Adult acne: causes and what helps

Adults get acne from changing hormone levels, stress, family history, skin and hair products, medicine side effects, and sometimes an undiagnosed medical condition. Those are the six causes the American Academy of Dermatology (AAD) lists for adult acne, and more than one can apply at once. The AAD says some adults keep getting acne well into their 30s, 40s and 50s, and that it is possible to get acne for the first time as an adult. AAD dermatologists say many adults with mild acne can treat it with products sold without a prescription, while deep, painful or scarring acne needs a dermatologist. Hormone-linked acne on the jawline has its own guide, hormonal acne vs regular acne. The full treatment plan is in how to get rid of acne.

How common adult acne is

A 2008 survey published in the Journal of the American Academy of Dermatology asked 1,013 adults aged 20 and older about acne. 73.3 percent said they had had acne at some point. After the teenage years, women were more likely than men to report acne in every age group.

Age	Women reporting acne	Men reporting acne
20 to 29	50.9 percent	42.5 percent
30 to 39	35.2 percent	20.1 percent
40 to 49	26.3 percent	12.0 percent
50 and older	15.3 percent	7.3 percent

The survey was done on one university campus and medical complex, and it relied on people's own sense of whether they had acne, without a doctor's exam. Even with those limits, it shows that acne is common in adults. NIAMS, part of the US National Institutes of Health, says acne that continues into adulthood is more common in women.

Why adults get acne

The AAD lists six reasons an adult may get acne. More than one can apply at once.

Changing hormone levels

The AAD says an imbalance of hormones can lead to breakouts. Women often have changing hormone levels around their periods, during pregnancy, perimenopause and menopause, and after starting or stopping birth control pills. The AAD says adult-onset acne is most common among women going through menopause.

Stress

Researchers have found a relationship between stress and acne flare-ups, the AAD says. Under stress, the body makes more androgens, a type of hormone that stimulates oil glands and hair follicles. The AAD's causes page adds that stress cannot cause acne on its own but may worsen acne you already have.

Family history

If a parent, brother or sister has acne, the AAD says you may have a genetic tendency toward it, which makes adult acne more likely.

Skin and hair products

The AAD asks adults with acne to read the labels on every skin and hair product, including moisturizer, cleanser and sunscreen, and look for one of these terms: non-comedogenic, non-acnegenic, oil-free, or won't clog pores. These products are least likely to cause acne. The comedogenic checker looks up the ingredients on a label you are not sure about.

Medicines

Acne is a side effect of some medicines. NIAMS names medicines that contain hormones, corticosteroids and lithium. MedlinePlus adds testosterone, estrogen and phenytoin, and says some medicine-containing IUDs can make acne worse. The AAD's advice is to keep taking the medicine and talk with the doctor who prescribed it. Ask whether acne is a known side effect and whether another medicine is possible.

An undiagnosed medical condition

The AAD says acne is sometimes a sign of an underlying medical condition, and that once that condition is diagnosed and treated, the acne often clears. The NHS names polyendocrine metabolic ovarian syndrome, a hormone condition, as one example. NICE advises doctors to consider specialist care when a medical disorder or medicine is likely to be contributing to acne.

Why teenage treatments may stop working

The AAD says a treatment that worked well in the teen years can be useless for adult acne, or even make it worse. The AAD's advice for any acne that will not clear includes: give a treatment at least 4 weeks, try only one or two products at a time, wash twice a day without scrubbing, and spread the medicine over all acne-prone skin.

What to use

AAD dermatologists Julie Harper, MD, and Ramone Williams, MD, say many adults with mild acne can treat it with products sold without a prescription. They define mild acne as blackheads and whiteheads with small pimples, or just small pimples. They recommend four active ingredients:

Ingredient	What they say it does
Adapalene	A retinoid that helps clear blackheads, whiteheads and pimples
Azelaic acid	Fights acne and can fade the dark spots left when a spot clears
Benzoyl peroxide	Works on mild pimples. Start with 2.5 percent to avoid dryness and burning
Salicylic acid	Unclogs pores and exfoliates. Works best on whiteheads and blackheads

Their method: choose one product with an ingredient that fits your acne, use it as directed for 6 to 8 weeks, and do not add or stop products during that time. Apply a thin layer to the whole area where you break out. If the medicine works, expect fewer breakouts in 4 to 8 weeks and clearing at 16 weeks.

Starting adapalene and benzoyl peroxide together also fits the guidelines. The UK NICE guideline lists adapalene with benzoyl peroxide as a first choice for acne of any severity, and the 2024 AAD guideline lists combining treatments that work in different ways as good practice. NICE means one gel that holds both. In the US, each is sold without a prescription as its own gel. The advice to add one new product at a time still applies to everything else.

Skinli's sample plan uses benzoyl peroxide 2.5 percent and adapalene 0.1 percent every other night for the first two weeks, then every night. On the 12 week plan, it adds azelaic acid 10 percent from week 5 when there are flat red or brown marks. Over-the-counter acne treatments explains how to read the labels.

Daily habits that matter more for adults

Several AAD habits are worth checking in an adult routine.

• Makeup. Remove it before bed, every night. The AAD says even non-comedogenic makeup can cause acne if you sleep in it, and that sharing makeup, brushes or applicators can pass bacteria, oil and dead skin cells from one face to another.
• Hair products. Oil from hair can cause acne on the forehead, the AAD says. Shampoo regularly and keep oily hair away from your face.
• Washing. Wash twice a day, when you wake up and before bed, and after sweating. The AAD says washing more often than that can irritate the skin and lead to more breakouts.
• Drying products. Avoid astringents, toners and rubbing alcohol. The AAD says dry skin is irritated skin, and irritated skin risks more acne. See rubbing alcohol for acne.
• Smoking. The AAD describes a study of women with acne in which many of the women smoked, and the more cigarettes a woman smoked, the more severe her acne. Smoking and acne covers how firmly the AAD states this link.
• Sun. Use a broad-spectrum sunscreen of SPF 30 or higher labeled non-comedogenic. Some acne medicines make skin more sensitive to the sun.

Dark marks on adult skin

AAD dermatologists say dark spots after acne clears, called post-inflammatory hyperpigmentation, are more common on darker skin. They show that the acne is causing a lot of inflammation, and treatment bought without a prescription usually cannot control that much inflammation. That makes dark marks a reason to see a dermatologist sooner. Dark marks after pimples covers how flat marks fade.

How long it takes, and what comes after

Adult acne follows the same timeline as any acne. The American Academy of Dermatology says to use an acne product for 6 to 8 weeks before judging it, and that complete clearing generally takes 3 to 4 months. The adapalene label says it may take up to 3 months of once daily use to see results. Dr. Harper says acne medication does not work overnight, that it must be used consistently and as directed, and that no one acne treatment works for everyone because every person's skin is different. If a product has not helped within a few months, she asks people to make an appointment instead of trying product after product. Skinli's guide on how to get rid of acne fast lists the habits that keep that wait as short as it can be, such as using one treatment every day and not switching products.

Once the skin clears, keep going. The AAD says that even when you see clearing, you should keep using the acne treatment to help prevent new breakouts. For adults whose acne keeps coming back, NICE suggests considering a maintenance treatment, and names a combination of adapalene and benzoyl peroxide as one option. How long an acne routine takes to work covers what to look for at each stage. When does hormonal acne stop? shows how acne changes with each decade.

Pregnancy and adult acne

Dr. Williams says to consult a dermatologist before treating acne yourself if you are pregnant or trying to get pregnant, because some acne treatments sold without a prescription are not safe during pregnancy. NICE says topical retinoids, the group that includes adapalene, should not be used during pregnancy or while planning one. Retinoids during pregnancy and breastfeeding has the details.

What a dermatologist adds

The AAD says that if nothing clears your acne, you should see a dermatologist, and that dermatologists often use two or more treatments together. For women with stubborn acne on the lower face that flares around periods, the AAD says a dermatologist may prescribe spironolactone or a combined birth control pill. The 2024 AAD guideline gives both a conditional recommendation. How to get rid of hormonal acne explains these hormone treatments and who they suit.

AAD dermatologists also say to see a dermatologist if dark spots appear after acne clears, because they show that acne is causing a lot of inflammation. Dr. Harper adds that it is never the wrong time to see a dermatologist for adult acne. Severe acne and when to see a dermatologist lists the other signs.