Adult acne
Acne in adults, driven by hormones, stress, products or medicines, has three patterns: never gone since your teens, gone and back again, or new after age twenty-five. Women get it more often than men.
Which of these is your story?
- Hormonal Fluctuations
- Stress
- Products and Medications
- Over-the-Counter (OTC) Topicals
Last reviewed
Adult acne pattern finder
What adult acne is
Adult acne is acne in people aged 25 or older. It means the same clogged follicles, oil, bacteria and inflammation as teen acne, set off by different triggers. The cause of adult acne is usually a mix of hormones, stress, products, medicines or an undiagnosed health condition.
Dermatologists split it into persistent acne, which carries on from the teens, and late-onset acne, which begins after 25. In one clinic sample of 208 women aged 25 and over, 47.1% had persistent, 26.9% late-onset and 26% recurrent acne. That is a single clinic, so read it as a rough guide. About 20 to 40% of women with adult acne get acne for the first time as adults, and adult-onset acne is most common in women going through menopause.
| Age | Women | Men |
|---|---|---|
| 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% |
Where it shows
In adult women, inflamed spots tend to cluster on the lower chin, jawline and neck, with more closed comedones (whiteheads). It is mostly mild to moderate but slow to respond. Yet in the 208-woman clinic study, the cheeks (87%) and the skin around the mouth (81.7%) were the most common sites, so location alone does not reveal the cause. Large whiteheads, called macrocomedones, are also more common than in teens.
If yours fits one of these, a photo narrows down the likely trigger.
Common Causes
Hormonal Fluctuations
Hormone levels shift around periods, in pregnancy, during perimenopause and menopause, and after starting or stopping the pill. Some medicine-containing IUDs can make acne worse.
Breakouts that start in your forties or around your last period are covered in acne in perimenopause and menopause.
Stress
Under stress the body makes more androgens, hormones that drive oil. Stress does not start acne from nothing, but it can make existing acne worse.
Genetics
A parent, brother or sister with acne raises your odds of having it as an adult.
Products and Medications
Check every label for non-comedogenic, non-acnegenic, oil-free or "won't clog pores". Acne from makeup can take a few days to 6 months to show up.
Corticosteroids, lithium, testosterone, estrogen and phenytoin can cause acne. Never stop a medicine on your own. Smoking has been linked to adult acne with many blackheads and whiteheads.
Diet
A low-glycemic diet cut acne in small studies, and cow's milk has been linked to breakouts, but other studies found no link. More research is needed; MedlinePlus calls the diet link controversial.
When adult acne is a sign of something else
| Condition | Clues | What to do |
|---|---|---|
| PCOS (the NHS now says PMOS) | Acne with irregular periods, extra facial hair, thinning scalp hair or darkening skin. It affects 7 to 10% of women of childbearing age. | See a doctor for a check |
| Rosacea | Acne-like bumps where the face is red, skin that stings or burns, gritty eyes | See a dermatologist |
| Perioral dermatitis | Small bumps only around the mouth, nose or eyes, dry and flaky skin, often after a steroid cream | Stop steroid creams, including hydrocortisone; see a dermatologist |
| A medicine side effect | Acne that began with a new medicine | Keep taking it and ask the prescriber |
| An undiagnosed condition | Acne with other new symptoms | Acne often clears once the condition is treated |
Treatment Options
- Over-the-Counter (OTC) Topicals
- Adapalene (the 0.1% gel is sold without a prescription), azelaic acid, which also fades dark spots, benzoyl peroxide, starting at 2.5%, and salicylic acid. Use one product for 6 to 8 weeks. Expect fewer breakouts in 4 to 8 weeks and clearing by about 16 weeks.
- Prescription Medications
- Ask your doctor about a prescription retinoid, or an antibiotic such as doxycycline paired with a topical. For women, ask about spironolactone or the pill; women 35 or older may not be able to take the pill.
- Severe Cases
- For severe or scarring acne, the 2024 US guideline strongly recommends isotretinoin. It must not be taken during pregnancy.
- Lifestyle Care
- A gentle cleanser up to twice a day, no scrubbing, hands off, and a non-comedogenic sunscreen of SPF 30 or higher.
Pregnant or trying? Talk to a dermatologist before you treat acne on your own. Options sorted by situation, including advice for pregnancy, are set out under adult acne treatment.
More adult acne guides
If you would rather see options ordered by how well they are proven, check the ranked best adult acne treatment list.
A step-by-step plan, one product at a time, is laid out under how to get rid of adult acne.
Straight answers to common questions
Why am I suddenly getting acne as an adult?
Most often it is a shift in hormones, stress, a new skin or hair product, a medicine, or a health problem nobody has found yet. When breakouts appear out of nowhere, those are the first things to check.
How to tell if acne is hormonal or bacterial?
It is not one or the other. Every breakout involves plugged follicles, oil and bacteria. If yours flares with your period or sits on the lower face, hormones are probably part of the mix.
What should I do if nothing is helping my acne?
Give a product at least 4 weeks. Then add a second one that works on a different cause. Still stuck after that? Time to see a dermatologist.
How can I treat stress acne?
Stress does not start acne from nothing, but it makes your body produce more androgens, which can make breakouts worse. Treat the acne itself and keep your routine steady through busy weeks.
Can hydrocortisone be used to treat pimples?
No. Steroid creams can set off a rash around the mouth that looks like acne, and steroid medicines can cause acne themselves.
Sources
- Adult acne, American Academy of Dermatology (AAD)
- Adult acne treatment you can do at home, AAD
- What causes acne, AAD
- Hormonal therapy for acne, AAD
- Is stubborn acne really acne?, AAD
- Perioral dermatitis, AAD
- Makeup and acne, AAD
- Diet and acne, AAD
- When acne won't clear, AAD
- Antibiotics for acne, AAD
- Skin care tips for acne, AAD
- Acne treatment in pregnancy, AAD
- Adult acne, DermNet
- Steroid acne, DermNet
- Acne, NIAMS (National Institutes of Health)
- Acne, MedlinePlus (National Library of Medicine)
- Polycystic ovary syndrome, Endocrine Society
- Acne, NHS
- Prescription to nonprescription switch list, US Food and Drug Administration
- The prevalence of acne in adults 20 years and older, Journal of the American Academy of Dermatology, 2008. PMID 17945383
- Adult female acne: a new paradigm, Journal of the European Academy of Dermatology and Venereology, 2013. PMID 23302006
- Adult female acne: clinical characteristics and factors significantly associated with polycystic ovary syndrome, Australasian Journal of Dermatology, 2021. PMID 34423850
- Guidelines of care for the management of acne vulgaris, Journal of the American Academy of Dermatology, 2024. PMID 38300170
Last reviewed . This page is general information, not a diagnosis. See a doctor if acne comes with irregular periods, new facial hair or thinning scalp hair, if it began after a new medicine, or if nothing has helped after a few months.