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Adult Acne - Everything You Need to Know

Adult Acne Affects Men and Especially Women, and Can Present Itself Differently than Adolescent Acne

By: Dan Kern, Acne.org Founder & CSO
Last updated: April 25, 2020

The Essential Information

Adult acne is usually defined as acne that affects people over the age of 25.

About half of all people see acne end by the end of adolescence (around 18-20). For the other half, acne simply continues into adulthood.

However, for a minority of people, particularly women, acne can subside after adolescence and then make a resurgence in adulthood.

Adult acne in men: Exactly why acne continues in men is not fully understood, but normally it is as simple as "it hasn't gone away yet." That means, just like what caused acne in the first place, it is a potential combination of:

  1. Hormones: Higher levels of testosterone and other male hormones, and/or higher sensitivity to these hormones lead to more acne. 
  2. Genetics: If your father or mother also had adult acne, your chances go up.
  3. Physical irritation of the skin: Wearing a face mask for a sport or frequently wearing a baseball hat are 2 examples of physically irritating the skin that could keep a man in a cycle of acne. Constantly physically irritating the skin, and even more so when sweat is also involved, tend to bring about acne. Even constantly touching the skin can aggravate acne.
  4. Stress, smoking: Medical evidence at this point shows us that when the body is chronically attacked with stress or with harmful substances, It has a harder time keeping its organs in top shape. The skin is the body's largest organ, so while the evidence regarding stress, smoking, and acne is not yet overwhelming, replicated, and completely understood, it makes common sense that chronic negative assaults to the body could lead to more acne.

Treatment of adult men: Treating acne with a proper benzoyl peroxide regimen can keep the vast majority of men clear. However, in some cases of severe, widespread (particularly if on large areas of the body), and scarring acne, isotretinoin (Accutane) is an option that can be carefully and soberly considered.

Adult acne in women: While girls as a whole have less acne than boys, this balance flips in adulthood, with more women struggling with adult acne after the age of 25. This is thought to be because of the fluctuating hormones during the menstrual cycle, but may also be due to:

  1. Genetics: If your mother or father also had adult acne, your are also more likely to struggle with it.
  2. Physical irritation of the skin: Wearing a face mask for a sport or wearing a lot of makeup, particularly if you apply it or remove it roughly, are 2 examples of physically irritating the skin that make it much harder for a woman to stay clear. Constantly physically irritating the skin, and even more so when sweat is also involved, tend to bring about acne. Even constantly touching the skin with your hands or hair, especially when you are using potentially pore-clogging hair products, can aggravate acne.
  3. Stress, smoking: Medical evidence at this point shows us that when anyone's body is chronically attacked with stress or with harmful substances, it has a harder time keeping its organs in top shape. Based on the research that has been produced so far, when it comes to the body's largest organ--the skin--and when we look at acne in particular, women may be more susceptible to both stress and smoking when compared to men.

Treatment of adult women: Treating acne with a proper benzoyl peroxide regimen can keep the vast majority of women clear, even through the hormonal rollercoaster a menstrual cycle entails. However, when blood tests show a hormonal imbalance, particularly when levels of androgens (male hornones) are overly elevated, hormonal treatment, including oral contraceptives (the birth control pill) and/or anti-androgens, can be the treatment of choice that produce consistently good results as well. In some cases of very severe and scarring acne, a last resort option is isotretinoin (Accutane), an oral medication that comes with with many side effects--some of which can be lifelong--but can clear acne in extreme cases. Isotretinoin is the #1 birth defect-causing medication on the market. Consider it only if under the supervision of an experienced physician, and if it is taken, always use at least two (2) forms of responsible and dependable birth control. And as with any medication that permanently changes the body, have your eyes open to potentially long-term side effects.

The Science

Adult Acne Defined

People often think of acne as a condition that affects teenagers that disappears naturally after adolescence, but different studies have shown that significant percentages of adults experience acne as well. Adult acne is normally defined as acne in persons 25 years of age or older.1

The Two Types of Adult Acne

There are two types of adult acne.1

  1. Persistent acne begins during adolescence and continues into adulthood
  2. Late-onset acne begins during adulthood, affecting people who did not suffer from acne during adolescence

The Two Types of Adult Acne

Causes of Adult Acne

Although the underlying causes of adult acne have not been thoroughly investigated, researchers in a 2006 report published in the American Journal of Clinical Dermatology claim that many of the same biological processes and other factors related to adolescent acne may also play some role in adult acne:

American Journal of Clinical Dermatology

"However, thus far, no clear causes for the clinical difference between adult and adolescent acne have been delineated, although endocrine abnormality, genetic predisposition, antibiotic resistant Cutibacterium acnes, cosmetics, smoking, and emotional stress are regarded as potential risk factors for the development of adult acne."2

Let's explain these factors in layman's terms and look at what each entails.

Endocrine abnormality (hormone imbalance). Acne is generally caused by an imbalance of hormones, which are produced by the endocrine system. Androgens, which are male hormones that are also present in females to a lesser degree, are primarily responsible for triggering acne. The increased production of these hormones contributes to the following events, which work together to cause acne.

  1. Increased sebum (skin oil) production in the pores
  2. Skin pores that become clogged by the protein keratin - which is produced by skin cells called keratinocytes - thus trapping sebum
  3. Increased growth of the bacteria Cutibacterium acnes (C. acnes), which lives in everyone's skin - regardless of whether she has acne
  4. Inflammation, which is the characteristic that makes pimples red and swollen2,3

Adolescent acne usually goes away with age - when hormone levels stabilize - but adult acne still occurs in some people for reasons that are not fully understood.4

Genetic predisposition (genes). If a person's parents suffer from a certain disease, he is more likely to develop that disease. In the case of adult acne, people who have relatives or a family history of adult acne are more likely to deal with it as well. However, studies on twins have revealed that, in addition to genetics, environmental factors can also contribute.5-7

C. acnes grows inside a pore and may contribute to the redness that we see in inflamed pimples.

Some Cosmetics and skincare products contain pore-clogging ingredients. Dermatologists refer to products that tend to clog pores as "comedogenic."2

Emotional stress. It has not been proven, but some researchers believe that stress affects how the immune system responds to infections, including infections by C. acnes. Stress may also affect how the body regulates hormones, which can trigger acne.2

Smoking. Not everyone in the acne research community agrees that smoking causes acne - some studies support this idea, and some do not. Some researchers have suggested that smoking results in acne by altering the composition of sebum.8-10

Diet.Although some research has indicated that high-sugar foods can bring about acne in some people, studies on diet and acne are mostly reliant on surveys and lack rigorous testing methods.11

Causes of Acne

Comparison of Features in Adult and Adolescent Acne

There are some notable differences in how acne strikes adults compared to adolescents. Adult acne tends to affect women more than men, whereas adolescent acne affects boys more than girls. Adults with acne tend to get fewer comedones (clogged pores) than adolescents with acne, but adult acne can produce pimples with more inflammation. Consequently, adult acne leads to scarring more often than adolescent acne.1 Both adult and adolescent acne can affect the face, neck, and torso. Several studies have demonstrated that adult acne is particularly present on areas near the cheeks, chin, and mandible (jaw) in both men and women.1,12 - 14 Below is a visible comparison of the features often seen in adolescent and adult acne.15

Representative patients showing different observed characteristic of acne according to age of onset: (a) Typical features of adolescent acne: Many comedones on the forehead and a few papules (inflammatory lesions) on the cheeks are observed. (b) Late-onset acne: Papules distributed mainly on the cheeks and chin.

Adolescent Acne vs. Adult Acne

The differences in features of adolescent and adult acne are organized in the table below.1

Differences Between Adolescent Acne and Adult Acne

What Studies Can Tell Us about Adult Acne

Although there is much that researchers don't understand about adult acne, scientific studies have been able to provide answers to some of the questions that people may have about it. The table below summarizes answers to some of these questions, based on the best research that is currently available. Details about the studies are explained further in this article.

Questions and Answers About Adult Acne

Late-onset acne affects women more than men

Two large studies have shown that late-onset acne is much more common in women than in men.1,13

Expand to read details of studies

Indian Journal of Dermatology, Venereology & Leprology

In a 2012 study published in the Indian Journal of Dermatology, Venereology and Leprology, there was clear evidence that women are more affected by late-onset acne than men. The study included 280 adults with acne, 230 of which were women, and 50 were men. The participants were over 25 years of age, with the average age being 30.5 years. Late-onset acne was experienced by 26.8% of the participants. This group included mostly women - 73 females, compared to only 2 males. The other 73.2% of participants experienced persistent acne - a group that included 160 females and 45 males. The severity of acne was mostly moderate among males and females, and both genders also had similar types of acne.1

International Journal of Dermatology

The tendency for adult acne to affect women more than men was also shown in a 2011 study in the International Journal of Dermatology, which also looked at how acne affected different age groups. This study included 225 female and 320 male participants with acne. The average age of the female participants was 24.5 years, and the average age of the males was 23.1 years. The results showed that females over the age of 30 were far more likely to have adult acne than males over the age of 30. The table below shows this data, as well as how often acne occurred in the other age groups. Acne was most prevalent in the adolescent age groups, and less prevalent in the adult age groups.13

The second large study also looked at how often acne occurred in different age groups, and the results of this comparison are shown in the table below.13

Incidence of Acne Throughout Lifespan

Hormonal changes can cause acne to affect women in adulthood

Menstrual cycles may cause adult acne to affect women more than men. The cycles cause changes in androgen levels, which are related to premenstrual flares of acne in adolescents as well as adult females.

A recent study found that about a third of women with adult acne have abnormally high androgen levels.16 Excessive amounts of androgens at certain points during the menstrual cycle may be one of the factors contributing to adult female acne, as shown in the diagram below.

Expand to read details of study

Archives of Dermatological Research

A 2014 study in the journal Archives of Dermatological Research reported that among 28 female participants with adult acne, 37% also possessed excess amounts of androgens. The diagram below shows how this factor combines with other factors to cause adult acne in women.16

Adult Female Acne: Potential Contributing Factors

Persistent acne is more common than late-onset acne, and may be more severe

Adults who experience acne are far more likely to have persistent acne, rather than the late-onset variety. We have evidence of this from a large 2012 study that included nearly 1400 participants. This study found that among people with adult acne, over 80% suffer from persistent acne, and that persistent acne tends to be slightly more severe than late-onset acne. The researchers also concluded that adult acne is most common in people who are in their late 20s, and that acne incidence decreases in the following decades.1

Expand to read details of study

Acta Dermato-Venereologica Journal

This was shown in a 2012 study published in the journal Acta Dermato-Venereologica. The study included 1399 participants of all ages who had acne, both male and female. Adult acne affected 25.7% of the participants in the study. Of these adults, 83.3% had persistent acne, and the other 16.7% had late-onset acne. The researchers found that adult acne was most prevalent in people during their late 20s, with a decrease in the decades that followed. Other data from the study, noted in the table below, showed the following:1

  • Persistent acne cases were slightly more severe than late-onset acne
  • Persistent acne resulted in more premenstrual flares than late-onset acne
  • Women are affected by late-onset acne more than men

Adolescent Acne vs. Adult Acne: Gender

Another study confirmed the finding that persistent acne is more common than late-onset acne, and again, found that late-onset acne is more likely to strike women than men.1

Expand to read details of study

Indian Journal of Dermatology, Venereology & Leprology

The previously mentioned 2012 study from the Indian Journal of Dermatology, Venereology and Leprology also showed that persistent acne was more common than late-onset acne, and late-onset acne affected women more than men.1

Adolescent Acne vs. Adult Acne: Severity

The cheeks, chin, and jaw areas are most prone to adult acne

While adolescent and adult acne both affect the face, research shows that adult acne is particularly common on the cheeks, chin, and jawline.1

Expand to read details of research

Indian Journal of Dermatology, Venereology & Leprology

In the previously mentioned 2012 study published in the Indian Journal of Dermatology, Venereology and Leprology, researchers recorded where acne occurred among the 280 male and female adult participants, and found that:1

  • 81% of the participants had acne on the cheeks
  • 67% of the participants had acne on the chin
  • 58.3% of the participants had acne on the jaw area

Incidence of Adult Acne on Cheeks, Chin and Jaw Area

The graph below shows the similarities and differences in how men and women with adult acne experienced acne on the U-zone as well as on the T-zone, which comprises forehead and nose areas.1

Distribution of Acne on Face: By Gender

Late-onset acne causes fewer comedones, but more inflammation than persistent acne

A study that looked at women with adult acne found that women suffering from late-onset acne had fewer acne lesions than women with persistent acne. However, the researchers also observed that lesions in late-onset acne were more inflamed or swollen compared to lesions in persistent acne.15

Expand to read details of study

The Journal of the European Academy of Dermatology and Venereology

A 2011 study published in the Journal of the European Academy of Dermatology and Venereology focused on the differences between persistent and late-onset adult acne in women. The study showed that late-onset acne was generally less severe and presented fewer comedones than persistent acne. This study included 89 female participants with adult acne and distinguished them based on the age at which their acne began. Researchers defined late-onset acne as acne occurring after the age of 21. Cases of acne that started before 21 years of age were considered persistent adult acne. The results showed that women with late-onset acne had fewer lesions, but those lesions were more inflamed or swollen. This study also provided more data showing that adult acne is likely to occur on the U-zone, while adolescent acne may be more likely to occur on the T-zone. The researchers also found that the levels of C. acnes and sebum production in the skin were similar in both late-onset and persistent adult acne types.15

The proportion of adults who have acne varies widely

A variety of acne studies conducted on groups of people in different countries reported incidences of adult acne. The following table summarizes the findings, and how they are categorized. There is some variation in how prevalent acne is, depending on gender, age, and ethnicity. Because of these variations, it is difficult to estimate how often adult acne that would be true for all adults occurs. But generally, we estimate that 31.9% of women and 20.5% of men between the ages of 20 and 70 years old are affected by acne, based on these studies.

Study-results on how genders are affected by adult acne:17-21

Adult Acne Study Results: Gender

Study-results on how the frequency of adult acne diminishes with age:18, 22

Adult Acne Study Results: Age

Study-results on how often adult acne occurs in different ethnicities:23-25

Adult Acne Study Results: Ethnicity

Conclusion

Adult acne is caused by the same factors as adolescent acne, but there are some notable differences in how it presents. Persistent adult acne is far more common than late-onset adult acne. Late-onset adult acne tends to affect women more than men, but adult acne in general is particularly common on the cheeks, chin, and jawline. In these regions, fewer comedones but more inflammation are seen than in adolescent acne.

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References:

  1. Khunger, N. & Kumar, C. A clinico-epidemiological study of adult acne: Is it different from adolescent acne? Indian J. Dermatol. Venereol. Leprol. 78, 335 (2012). https://www.ncbi.nlm.nih.gov/pubmed/22565434
  2. Williams, C. & Layton, A. M. Persistent Acne in Women Implications for the Patient and for Therapy. Am. J. Clin. Dermatol. 7, 281 - 290 (2006). https://www.ncbi.nlm.nih.gov/pubmed/17007539
  3. Dawson, A. L. & Dellavalle, R. P. Acne vulgaris. BMJ 2634, 1 - 7 (2013). https://www.ncbi.nlm.nih.gov/pubmed/23657180
  4. Tom, W. L. & Barrio, V. R. New insights into adolescent acne. Curr. Opin. Pediatr. 20, 436 - 440 (2008). https://europepmc.org/abstract/med/18622200
  5. Bhate, K. & Williams, H. C. Epidemiology of acne vulgaris. Br. J. Dermato.l 168, 474 - 485 (2013). https://www.ncbi.nlm.nih.gov/pubmed/23210645
  6. Walton, S. H., Wyatt, E. H. & Cunliffe, W. J. Genetic control of sebum excretion and acne - a twin study. Br. J. Dermatol. 118, 393 - 396 (1988). https://www.ncbi.nlm.nih.gov/pubmed/2965597
  7. Bataille, V., Snieder, H., Macgregor, A. J., Sasieni, P. & Spector, T. D. Twin study of acne in women. J. Invest. Dermatol. 119, 1317 - 1322 (2002). https://www.ncbi.nlm.nih.gov/pubmed/12485434
  8. Yang, Y. S. et al. Cigarette smoke-induced interleukin-1 alpha maybe involved in the pathogenesis of adult acne. Ann. Dermatol. 26, 11 - 16 (2014). https://www.ncbi.nlm.nih.gov/pubmed/24648681
  9. Wolkenstein, P. et al. Smoking and dietary factors associated with moderate-to-severe acne in French adolescents and young adults : results of a survey using a representative sample. Dermatology 19, 1 - 6 (2014). https://www.karger.com/Article/Abstract/366195
  10. Lynn, D., Umari, T., Dunnick, C. & Dellavalle, R. The epidemiology of acne vulgaris in late adolescence. Adolesc. Health. Med. Ther. 7, 13 - 25 (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769025/
  11. Youssef, E. M. & Youssef, M. K. Diet and acne in upper Egypt. Am. J. Dermatol. Venereol. 3, 13 - 22 (2014). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080563/
  12. Swathi, G. & Kusagur, M. S. A clinico-epidemiological study of acne in adults. Int. J. Sci. Res. 4, 2013 - 2016 (2015). https://www.jbclinpharm.org/articles/drug-utilizing-pattern-for-acne-vulgaris-in-a-tertiary-care-teaching-hospital-3932.html
  13. Suh, D. H. et al. A multicenter epidemiological study of acne vulgaris in Korea. Int. J. Dermatol. 50, 673 - 681 (2011). https://www.ncbi.nlm.nih.gov/pubmed/21595660
  14. Dréno, B. et al. Large-scale international study enhances understanding of an emerging acne population: Adult females. J. Eur. Acad. Dermatol. Venereol. 29, 1096 - 1106 (2015). https://www.ncbi.nlm.nih.gov/pubmed/25296739
  15. Choi, C. W. et al. The clinical features of late onset acne compared with early onset acne in women. J. Eur. Acad. Dermatol. Venereol. 25, 454 - 461 (2011). https://www.ncbi.nlm.nih.gov/pubmed/20659307
  16. Albuquerque, R. G., Rocha, M. A., Bagatin, E., Tufik, S. & Andersen, M. L. Could adult female acne be associated with modern life? Arch. Dermatol. Res. 306, 683 - 688 (2014). https://www.ncbi.nlm.nih.gov/pubmed/24952024
  17. Shen, Y. et al. Prevalence of acne vulgaris in Chinese adolescents and adults: A community-based study of 17,345 subjects in six cities. Acta. Derm. Venereol. 92, 40 - 44 (2012). https://pdfs.semanticscholar.org/c638/70a8e25bd12b097dac2791015f013b5cbcca.pdf
  18. Collier, C. N. et al. The prevalence of acne in adults 20 years and older. J. Am. Acad. Dermatol. 58, 56 - 59 (2008). https://www.ncbi.nlm.nih.gov/pubmed/17945383
  19. Poli, F., Dreno, B. & Verschoore, M. An epidemiological study of acne in female adults: Results of a survey conducted in France. J. Eur. Acad. Dermatol. Venereol. 15, 541 - 545 (2001). https://www.ncbi.nlm.nih.gov/pubmed/11843213
  20. Goulden, V., Stables, G. I. & Cunliffe, W. J. Prevalence of facial acne in adults. J. Am. Acad. Dermatol. 41, 577 - 580 (1999). https://www.ncbi.nlm.nih.gov/pubmed/10495379
  21. Cunliffe, W. J. & Gould, D. J. Prevalence of facial acne vulgaris in late adolescence and in adults. Br. Med. J. 1, 1109 - 10 (1979). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1598727/
  22. Perkins, A. C., Maglione, J., Hillebrand, G. G., Miyamoto, K. & Kimball, A. B. Acne Vulgaris in Women: Prevalence Across the Life Span. J. Women's Health (Larchmt) 21, 223 - 230 (2012). https://www.ncbi.nlm.nih.gov/pubmed/22171979
  23. Kiprono, S. K. & Wamburu, G. Acne vulgaris in general population of rural western Kenya: Cross-sectional community survey. Int. J. Dermatol. 55, e212 - e214 (2016). https://www.ncbi.nlm.nih.gov/pubmed/26567059
  24. Perkins, A. C., Cheng, C. E., Hillebrand, G. G., Miyamoto, K. & Kimball, A. B. Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women. J. Eur. Acad. Dermatol. Venereol. 25, 1054 - 1060 (2011). https://www.ncbi.nlm.nih.gov/pubmed/21108671
  25. Dalgard, F., Holm, J. Ø., Svensson, A., Kumar, B. & Sundby, J. Self reported skin morbidity and ethnicity: a population-based study in a Western community. BMC Dermatol. 7, 4. (2007). https://www.ncbi.nlm.nih.gov/pubmed/17603893

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