8 causes of adult acne—and how to treat it

Acne, sometimes called acne vulgaris, is the most common chronic skin condition in the United States; it impacts people of all races and ages. In fact, according to the American Academy of Dermatology (AAD), up to 50 million Americans are affected by acne each year. Though the skin disorder is most common in adolescents and young adults between the ages of 12 and 24, acne breakouts, papules, and blackheads can continue well into adulthood. Even if you’ve never experienced it before, acne can arise in your 30s to 50s, referred to as adult-onset acne. Here, experts explain why acne occurs in adults and what to do about it.

8 causes of adult acne

Acne is most common in the teenage years, but it doesn’t always end after puberty. In many people, acne blemishes resolve in their 30s, but it’s possible for older adults to get acne, too. “Acne is the most common skin disorder period,” says Flor Mayoral, MD, a dermatologist at Mayoral Dermatology in Coral Gables, Florida. “It’s prevalent in all races, ethnicities, and age groups.”

Adult acne causes are similar across all age groups. “Adult acne can be the product of several factors that are similar to adolescent breakouts,” says Lucy Chen, MD, FAAD, a board-certified dermatologist at Riverchase Dermatology in Miami, Florida. “The most common factors are excess oil production, clogged pores, inflammation, and bacteria.” Testosterone (a hormone found in males and females) is the underlying cause of all the acne processes. Testosterone causes oil production near the skin, which can clog pores, attract acne, promote inflammation, and trigger breakouts.

Learn all the potential causes of acne as an adult:

1. Hormonal fluctuations
2. Clogged pores
3. Bacteria
4. Inflammation
5. Genetics
6. Diet
7. Heat and humidity
8. Medications

1. Hormonal fluctuations

Sudden breakouts often occur during times of hormonal changes due to weight changes, stress, and certain medications, and the menstrual cycle, pregnancy, menopause in women. 

“[In women], a breakout could happen around your period if you’re on/off birth control or even pregnant,” Dr. Chen says. “Any fluctuation in hormone levels can stimulate sebaceous glands to produce excess oil.”

Pay attention to patterns of acne breakouts that could be hormone-related. “Hormonal breakouts usually affect the face [especially on the chin and along the jawline],” Dr. Chen says.

The condition polycystic ovary syndrome, which causes the ovaries to produce more androgens (commonly known as testosterone), is also associated with increased risk of acne. Certain hormonal treatments such as combined hormonal birth control pills, contraceptive patch, or vaginal ring, or oral spironolactone can help with getting your hormone levels under control. Be sure to consult with your primary care provider or dermatologist for treatment options.

2. Clogged pores

The underlying cause of a breakout can vary depending on the type of acne, but dead skin cells trapped on the surface of skin is a universal trigger. “While there are many forms and causes of acne, the main cause of acne is overproduction of sebum [an oily, waxy substance] and clogged pores,” says Michele Green, MD, a cosmetic dermatologist in New York, NY.

“Sweat, dirt, oil, and friction on your body can cause acne,” Dr. Chen says. “Whether it’s on your chest, shoulders or back, it’s all coming from the same place—a clogged pore with excess oil getting inflamed and leading to acne.”

Skincare products (like lotions and moisturizers), makeup, sunscreen, and even hair products can clog your pores, too. This type of acne is called acne cosmetica. Make sure to wash your face before going to sleep, and always make sure to use oil-free and non-comedogenic products. “These topical treatments don’t stimulate excess oil production or clogged pores,” Dr Chen says. Good daily skin care involves using a gentle skin cleanser and oil free moisturizer with sunscreen. Scrubbing your skin or using drying soaps may actually make skin worse.

3. Bacteria

Redness, papules, nodules, and cysts result when bacteria moves into the area of oil and sebum build-up and causes a local inflammatory reaction. There are a variety of bacteria that can cause acne inflammation. Sometimes even certain types of fungus or yeast can cause inflammation. Part of acne treatment involves using bacteriostatic gels or creams (such as benzoyl peroxide), antibiotics (such as gels, creams, or oral medications), or antibacterial therapies (such as bleach baths and hibiclens washes). In the event that fungus is contributing to the outbreaks, then antifungal therapies may be helpful.

4. Inflammation

Acne forms when sebum and oil become trapped in the sebaceous glands (oil glands) of the skin. “Once the glands are clogged, the bacteria that normally lives there begins to multiply rapidly, causing inflammation in the skin cells,” Dr. Green says. “This inflammation is what causes the pimples, pustules, and cysts associated with acne.” 

Inflammation is already at play prior to a breakout. “Even before you see an acne lesion, there’s an increase in inflammation that takes place, and it can happen at any age,” says Dr. Mayoral. In fact, research indicates that acne is primarily an inflammatory skin disease, and the inflammation begins very early on, prior to the development of acne lesions. Elevated levels of CD3+ and CD4+ T cells (lymphocytes triggered by an immune response in the body) have been identified in the normal, pre-breakout skin of acne patients, indicating that an inflammatory response is already happening before a breakout starts.

5. Genetics

Acne is not selective and anyone can get it, though some individuals are genetically predisposed. According to the AAD, people with a close family member, such as a sibling or parent who has acne, are more likely to get it, too. But even when acne is hereditary, it can still be successfully treated. “All forms of acne are treatable; however, some forms take longer to treat than others,” says Dr. Green. “The treatment of acne should be taken seriously … to prevent scarring.”

6. Diet

Inflammation and diet are intricately connected. Eating certain foods that contain a high sugar load can cause skin inflammation, contributing to breakouts. Some experts recommend avoiding spicy foods, chocolate, cola, and highly processed foods to help curtail acne.  There is limited evidence that a high protein, low glycemic diet may also be helpful in reducing breakouts. It is a myth that junk food, greasy foods, chocolate, or sugar alone cause acne.

“When it comes to your diet, cutting back on dairy and focusing on low glycemic intake can help lessen sebum production, contributing to oil production and acne,” Dr. Green says. A low glycemic diet focuses on unprocessed whole grains, whole fruits and vegetables, legumes, nuts, lean proteins, and healthy fats to help keep your blood sugar levels down, thus reducing inflammation in the body.

7. Heat and humidity

Heat and humidity can cause an increase in the bacteria that causes acne. That’s the reason why people are more likely to develop acne—or maskne—when they wear a face mask. “The temperature and the humidity is extremely high where you have the mask,” says Dr. Mayoral. “I have seen patients only develop acne in the area where the mask touches the skin. A synthetic or rough fabric may cause a little bit of friction and make the acne worse in the area where the mask touches the face.” Try swapping out the type of face mask you’re using if acne is developing in the area.

Sport-specific gear such as football padding or bicycling helmets may also cause friction that results in acne. “When you have mechanical friction, the acne can get worse in the areas where there’s contact with something like a football helmet,” Dr. Mayoral says. This type of acne, called acne mechanica, often responds well to over-the-counter products that contain benzoyl peroxide or salicylic acid. Also, it is important to shower or bathe as soon as possible after sweating heavily to clean off sweat, bacteria, and unclog pores. Additionally, it is helpful to wear breathable/wickable clothing and wipe down equipment with an antibacterial solution or wipe after using it (helmets, pads, eyewear, etc).

RELATED: Does working out cause acne?

8. Medications

Some medications can trigger acne breakouts as a side effect. Research indicates that oral corticosteroids, certain contraceptives, testosterone, and anabolic steroids can cause acne-like skin eruptions. The following may also aggravate or worsen acne: 

• Progesterone containing contraceptives, particularly the hormonal implant, the progesterone injection, progesterone intrauterine device, and progesterone pills
• Steroids including ones commonly used for respiratory and autoimmune disease 
• Halogen compounds such as iodine, bromine, fluorine, and chlorine
• Antiepileptic drugs such as carbamazepine, phenytoin, and phenobarbital
• Antibiotics used to treat tuberculosis including ethionamide, isoniazid, and rifampin
• Antidepressants such as lithium and amoxapine
• Cyclosporin A
• Epidermal growth factor receptor (EGFR) inhibitors such as cetuximab, gefitinib, and erlotinib
• Biologic agents such as TNF alpha inhibitors 
• Azathioprine 
• Rebif
• Clofazimine
• Gold salts

Does adult acne go away?

Adult acne can be a hassle, but there are many treatment options available to prevent and minimize breakouts. With an appropriate treatment plan and lifestyle changes, acne can go away. Effective and safe treatments include both over-the-counter and prescription treatments.

The first step in treating acne is having good skincare routines. Wash skin once a day with a gentle unscented cleanser. You do not need to wash skin more than once a day unless you are sweating heavily or working in a dirty or greasy environment. Harsh soaps and scrubbing are not recommended as they may promote irritation or inflammation. Use an oil-free unscented moisturizer after cleansing the skin with sunscreen and use only oil-free and unscented cosmetic products.

Next, use products with acne-treating ingredients. Look for benzoyl peroxide, salicylic acid, azelaic acid, tretinoins, and glycolic acid. “These ingredients are effective at controlling excess sebum production that contributes to acne,” Dr Green says.

OTC and prescription treatments

There are multiple OTC and prescription remedies for adult acne available. Effective medications include:

• • Retinoids to unclog pores and calm inflamed skin (available OTC)
  • Antibiotics, including topical and oral treatments including erythromycin, clindamycin, tetracycline, and doxycycline
  • Azelaic acid to soothe inflammation (available OTC)
  • Oral anti-adrenergics such as spironolactone
  • Oral contraceptives to balance hormone levels
  • Oral isotretinoin which can treat acne, as well as cause long term remission, and reduce redness and scarring

Adult acne treatments
Drug name	Rx or OTC?	Considerations	Coupons
Benzoyl peroxide	OTC	None	Get benzoyl peroxide coupons
Salicylic acid	OTC	Can cause skin irritation	Get salicylic acid coupons
Glycolic acid	OTC	Do not use along with products containing retinol	Get glycolic acid coupons
Differin (adapalene)	Rx	Use with caution if pregnant or breastfeeding	Get Differin coupons
Isotretinoin (formerly known as Accutane)	Rx	Contraindicated if pregnant or breastfeeding, if you have high cholesterol, liver disease, anorexia, alchoholism, depression, suicidal thoughts, or if you are obese	Get isotretinoin coupons
Erythromycin	Rx	Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding	Get erythromycin coupons
Dapsone	Rx	Pregnancy  class C medication	Get Dapsone coupons
Doxycycline	Rx	Do not use during pregnancy; avoid exposure to sunlight and wear sunscreen, can cause severe sunburn	Get doxycycline coupons
Azelaic acid	Rx	May cause skin irritation; use with caution when pregnant or breastfeeding (Pregnancy class B)	Get azelaic acid coupons
Yaz	Rx	Should not be used in patients with liver or kidney disfunction, breast cancer,  abnormal uterine bleeding, pregnant women, or smokers	Get Yaz coupons
Estrostep Fe	Rx	Should not be used in patients with liver or kidney disfunction, breast cancer,  abnormal uterine bleeding, pregnant women, or smokers	Get Estrostep Fe coupons
Beyaz	Rx	Should not be used in patients with liver or kidney disfunction, breast cancer,  abnormal uterine bleeding, pregnant women, or smokers	Get Beyaz coupons
Spironolactone	Rx	Avoid potassium supplements and foods high in potassium. Consult with your doctor if pregnant or breastfeeding	Get spironolactone coupons
Winlevi	Rx	Avoid using with products that contain salicylic acid and on dry or damaged skin	Get Winlevi coupons

Natural remedies

“There are a number of natural remedies available that can be used to complement different acne medications and skincare products,” says Dr. Green. However, there is very little evidence to support the safety and effectiveness of these treatments.

• Applying tea tree oil or topical zinc. “Tea tree oil and topical zinc have antibacterial properties and can help minimize or clear up body acne,” Dr. Green says. Use caution as these can be poisonous to children and pets.
• Using green tea. Some people have succeeded in treating acne with green tea, which has potent anti-bacterial and anti-inflammatory properties. Turmeric also has these properties.
• Changing your diet. For older adults with severe acne or chronic cystic acne, try eliminating dairy products to avoid flare-ups.
• Trying supplements. “Supplements like zinc and fish oil have also helped some people decrease acne breakouts. A proven supplement that can address diet, hormones, and even stress in one is vitamin B6,” says Dr. Chen. “Taking a pill every day could help the body produce neurotransmitters, including serotonin, making you feel happier.“

If your acne is stubborn, and nothing seems to be working, you can always seek medical care. “It’s very important to treat acne deliberately and effectively in order to prevent permanent scarring,” says Dr. Green. “Acne scars develop as a result of damage done to the skin tissue caused by inflammation around the acne lesions. Medical treatment for acne is the most efficient form of care and the best way to prevent scarring.”