggressively.

Hormones are the most common cause of both adult acne and teenage acne. However, there are different reasons why hormones fluctuate at different stages of life. In adolescent cases, an increase in sex hormones around puberty causes oil glands to enlarge and become overactive. In adulthood, the hormonal changes that occur around the menstrual cycle, pregnancy, menopause and peri-menopause are what trigger acne breakouts in women. Stopping (or starting) birth control pills can also cause acne to develop. 

For men, high testosterone levels are a primary cause of adult acne. Testosterone peaks in adolescence and gradually declines thereafter. This explains why fewer men than women suffer from acne in adulthood. However, for some men, testosterone levels remain high well into their 20s and 30s. These men are more likely to experience adult acne.

Interestingly, adult acne appears to impact quality of life more than teenage acne, particularly for women. The psychological, social and emotional impacts of adult acne include depression, anxiety and stress. These impacts tend to increase with age and when the duration of adult acne extends beyond 5 years.

Adult acne in your 20s, 30s and 40s

Adult acne can occur at any age, as hormones fluctuation throughout adulthood. However, a study by the American Academy of Dermatology found that adult acne decreased with age. Specifically, the study found that:

• During their 20s, 50.9% of women and 42.5% of men reported experiencing adult acne.
• During their 30s, 35.2% of women and 20.1% of men reported experiencing adult acne.
• During their 40s, 26.3% of women and 12% of men reported experiencing adult acne.

It is clear that, in all age groups, women are far more affected than men. Even in their 50’s, 15.3% of women reported experiencing adult acne, with the number of cases decreasing around the age of menopause. 

Where is adult acne most likely to occur?

Adult acne is most likely to occur on the lower third of the face, including the chin, neck and jawline. 

If you’re familiar with face mapping, you may know that acne on certain areas of the face is related to different causes. Acne on the chin and jawline is often related to hormonal changes, particularly in women. 

What causes adult acne?

Regardless of age, all acne is caused when pores become blocked by excess oil, dirt or dead skin. However, there are specific reasons why pores become blocked in cases of adult acne.

Hormonal fluctuations

Hormonal fluctuations are the most common cause of adult acne. For women, hormones called androgens can increase during the menstrual cycle, menopause and pregnancy, causing the skin to produce too much oil. This results in clogged pores and leads to breakouts.

For men, the androgen testosterone is what drives the production of oil. When a man’s testosterone spikes, his sebaceous glands can’t keep up. This results in an over-production of oil, which creates the perfect environment for bacteria to grow. For most men, testosterone production peaks at around age 17, but can remain high well into the 40s. 

Stress

Studies have found a correlation between stress and adult acne symptoms, with 71% of sufferers citing stress as a worsening factor. Job stress, in particular, was associated with more severe forms of adult acne in women. 

The connection between stress and acne is understood through the higher production of androgens, which stimulate sebum production. Stress-driven behaviors, such as neglecting personal hygiene or skincare, can also worsen adult acne.

Medications

Adult acne is a side effect of some medications including corticosteroids, anabolic steroids, testosterone, halogens, isoniazid, lithium and some new anticancer agents.

While birth control pills are widely used to treat adult acne, there are some specific formulations that may cause or worsen symptoms. Progestin-only contraceptive pills (commonly known as “mini pills”) don’t contain estrogen like most other pills. As such, they can cause androgen levels to fluctuate, resulting in acne breakouts. 

For men being treated for andropause, which can occur in the 40s and 50s, testosterone replacement medications can cause acne by overstimulating oil glands.

Cosmetics

Many adult acne sufferers use cosmetics to cover up blemishes. Ironically, these products can do more harm than good. Many cosmetics contain oil and other ingredients that can clog pores. Some products, like harsh cleansers, can irritate skin and trigger a protective reaction that leads to inflammation. This is called contact irritation.

When choosing skin care products and cosmetics, look for products labelled “non-comedogenic”, as these products won’t clog pores.

Other causes

Aside from hormones, stress, medications and cosmetics, there is a causal link between adult acne and other factors, including: 

• Smoking
• Genetics
• Endocrine disorders

Smoking is directly related to adult acne in women. In a study of over 1,000 women, clinical evidence showed that smokers were more likely to suffer from adult acne, particularly non-inflammatory acne in the form of blackheads.

Genetics can influence the likelihood of developing acne as a teenager or adult. If your mother or father suffered from acne, you may inherit this tendency.

Endocrine disorders such as Polycystic Ovarian Syndrome (PCOS) increase androgens in the body. This leads to excess oil production which, in turn, can cause adult acne.

Can you prevent adult acne breakouts?

There are simple lifestyle and hygiene habits that can help prevent adult acne. Skin care is particularly important to remove excess oil and keep pores clear. 

Start by washing your face twice a day with a mild cleanser. Products containing salicylic acid are especially useful to penetrate clogged pores and soothe mild-moderate adult acne. If you have very oily skin, use an astringent toner after cleansing to dry out blemishes. If your skin is dry, follow with an oil-free moisturizer. You should also use an oil-free sunscreen if your skin will be exposed to the sun.

When choosing skin care products, look for oil-free formulas that are labeled “non-comedogenic”. 

It is also important to avoid touching your face and picking at acne blemishes. The oil and dirt from your fingers adds more bacteria to the skin. This can aggravate adult acne and lead to infection.

Practicing a healthy lifestyle can also help prevent adult acne. Eat a balanced diet, drink plenty of water, avoid smoking and manage stress levels.

Adult acne treatments

There are various treatments for adult acne, including topical over-the-counter (OTC) treatments and prescription medications. The type of treatment usually depends on the severity of symptoms.

Over the counter (OTC) treatments

OTC treatments like cleansers, lotions or gels are suitable for mild-moderate cases of adult acne. Look for products containing acne-fighting ingredients such as:

• Salicylic acid
• Topical retinoids
• Benzoyl peroxide

Salicylic acid is most commonly found in OTC cleansers. It helps clears pores and correct abnormal shedding of skin cells. It is proven to effectively treat non-inflammatory acne like blackheads, whiteheads and small pimples. However, as it does not reduce oil production or kill bacteria, it’s less effective for inflammatory acne.

Topical retinoids have been used for decades to treat mild-moderate adult acne. Available in gel and cream solutions, topical retinoids regulate cell growth and help prevent clogged pores. They can also be used to maintain clear skin after successful treatment.

Benzoyl peroxide is an organic acid that is proven to effectively treat mild to severe adult acne. It unblocks pores, dries out lesions and has strong antibacterial properties. It is available in lotions or gels, in different concentrations.

When using OTC adult acne treatments, it may take several weeks to start noticing improvements. Be patient and stick with the treatment for the instructed time. If symptoms don’t improve, you can gradually increase the strength of products. 

Medical treatments

If adult acne is deep and severe, talk to your doctor or dermatologist about prescription medications. There are a number of topical and oral medications that may be prescribed as standalone treatments or in combination.

• High-strength retinoids
• Topical antibiotics
• Oral antibiotics
• Hormone-based therapies

High-strength retinoids like adapalene or tretinoin are effective for treating moderate to severe adult acne, and for reducing scarring.

Topical antibiotics reduce inflammation and fight bacteria. These are often combined with topical retinoids to speed up treatment and reduce exposure to antibiotics.

Oral antibiotics fight bacteria and infection from the inside out. They are more aggressive than topical antibiotics and should be used for the shortest time possible.

Hormone-based therapies, including birth control pills, help regulate hormonal fluctuations that cause acne in women. While these medications are safe for most women, there are potential risks that should be discussed with your doctor.

Home remedies

There are many home remedies to treat adult acne using natural ingredients. While these are not as powerful as medications, they can relieve inflammation and soothe mild-moderate  symptoms. Some common home remedies for adult acne include:

• Tea tree oil
• Witch hazel
• Honey

Tea tree oil has anti-inflammatory and antimicrobial properties. It helps prevent lesions and reduce swelling associated with inflammatory acne. Tea tree oil is a gentle alternative to salicylic acid and benzoyl peroxide and is proven to be equally effective.

Witch hazel is a medicinal plant that is commonly used in toners. It is a natural astringent that helps reduce the excess oil that causes adult acne breakouts. It also has anti-inflammatory properties, which combat redness and swelling. 

Honey has strong anti-inflammatory and anti-bacterial properties. It soothes and cleanses acne-prone skin, without drying it out. It also contains antioxidants which help clear oil and dirt from clogged pores.

Takeaway

Adult acne occurs when excess oil, dirt or dead skin clogs pores. It usually presents around the lower part of the face including the chin and jawline. Adult acne can persist from adolescence or occur for the first in adulthood.

The primary cause of adult acne is hormonal fluctuations, which explains why far more women are affected than men. Other causes of adult acne include stress, medications and cosmetics.

Aside from the physical symptoms, which include blackheads, whiteheads, nodules and cysts, adult acne can have devastating social and emotional impacts. These impacts worsen with age and the longer acne persists.

Thankfully, there are various options for effectively treating adult acne. These include OTC treatments with active acne-fighting ingredients like salicylic acid and benzoyl peroxide. For more severe cases, prescription medications are available in oral and topical formulas. These include high-strength retinoids, antibiotics and birth control pills.

Regardless of the severity of symptoms, a good daily skincare routine is essential for managing adult acne. Natural remedies like tea tree oil, witch hazel and honey can also be used to treat mild symptoms.