Why Do I Still Have Acne as an Adult?

If you thought acne was something you'd leave behind in your teens, you're far from alone in being frustrated. Adult acne — defined as acne occurring after age 25 — is increasingly common and affects women disproportionately (though men are certainly not immune).

The good news is that adult acne responds well to treatment. The key is understanding what's driving it, because the answer shapes the approach.

Adult Acne Is Different From Teenage Acne

Teenage acne is largely driven by the surge of androgens at puberty, which triggers increased sebum production across the entire face. The result is often widespread comedonal (blackheads and whiteheads) and inflammatory acne, particularly on the forehead and nose (the T-zone).

Adult acne tends to be different:

• More often in the lower face — jawline, chin, neck, and cheeks
• More often inflammatory (red papules and cysts) rather than comedonal
• More often cyclical in women — flaring predictably before periods
• More often hormonal in origin

Common Causes of Adult Acne

Hormonal fluctuations

Androgens — including testosterone — stimulate sebaceous glands to produce more oil (sebum). This excess oil, combined with dead skin cells, creates the environment where acne-causing bacteria (Cutibacterium acnes, formerly called P. acnes) thrive.

In women, hormonal fluctuations throughout the menstrual cycle, with starting or stopping birth control, during pregnancy, and during perimenopause can all trigger or worsen acne.

Women who break out primarily along the jaw, chin, and lower cheeks in the week before their period are likely experiencing hormonal acne driven by the relative androgen dominance in the luteal phase.

Stress

Stress increases cortisol, which in turn drives sebum production. Stress also affects the skin's inflammatory response, potentially worsening existing lesions.

Many people notice that their skin worsens during high-stress periods — this isn't coincidence.

Certain medications

• Lithium can cause acne-like eruptions
• Corticosteroids (prednisone, topical steroids on the face)
• Certain progestins in birth control — pills containing more androgenic progestins can worsen acne in susceptible women
• Testosterone and anabolic steroids

Skincare and haircare products

Comedogenic ingredients — those that clog pores — can trigger or worsen acne. Heavy moisturizers, sunscreens with certain emollients, and haircare products that contact the hairline and forehead are common culprits.

If your acne is primarily along the hairline or forehead, haircare products are worth examining.

Diet (potentially)

The evidence is still evolving, but high glycemic index foods and dairy products (particularly skim milk) have the most support as dietary acne triggers in susceptible individuals. A [2018 meta-analysis pooling nearly 80,000 people](https://pubmed.ncbi.nlm.nih.gov/30096883/) found dairy intake — especially skim milk — was associated with higher odds of acne. For some people, reducing these makes a meaningful difference; for others, diet has little effect.

Underlying conditions

PCOS is associated with acne due to elevated androgens. If your acne is accompanied by irregular periods, excess facial or body hair, or difficulty managing weight, PCOS is worth evaluating.

Why Standard Teen Acne Treatments May Not Work for Adults

Over-the-counter benzoyl peroxide and salicylic acid products are the workhorses of teenage acne treatment. They help many adults too — but their effects on hormonal acne are limited.

If your acne is primarily hormonal, you may need:

• Topical retinoids (tretinoin): Increase cell turnover, prevent pore clogging, reduce inflammation
• Topical or oral antibiotics: For inflammatory acne with bacterial involvement (antibiotics are typically used short-term to avoid resistance)
• Hormonal treatments: Combined oral contraceptives, spironolactone (an anti-androgen), or both. The [SAFA randomized trial published in the BMJ](https://pubmed.ncbi.nlm.nih.gov/37192767/) showed spironolactone meaningfully improved acne in adult women compared with placebo, offering a useful alternative to long-term oral antibiotics.
• Oral isotretinoin (Accutane): For severe or treatment-resistant acne

These all require a physician's prescription and oversight.

When to See a Doctor

If you've had acne for more than a few months, tried OTC products without meaningful improvement, or your acne is causing distress or scarring — a physician can prescribe effective treatment.

Waiting tends to mean more scarring, not the acne eventually resolving on its own. Most adult acne responds well when properly treated.

Ready to talk to a real doctor? Get started with Coral Health today.

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Sources

• Juhl CR et al. Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults. Nutrients, 2018. [PubMed](https://pubmed.ncbi.nlm.nih.gov/30096883/)
• Santer M et al. Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial. BMJ, 2023. [PubMed](https://pubmed.ncbi.nlm.nih.gov/37192767/)