Acne's not just for teens! Here's how to beat adult acne at every age, according to science

Spots and breakouts are often associated with teenage years however, adults suffer with acne too. Tackling skin problems can be physically painful and harmful for your mental health. A recent study in the Journal of the European Academy of Dermatology & Venereology revealed that adults with acne have a higher likelihood of having eating disorders. Other research has confirmed it can cause depression, anxiety and low self-esteem. But it’s important to remember, there is help available.

Dr Robert White, a Doctify-rated GP specialising in Dermatology and Skin Surgery says, ‘My key take-home message with adult acne is that treatments are available. Acne can have a very significant impact on the mental well-being of patients as well as causing lifelong scarring. Not all treatments work for all patients, but with support and guidance from an experienced clinician there are always options to gain control over acne.’

Acne is caused when the tiny holes (hair follicles) in your skin become blocked. Sebaceous glands are attached to hair follicles, and they lubricate the hair and skin by producing an oily substance called sebum. With acne, too much sebum can mix with skin cells and block the follicle, causing spots, like whiteheads and blackheads. Harmless bacteria that live naturally on the skin, or bacteria transferred from your hands can also infect the plugged follicle and cause cysts or papules.

What age is it most common? *
Of adults in their 20s – over 50% of women versus 43% of men.
Of adults in their 30s – 35% of women versus 20% of men.
Adults in their 40s – 26% of women versus 12% of men.
Adults 50 years and older – 15% of women versus 7% of men.

The Journal of the American Academy of Dermatology

Those struggling with adult acne can have suffered as a teenager but also, you might never have had skin care problems before. Dr Robert says, ‘Adult acne is common, with up to 50% of adults between the ages of 20 and 40 suffering some form of acne. Acne most commonly presents during a patient’s teenage years when high levels of circulating sex hormones which drive pubertal development and growth increase sebum production. Sebum is an oily substance secreted by glands near the skin surface which produces ‘greasy teenage skin’ and is a major factor in acne lesion formation.

‘Adult acne can be a continuation of ’teenage acne’ which never fully settles, a recurrence of acne which settled during teenage years or in some cases the first presentation of acne in patients who never struggled with acne during their teenage years.’

More commonly seen in women

Dr Robert says that adult acne is much more commonly seen in women than men. ‘Hormonal fluctuations, especially related to menstrual cycles, pregnancy, and conditions like polycystic ovary syndrome (PCOS) can all impact on acne lesion formation.

‘Acne can present in a cyclical pattern alongside regular periods, often flaring in the days before and during menstruation. Patients with PCOS can be particularly prone to persistent and severe acne. During the perimenopause (a time of hormonal change prior to the onset of the menopause, commonly presenting during a female patient’s 40s) along with other skin changes, acne can present as circulating oestrogen levels fall.’

So, what can we do about it? Dr Robert shares the key treatment options.

1. Dermocosmetics

• Multiple products are available over-the-counter which can be used to manage acne. These products contain substances such as benzoyl peroxide, azelaic acid and niacinamide. For mild to moderate acne dermocosmetics can be very effective.
• Aesthetic procedures such as facials, chemical peels, microneedling and the use of laser therapy can be of benefit for some patients. 

2. Lifestyle changes

• There is limited evidence to support dietary change to prevent acne. However, some patients find that high dairy or high sugar containing diet can cause acne flare-up.
• General measures such as good hydration, regular cleansing with a non-soap containing facial wash and a light non-oil based (often referred to as anti-comedogenic) moisturiser can all help to reduce acne lesion formation.

3. Prescribed topical treatments

• Multiple topical treatments are available on prescription including topical antibiotics, topical retinoids and benzoyl peroxide. Combination products tend to produce both the best results and increase adherence. NICE guidelines advise use of a topical combination of products as first line treatments in the majority of cases of adult acne.

4. Oral antibiotics

• Antibiotics can be effective in cases of adult acne, particularly in moderate to severe acne with significant numbers of inflammatory lesions. However, they should not be used long-term due to the risks of antibiotic resistance.

5. Hormonal therapies

• Hormonal medication such as the combined hormonal contraceptive pill can be very effective in managing acne in female patients where there is evidence of a hormonal cause, such as in cyclical acne or in cases of PCOS.
• In perimenopausal patients presenting with new onset of acne, particularly in cases where there are other perimenopausal symptoms, it may be appropriate to discuss the role of HRT or other strategies to manage hormonal change.

6. Isotretinoin

• Available in the UK as Roaccutane, this strong oral medication is incredibly effective at managing moderate to severe acne which has not responded to other treatment options. It is particularly helpful for those adult patients who have suffered with persistent acne since their teenage years and certainly in cases where there is evidence of acne scarring.
• As with all strong medication, it is not without risks and it is important that appropriate pre-treatment investigations and monitoring is undertaken. Isotretinoin can cause changes to liver function and blood cholesterol levels so blood testing prior to and during treatment is required.
• It is important that female patients taking isotretinoin do not become pregnant and as such there is a dedicated pregnancy prevention program which requires female patients to take contraception throughout treatment.
• Mood changes have been seen with patients taking isotretinoin, so careful monitoring of mood during treatment is also essential.
• However, when appropriately prescribed and monitored by experienced clinicians, isotretinoin is often life changing for patients who have suffered with acne throughout their lives.

Experts answer common questions

Does suncream make acne worse?

Doctify rated GP, Dr Robert says, ‘It is certainly the case that many patients with dermatological problems have concerns regarding the use of sunscreens. This may be due to possible irritant to allergic contact dermatitis to sunscreen use, or in the case of acne and rosacea the risk of blocking pores which risks the development of spots. Clearly, adequate sun protection is essential for all patients, and it is therefore important that patients with skin conditions have access to a product which does not worsen their skin condition.

‘In the majority of cases a cream-based sunscreen will be well tolerated. Certainly, in the case of acne this is preferred to an ointment which with greater oil content is more prone to causing pore blocking, increasing acne lesions, in particular comedonal acne, a type of acne that's characterised by small, non-inflamed bumps called 'comedones'.

‘Where patients are concerned by possible irritant or allergic reactions to sunscreens, they should try a test area first, to see how their skin reacts. Patients with eczema should remember that if their eczema is not well controlled, they will be much more likely to react to any topical product, including sunscreens; so aggressively managing their eczema is also important. 

‘One sun protection product which I frequently recommend to patients is Altruist. This comes in various forms and SPF levels, has excellent broad UV protection and is very reasonably priced.’

Does stress play a part?

Superintendent pharmacist, Abbas Kanani at Chemist Click  says, ‘Adults are likely to get acne through stress. The science behind the reasoning is varied, however, research has demonstrated that there is a correlation between increased stress levels and acne.

‘A common theory is that stress triggers the release of cortisol, a hormone that helps the body deal with stress. Excess cortisol caused by increased stress levels stimulate the sebaceous glands in your skin to produce more sebum, a natural oil that lubricates your skin. Sebum protects the skin keeping it moist and acts as a protective barrier. However, an overproduction of sebum can clog pores and create an environment for bacteria associated with acne to grow. Increased stress levels can also have a negative impact on the quality of your sleep and your diet. This can compromise your immune system and lead to breakouts.

‘Although pimples and whiteheads can be uncomfortable and may cause low confidence, it is important that you do not squeeze acne lesions as this can worsen your acne, causing scarring, infection, inflammation and discolouration. Using harsh cleansers or scrubbing will also make acne worse. Products such as Differin and Epiduo are effective and you should speak to your doctor if your acne is getting worse.

‘There are also antibiotic creams that are available on prescription such as Duac gel, Zineryt or Treclin. These creams contain antibiotics along with another ingredient such as a retinoid or an anti-inflammatory agent that can help to clear acne.’

What can we do about back acne?

With summer around the corner, is there anything we can do about pimply backs? Multi award-winning aesthetic doctor Priya Verma (drpriyaverma.com/) says, ‘Back acne, or “bacne”, is especially frustrating as it often worsens with sweat, sunscreen and tight clothing, all common in warmer months.

‘First, use a gentle exfoliating body wash with salicylic acid or glycolic acid a few times a week to help clear clogged pores. Avoid heavy body lotions that may trap sweat and oil and always shower promptly after workouts or sun exposure.

Loose, breathable clothing helps minimise friction and sweat buildup. You might also consider a back ‘facial’ treatment, which includes deep cleansing, exfoliation and extractions, ideal before a summer holiday or special event.’

What can we do about the scars?

Doctor Priya says, ‘Acne scarring is a common concern among adults, and the best approach is always a combination of prevention and targeted treatment. Prevention is key, so as tempting as it can be, try not to pick or squeeze spots. This can really disrupt the skin’s healing process, increase inflammation and make scarring more likely to occur. Gentle cleansing, using non-comedogenic products, and maintaining a consistent skincare routine with ingredients like salicylic acid or benzoyl peroxide can help manage breakouts.

‘To minimise long-term effects, it’s important to manage breakouts early with a combination of topical actives such as retinoids, niacinamide, or azelaic acid, which help to regulate skin turnover, reduce pigmentation, and calm inflammation.

‘When it comes to treating existing acne scars, a personalised, staged approach yields the best results. We typically begin with microneedling using SkinPen, a medical-grade device that promotes collagen production and helps improve skin texture. Chemical peels can be used in tandem to even out pigmentation and accelerate skin renewal.

For more tethered or indented scars, subcision is an advanced technique that involves releasing the fibrous bands under the skin. This is often combined with injectable polynucleotides or PLLA (poly-L-lactic acid) to support tissue regeneration and stimulate long-term collagen synthesis.

‘In cases of more severe or textural scarring, we may progress to ablative laser resurfacing using CO₂ or Erbium:YAG lasers. These powerful treatments precisely remove damaged layers of skin and trigger significant dermal remodelling, delivering dramatic results in expert hands, with appropriate recovery time.’

Can changing your diet help?

Zoe Williams, founder of wellness brand Aegles, says your diet can make a difference in your skin journey. ‘While some doctors remain cautious about the role of diet in acne, at Aegle's we see time and again how food choices can dramatically affect skin health. There’s growing evidence – and plenty of real-world experience – showing that diet is one of the biggest contributors to acne. Certain foods, particularly high-glycaemic carbs and dairy can spike hormones and blood-sugar levels, which often leads to breakouts.

‘Of course, everyone’s skin is different, and diet isn’t a magic cure for all. But for many people, reducing processed sugar, cutting back on dairy, and increasing anti-inflammatory nutrients can make a real difference.

‘That’s exactly why I created Aegle’s Clear Skin Complex — a science-backed supplement designed to support clearer skin from within. It combines probiotics to balance the gut microbiome, broccoli seed extract to balance hormones and chromium to reduce blood-sugar spikes. It’s a holistic approach, rooted in nutritional science, and I’ve seen it help so many people reclaim control over their skin.

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What to eat at every age

If you want to get that glow from within, it’s important to fuel your body with the right foods. Feel your best at every age by learning what to eat at each stage of life.

Reference:

*J Am Acad Dermatol. 2008 Jan;58(1):56-9.