Acne in Adults: What causes it?

Woman looking in the mirror, checking her face.

Acne, those annoying spots and pimples we associate with teenagers, can still plague some of us well into our 30s and 40s. Acne is a common skin problem particularly during the teenage years, but for some it can continue for decades after adolescences or even appear for the first time later in life.

Experts now recognise two separate types of adult acne: the more common ‘persistent’ form which has stubbornly held on since adolescence and the less common ‘late onset’ acne that pops up in adulthood.

Unlike teenage acne where boys are likely to be more severely affected than girls, more women than men tend to have and seek help for adult acne. For most men it’s simply a case of acne that has persisted from adolescence, while women have the persistent form and many also experience late onset acne.

Dermatologists have been noticing more adult acne than they used to and it’s lasting longer. Even though acne is not a life-threatening disease, self-esteem and body image can take a battering and scarring is more likely if it persists over long periods. So it’s important to treat your acne early, try and understand what’s causing it and how to help prevent it.

Causes of Adult Acne

We don’t yet fully understand all the causes of adult acne, but persistent acne is seen as a continuation of the teenage form and may share similar features such as:

  • Increased oil (sebum) production by glands in the face, neck, back and shoulders – caused by increased amounts of androgen hormones (usually seen in puberty)
  • The oil and skin cells block skin pores (hair follicles), which can lead to blackheads and whiteheads
  • Bacterial activity in the blocked pores leads to inflammation, resulting in red, angry spots.

Late onset acne is trickier to explain as it starts well after all the hormonal fluctuations of puberty should have finished. Factors that have been suggested as possibly contributing to adult acne include:

  • Cosmetics – which may aggravate your acne, but are probable not the cause. Try using ‘non-comedogenic’ formulations which are less likely to block skin pores and make things worse
  • Genetics – there may be a family history of adult acne (one study found that 50% of people with adult acne had a first-degree relative with the same condition)
  • Hormone fluctuations caused by using oral contraceptives, pregnancy, periods, menopause, and increases in androgen hormones (for example, due to polycystic ovary syndrome or some medicines).  Most women who suffer from acne find that it gets worse just before their period starts as hormone levels vary through the mensural cycle. These premenstrual flare-ups can occur in both persistent and late onset forms of acne.
  • Environmental factors, such as stress (which may trigger hormone changes), diet and smoking, have also been linked to acne.

Managing Adult Acne

Day-to-day management of adult acne is really no different from that recommended for the treatment of acne in adolescents. However, because of its persistence, longer or more aggressive treatments may be recommended for what might be considered relatively mild symptoms.

You can help control mild symptoms with over-the-counter topical acne treatments available without a prescription at pharmacies and supermarkets. For example, using anti-bacterial washes, such a pHisohex, as part of your daily routine may help as they kill bacteria and remove dirt and oils that can block skin pores.

More severe acne may require additional measures, such as oral antibiotics and retinoids, or a combination of treatments. Some people may need hormonal treatments to help control their acne, particularly if it is linked to androgen imbalances.

Everyone is different and so is their experience of adult acne. You should talk to your doctor and find out the best type of treatment for your acne.


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