- Adult acne is caused primarily by the same factors as acne in puberty
- Acne develops due to the accumulation of excess sebum, dead skin cells, debris and bacteria
- Women are more at risk than men due to hormonal fluctuations
- Effective treatments include over the counter and prescription medication, and natural home remedies
Acne is a chronic skin condition that develops when excess sebum (oil) dead skin cells and grime become trapped in skin cells to form noninflammatory acne. It can progress to inflammatory lesions when Cutibacterium acnes bacteria multiply which causes worsening symptoms. The formation and progression remains the same whether it is adolescent or adult acne.
What Is Adult Acne?
Acne pimples and lesions are defined as noninflammatory or inflammatory and can be categorized by severity in the following order:
Excess oil production is the biggest contributor to acne formation — which also has a greater impact for those with oily skin.
Adult acne is defined as acne that develops after the age of 25; it can be a continuation of symptoms that developed during puberty or first present in adulthood, termed new-onset or adult-onset acne.
Previously, this skin condition was thought to primarily affect adolescents, but science has shown that a great number of patients either continue to experience acne in adulthood or develop new-onset acne after adolescence.
One study review on this topic examined existing data to reveal that adult patients are primarily women over 25 years old, and that their acne is more severe compared to men in the same age group. Acne lesions were primarily inflammatory, and mild-to-moderate in intensity.
The exact percentage of adult women affected is difficult to pinpoint as a plethora of studies report different percentages found within their study groups such as 1%–22%,12%,15% and so on up to 85%.
However, all studies support that adult women with acne bear a heavy burden as this skin condition impacts quality of life and is linked to depression, anxiety and diminished concentration at work or school.
Adult acne vs. teenage acne
Adult and teenage acne develop due to the same reasons, and both share the same symptoms.
Hormonal fluctuations are the most common cause of both adult acne and teen acne but occur for different reasons.
In puberty, an increase in androgen hormones causes sebaceous glands to enlarge and become overactive. This produces excessive amounts of sebum which causes oily skin; this oily layer traps dead skin cells and debris to clog hair follicles.
Adult females face greater fluctuations in hormone levels due to menstrual cycles, pregnancies, menopause and perimenopause. These fluctuations trigger an overproduction of sebum which increases the risk of acne breakouts. Stopping (or starting) birth control pills can also have the same effect.
For males, high testosterone levels prompt increases in sebum production which leads to acne flare-ups. Testosterone peaks in adolescence and then gradually declines by the mid-30’s to decrease the likelihood of acne.
Adult acne in your 20s, 30s and 40s
Adult acne has been shown to diminish with age as hormones fluctuate throughout adulthood and then level off.
One study of females aged 10–70 were recruited from the general population. Researchers found 55% had some form of inflammatory or comedonal acne. While acne peaked in the teenage years 45% of women aged 21–30, 26% aged 31–40 and 12% aged 41–50 had clinical acne.
Another study examining the prevalence of acne in patients of both sexes 20 years and older:
While the percentages fluctuate in different studies, It’s clear that in all age groups, women face a greater burden than men, with numbers decreasing with age as hormone levels stabilize.
Where is adult acne most likely to occur?
As with any form of acne, adult acne can develop almost anywhere but is most likely to occur where there is a high concentration of sebaceous glands. This would be the face, including the chin, neck and especially the jawline.
In one study, researchers found that the majority of adult female patients had a history of acne since adolescence, but in many cases the lesion distribution and intensity changed over time, with lesions more often developing in the lower third of the face.
What causes adult acne?
Regardless of age, acne results due to an accumulation of oil, grime, dead skin cells and debris which can lead to clogged pores.
In addition to fluctuations in hormones which play a key role in overproduction of sebum, several other causes have been linked to adult acne development.
Comedogenic hair and skin care products can cause or exacerbate acne by clogging pores or irritating skin and inflaming skin.
In one study of patients with mild-to-moderate acne facial and truncal symptoms, participants reported a 74% improvement in acne after using noncomedogenic hair products for 8 weeks.
Often overlooked, this study showcases how comedogenic shampoo and conditioner as well as leave-in hair care products can contribute to acne development.
When choosing skin and hair care products as well as cosmetics, opt for those labeled as noncomedogenic. Pore-clogging topicals include cocoa butter, petroleum, silicone and lanolin; and mineral, jojoba and coconut oils. Emulsifiers such as sodium lauryl sulfate and butyl sterate can also irritate skin and cause acne.
While more studies are needed for further clarification, science has established a link between diet and acne. Certain foods cause spikes in sebum production and can also cause greater skin inflammation.
In one study, consuming milk, sugary drinks and fat and sugar-laden products appeared to be associated with acne in adults.
In a large study review of children to adults aged 7–30, researchers found any dairy product (milk, yogurt and cheese) was associated with an increase in acne.
In contrast, evidence supports adopting a healthy Mediterranean diet which avoids these types of foods. One study examining this diet among women with mild-to-severe acnes found a significant negative correlation between the severity of acne and the adherence to the Mediterranean diet in these patients.
There is a genetic component to acne development which not only affects risk but also acne severity. Specific genes are understood to influence the sebaceous gland activity as well as induce inflammatory responses.
One twin study of acne in women highlighted this theory when they reported that 81% of acne scores were attributable to the combined effects of multiple genes which exerted an influence on acne development. A family history of acne was also strongly associated with increased risk.
Stress can have a significant impact on acne by prompting acne formation and by worsening existing symptoms.
In times of stress, the body experiences a fight-or-flight response which causes the release of cortisol and androgen stress hormones. These hormones can produce negative effects by increasing inflammation and stimulating sebum production.
Many studies support this theory as well as provide evidence that the greater the stress the worse the acne.
Lastly, acne itself can have an emotional and psychological impact which can lead to higher levels of stress, depression and anxiety.
Other causes have also been known to prompt acne development such as the following:
Endocrine disorders such as polycystic ovarian syndrome (PCOS) cause excessive levels of androgens in the body, leading to increased oil production.
Medications such as corticosteroids, anabolic steroids, testosterone, halogens, lithium and some new anticancer agents can trigger a sudden onset of inflammatory acne.
While oral contraceptives are widely used to treat adult acne, there are some specific formulations that may cause or worsen symptoms; progestin-only contraceptive pills can cause androgen levels to fluctuate, resulting in acne breakouts.
Smoking and acne is currently a controversial topic as some studies indicate a link while others do not. That being said, a review and analysis of current study findings on the topic did produce evidence that smoking is a risk factor.
Can you prevent adult acne breakouts?
While some things can be beyond your control such as genetics, there are steps you can take to help prevent acne breakouts.
Follow an effective skin care routine
- Select noncomedogenic skin care products that are designed for your skin type—from oil-free for oily skin to moisturizing for dry skin—and are formulated to treat and prevent acne
- Include a gentle cleanser, toner to clear skin of all debris and residue, and a high-quality moisturizer to hydrate and protect skin
- Before leaving your home each day, apply a broad spectrum SPF to protect your skin against damaging UVA and UVB rays; sunscreen will also protect your skin against free radicals which can worsen acne
Avoid picking at your skin
- Touching your face can transfer oil, dirt and bacteria from your fingers to your face and worsen symptoms
- Picking and squeezing your blemishes will increase inflammation, redness and swelling, spread the infection and increase the risk of postinflammatory hyperpigmentation (PIH) and scarring
Improve lifestyle habits
- Reduce or eliminate consumption of dairy products, sugary drinks and high fat and sugar foods
- Make healthier food choices to include whole foods, fresh vegetable and fruits, nuts and legumes
- Avoid smoking and find ways to manage stress levels through meditation, talk therapy, exercise, or enjoyable group or solo activity
Adult acne treatments
There are many established treatments for adult acne, including topical over-the-counter (OTC) treatments and topical and oral prescription medications. Treatment will depend on the severity of your symptoms and your response.
For best results, see your dermatologist to decide the best course of action.
Over the counter treatments
OTC treatments are available in cleanser, toner, lotion, cream or gel formats; many have several active agents to target specific acne symptoms. Your chosen products should be based on your skin type and in a suitable strength to avoid irritation.
Benzoyl peroxide has long played a key role in treating acne as it can markedly reduce acne-causing bacteria and inflammatory acne lesions, and has a moderate effect against noninflamed lesions.
This compound can slough away the debris and dead skin cells that block pores, kill bacteria, and dry out and reduce the appearance of lesions.
It’s effective on its own or can be combined with prescription medications such as oral antibiotics to target acne for a combined effect; importantly, benzoyl peroxide can help suppress the emergence of resistant strains of P. acnes.
Retinol is a milder form of prescription-strength retinoid. It’s been shown to play an essential role in acne management as it deeply penetrates to exfoliate away dead skin cells and promote skin cell turnover to help treat and prevent future lesions from forming. It’s effective against both comedonal as well as inflammatory acne and can alleviate swelling and redness.
Salicylic acid is a chemical exfoliant that can help treat inflammatory acne but is most effective against noninflamed comedones. It’s valued for its ability to deeply penetrate pores to break down plugs of oil and debris; and can slough off dead skin cells. This effectively clears away comedones and prevents new pimples from forming.
You can combine salicylic acid with benzoyl peroxide to gain the benefits that each has to offer; as well, any topical medication or skin care product will better absorb with clear pores and provide better results.
Prescription-strength medications are commonly used alongside OTC solutions for moderate-to-severe acne and for treatment-resistant cases. Your dermatologist will create a treatment plan based on your particular needs.
Antibiotics are commonly prescribed for a set period of time to treat moderate-to-severe inflammatory acne and acne that fails to respond to topical treatment. Antibiotics such as doxycycline and minocycline can kill bacteria and reduce inflammation, irritation and pain.
Retinoids such as adapalene, isotretinoin and tazarotene provide the same benefits as retinol but are more powerful and work faster; they are typically prescribed for moderate-to-severe acne, and to reduce scarring.
Hormone-based therapies for adult women include oral contraceptives and spironolactone. These work to regulate fluctuations in hormones and have been shown to produce significant reductions in lesion counts across all lesion types.
While these medications are safe for most women, there are potential risks that should be discussed with your doctor.
Home remedies can be used in conjunction with OTC and prescribed medications to relieve inflammation and soothe irritation and pain.
Tea tree oil is an essential oil that can provide multiple health and skin benefits. It has anti-inflammatory and antimicrobial properties to calm swelling and redness, and has been demonstrated to reduce the number of lesions in those with mild-to-moderate acne.
Witch hazel is a natural astringent that can help reduce acne-causing excess oils; it also has anti-inflammatory properties to combat redness, swelling and irritation.
Honey, especially Manuka honey, can speed up wound healing and is rich in antioxidants which help repair and protect skin. Honey can also hydrate dry skin and exfoliate away dead skin cells to improve the appearance of skin
Adult acne is acne that develops after the age of 25, but it can also be a continuation of acne that began at puberty. All acne begins when excess oil, dead skin cells and grime become trapped within follicles to form lesions. When bacteria accumulates, inflammatory symptoms develop.
Excess oil production is the biggest contributor to acne formation; hormonal fluctuations, diet, a genetic disposition and stress have all been identified as instigators in acne development as they all increase oil production.
Acne can be successfully treated with OTC agents as well as prescribed topicals and oral therapies. Depending on the severity, a treatment regimen may include several medications to quickly control symptoms and kill bacteria. At home, natural remedies can support conventional treatments by alleviating dryness, redness, irritation and pain.
There are several steps you can take to help prevent acne from forming, such as following an effective skin care program and improving lifestyle habits such as eating healthy whole foods and learning stress-reducing techniques.
Bagatin E, Freitas THP, Rivitti-Machado MC, et al. Adult female acne: a guide to clinical practice [published correction appears in An Bras Dermatol. 2019 Mar-Apr;94(2):255. Machado MCR [corrected to Rivitti-Machado MC]]. An Bras Dermatol. 2019;94(1):62-75. doi:10.1590/abd1806-4841.20198203
Rocha MA, Bagatin E. Adult-onset acne: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol. 2018;11:59-69. Published 2018 Feb 1. doi:10.2147/CCID.S137794
Richter C, Trojahn C, Hillmann K, et al. Sensitivity to change of the Dermatology Life Quality Index in adult females with facial acne vulgaris: a validation study. J Eur Acad Dermatol Venereol. 2017;31(1):169-174. doi:10.1111/jdv.13757
Makrantonaki E, Ganceviciene R, Zouboulis C. An update on the role of the sebaceous gland in the pathogenesis of acne. Dermatoendocrinol. 2011;3(1):41-49. doi:10.4161/derm.3.1.13900
Iftikhar U, Choudhry N. Serum levels of androgens in acne & their role in acne severity. Pak J Med Sci. 2019;35(1):146-150. doi:10.12669/pjms.35.1.131
Perkins AC, Maglione J, Hillebrand GG, Miyamoto K, Kimball AB. Acne vulgaris in women: prevalence across the life span. J Womens Health (Larchmt). 2012;21(2):223-230. doi:10.1089/jwh.2010.2722
Collier CN, Harper JC, Cafardi JA, et al. The prevalence of acne in adults 20 years and older [published correction appears in J Am Acad Dermatol. 2008 May;58(5):874. Cafardi, Jennifer A [added]]. J Am Acad Dermatol. 2008;58(1):56-59. doi:10.1016/j.jaad.2007.06.045
Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016;9:241-248. Published 2016 Sep 2. doi:10.2147/CCID.S114830
Rubin IK. Efficacy of a Non-Comedogenic Hair Care Regimen for the Reduction of Mild-to-Moderate Truncal and Facial Acne: A Single-Arm 8-Week Study. J Drugs Dermatol. 2021;20(6):690-693. doi:10.36849/JDD.2021.5772
Penso L, Touvier M, Deschasaux M, et al. Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study. JAMA Dermatol. 2020;156(8):854-862. doi:10.1001/jamadermatol.2020.1602
Juhl CR, Bergholdt HKM, Miller IM, Jemec GBE, Kanters JK, Ellervik C. Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults. Nutrients. 2018;10(8):1049. Published 2018 Aug 9. doi:10.3390/nu10081049
Ah-Thiane L, Nguyen JM, Khammari A, Dréno B. Lifestyle habits and impact of the Mediterranean diet on facial acne severity in French women: a case-control study. Int J Womens Dermatol. 2022;8(2):e017. Published 2022 May 13. doi:10.1097/JW9.0000000000000017
Heng AHS, Say YH, Sio YY, Ng YT, Chew FT. Gene variants associated with acne vulgaris presentation and severity: a systematic review and meta-analysis. BMC Med Genomics. 2021;14(1):103. Published 2021 Apr 13. doi:10.1186/s12920-021-00953-8
Bataille V, Snieder H, MacGregor AJ, Sasieni P, Spector TD. The influence of genetics and environmental factors in the pathogenesis of acne: a twin study of acne in women. J Invest Dermatol. 2002;119(6):1317-1322. doi:10.1046/j.1523-1747.2002.19621.x
Zari S, Alrahmani D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. 2017;10:503-506. Published 2017 Dec 5. doi:10.2147/CCID.S148499
Tan JK. Psychosocial impact of acne vulgaris: evaluating the evidence. Skin Therapy Lett. 2004;9(7):1-9. https://pubmed.ncbi.nlm.nih.gov/15334275/
Zhang JZ, Xiang F, Yu SR, Luo D, Li TT, Kang XJ. Association between acne and smoking: systematic review and meta-analysis of observational studies. Chin Med J (Engl). 2021;134(15):1887-1888. Published 2021 Jan 5. doi:10.1097/CM9.0000000000001286
Kazandjieva J, Tsankov N. Drug-induced acne. Clin Dermatol. 2017;35(2):156-162. doi:10.1016/j.clindermatol.2016.10.007
What is the Role of Benzoyl Peroxide Cleansers in Acne Management?: Do they Decrease Propionibacterium acnes Counts? Do they Reduce Acne Lesions?. J Clin Aesthet Dermatol. 2008;1(4):48-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016935/
James D et al. Benzoyl Peroxide. Andrews’ Diseases of the Skin. Publisher: Elsevier 2020; 13, 231-251.e1. https://www.sciencedirect.com/topics/neuroscience/benzoyl-peroxide
Thielitz A, Abdel-Naser MB, Fluhr JW, Zouboulis CC, Gollnick H. Topical retinoids in acne–an evidence-based overview. J Dtsch Dermatol Ges. 2008;6(12):1023-1031. doi:10.1111/j.1610-0387.2008.06741.x
Trivedi MK, Shinkai K, Murase JE. A Review of hormone-based therapies to treat adult acne vulgaris in women. Int J Womens Dermatol. 2017;3(1):44-52. Published 2017 Mar 30. doi:10.1016/j.ijwd.2017.02.018
Hammer KA. Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action. Int J Antimicrob Agents. 2015;45(2):106-110. doi:10.1016/j.ijantimicag.2014.10.011
Piazza S, Martinelli G, Vrhovsek U, et al. Anti-Inflammatory and Anti-Acne Effects of Hamamelis virginiana Bark in Human Keratinocytes. Antioxidants (Basel). 2022;11(6):1119. Published 2022 Jun 5. doi:10.3390/antiox11061119