When does hormonal acne stop? Ages and timelines

"When will this end?" is the question behind a lot of searches about hormonal acne. The answer depends on your age, your sex and what is causing your acne, and that no source gives a fixed end date. The research does show how acne changes by decade, the life stages that make it better or worse, and why waiting for it to stop on its own carries a cost. For treatment, see the hormonal acne treatment guide.

Skinli gives general education and is not a doctor. Acne that is deep, painful or scarring should be treated now, whatever your age.

What happens to acne with age

NIAMS, part of the US National Institutes of Health, says acne tends to go away by the thirties for most people, while some people in their forties and fifties still have it. It says teenage acne is more common in males, and that acne continuing into adulthood is more common in women.

The clearest numbers come from a 2008 survey of 1,013 adults, published in the Journal of the American Academy of Dermatology. The survey asked adults about acne, with these results by age group:

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

The table shows two patterns. Acne becomes less common with each decade. And at every age after the teens, more women than men report it. The authors say the answers rest on people's own view of their skin, without an exam.

Three kinds of adult acne

A 2019 review in the International Journal of Women's Health sorts adult acne into three types by when it began:

1. Persistent acne, which started in the teenage years and never cleared. The review says this is the most common type.
2. New-onset acne, which starts for the first time in adult life.
3. Recurrent acne, which cleared after the teenage years and came back later.

The American Academy of Dermatology (AAD) says most women with adult acne had acne as teens and continue to break out, and that 20% to 40% of women with adult acne develop it for the first time as adults. It says adult-onset acne is most common among women going through menopause.

Life stages that change hormonal acne

Monthly cycles

A 2001 study of 400 women found that 44% had acne flares before their periods, and that women older than 33 had these flares more often than women aged 20 to 33. The authors wrote that monthly flares may be more common in older women. See period acne.

Pregnancy

The American College of Obstetricians and Gynecologists says some women see their acne get worse in pregnancy, and others develop acne for the first time. A 2022 review says pregnancy acne is usually worst in the second and third trimesters. See pregnancy acne.

Starting or stopping birth control

The AAD lists starting or stopping birth control pills among the hormone changes that bring breakouts in adult women. See birth control for acne.

Perimenopause and menopause

The AAD lists perimenopause and menopause among the times women's hormones change and acne can flare. The 2019 review explains that estrogen falls sharply after menopause while androgens, the male-type hormones, fall slowly, which can bring acne in women who never had it. See menopause acne.

PMOS, once called PCOS

The NHS says PMOS symptoms usually start at puberty and continue until menopause, and that after menopause some symptoms will stop or may change. See PCOS acne.

Things that keep adult acne going

Some causes of adult acne are within your control. The AAD lists these reasons adults keep getting acne:

• Skin and hair products. It says every product you use should be labeled "non-comedogenic," "non-acnegenic," "oil-free" or "won't clog pores." See what non-comedogenic means.
• Medicines. Acne is a side effect of some medicines. The AAD says to keep taking the medicine and ask the doctor who prescribed it whether acne is a known side effect.
• Stress. The body makes more androgens under stress, which can keep acne going while stress lasts.
• Smoking. The AAD cites a study in which women who smoked more cigarettes had more severe acne, and says other studies found smokers more likely to have acne.
• Family history. People with a close relative who had acne may be more likely to get adult acne.
• An undiagnosed medical condition. The AAD says acne often clears once the condition is diagnosed and treated.

Men and hormonal acne over time

Men's acne changes with age in a different way. NIAMS says acne in the teenage years is more common in males, while adult acne is more common in women. In the 2008 survey, the share of men reporting acne fell from 42.5% in their 20s to 7.3% at 50 and older. The hormonal pills used for women's acne are not given to men, so the AAD's options for men are treatments on the skin, including a hormone-blocking cream called clascoterone, antibiotic pills and, for severe acne, isotretinoin. See hormonal acne in men.

Why waiting it out is risky

Acne may fade on its own, but waiting has risks:

• Scars. The UK's NICE guideline says the risk of scarring rises with how severe acne is and how long it lasts. The AAD says the more severe acne is, the more likely it is to scar, and that even mild acne can scar when picked.
• Dark marks. The AAD says people with medium to dark skin may see a dark spot where a pimple cleared, and that these spots can last for months.
• Time. The AAD says waiting out severe acne can take years.

The AAD says treating acne early may prevent scars. So the useful question is how to control acne until it fades, since the date it stops cannot be predicted. For scars that have already formed, see are acne scars permanent?.

How long treatment takes to work

Knowing the timeline helps you judge whether a treatment is working:

Treatment	When the AAD says to expect change
A product on the skin, such as adapalene or benzoyl peroxide	Some improvement in 4 to 6 weeks, clearing in 2 to 3 months or longer
Birth control pill	Improvement in 2 to 3 months on average
Spironolactone	Fewer breakouts and less oil within a few weeks

The AAD says to give a treatment at least 4 weeks before judging it, and that switching products every few days can make acne worse. See spironolactone for acne.

A plan while you wait for acne to fade

1. Pick one proven product and use it on the whole area, including skin with no spots. The AAD's list for adults is adapalene, azelaic acid, benzoyl peroxide and salicylic acid.
2. Give it 6 to 8 weeks before judging, and add a second product only after that.
3. Use sunscreen every day. The AAD's back acne page says the sun's rays tend to darken acne and make it last longer.
4. Take a photo every two weeks in the same light, so you can see whether acne is fading. The progress photo guide shows how.
5. Review at 3 months. If acne is no better, see a doctor about prescription options.

When acne comes back

Acne can return after treatment stops. The UK's NICE guideline says that if acne clears on a first-line treatment and then relapses, a doctor should consider another 12-week course of the same or another treatment. It says ongoing maintenance treatment is not always needed, but should be considered for people whose acne often comes back, and suggests a gel with adapalene and benzoyl peroxide for this. The AAD says that when hormonal therapy clears acne, women may stay on it for a long time, and that long-term hormonal therapy appears to be safe.

When to see a dermatologist

The AAD says that if nothing clears your acne, see a dermatologist, and that with a dermatologist's help virtually every case of acne can be controlled. See one sooner if:

• Acne is deep, painful or leaving scars or dark marks
• Acne started suddenly in adulthood, or after a new medicine
• It comes with irregular periods, new hair growth or hair thinning
• Nothing has helped after 2 to 3 months

Skinli's free acne plan gives you a routine to keep acne under control in the meantime, and a way to track progress with photos.