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How Is Teen Acne Different from Adult Acne?

Females Tend to Be More Affected as Adults, and All Adults Tend to See Breakouts More Around the Chin and Jawline

By: Dan Kern, Acne.org Founder & CSO
Last updated: November 29, 2019

The Essential Information

Age: Adolescent acne, often referred to as "teen acne," affects people 25 years of age and younger, while adult acne affects people older than 25.

Overall prevalence: Teen acne is more common than adult acne.

Gender: Teen acne is more common in males, while adult acne--especially late-onset acne--is more common in females.

Location of breakouts: Teen acne often includes breakouts on the forehead and temples, where as in adult acne, breakouts are more common on the lower half of the face.

What they have in common: Teen and adult acne have in common that they are both hormonal conditions, are passed down in a family through genetics, and may be affected by diet.

The Science

What Are the Definitions of Teen and Adult Acne?

Acne is classified as either:

  1. Adolescent or teen acne, which occurs in people under 25 years of age.
  2. Adult acne, which is acne that occurs in people over 25 years of age, and can be either persistent or late-onset.
    • Persistent acne: If teen acne never goes away and sticks around past the age of 25, it becomes adult acne and is called persistent acne.
    • Late-onset acne: If acne shows up spontaneously after the age of 25, it's called late-onset acne. Late-onset acne can be further broken down into either chin acne or sporadic acne.
      • Chin acne: Breakouts occur on the chin and around the mouth.
      • Sporadic acne: Breakouts can show up anywhere on the skin.

In both teens and adults, acne develops the same way. First, skin pores are clogged with dead skin cells. Skin oil (sebum) gets trapped inside the clogged pore, which then causes an overgrowth of acne bacteria (P. acnes). This leads to inflammation, breakouts, and possibly scarring.2

Persistent Acne and Late-onset Acne are Two Types of Adult Acne Vulgaris

Although teen and adult acne are the same skin disease, teen acne is much more common than adult acne.

Acta Dermato-Venereologica

A comprehensive study of over 17,000 Chinese acne sufferers published in 2012 in the journal Acta Dermato-Venereologica found that only 25% of all acne cases were adult acne, most of which were persistent.3

Differences in Symptoms Between Teen and Adult Acne

Teen and adult acne differ in type of breakouts, location of breakouts, and presence or absence of scarring.

Teen acne:

  1. Type of breakouts: A combination of inflammatory lesions (papules, pustules, nodules, and cysts)4 and non-inflammatory lesions (whiteheads and blackheads)
  2. Location of breakouts: Usually on the forehead, nose, and chin4
  3. Scarring: Less common in teen acne than in adult acne5

Adult acne:

  1. Type of breakouts: Mainly papules and pustules5
  2. Location of breakouts: Usually on the cheeks and lower part of the face, including the chin and jawline.5 More breakouts around the mouth, on the neck, chest, and on the back in adult acne than in teen acne.6
  3. Scarring: More common in adult acne. Doctors believe that scarring is more common in adult acne because there are more inflammatory breakouts in adult acne, and adult acne is more resistant to treatment and takes longer to heal.5

Expand to read details of studies


Teen acne

International Journal of Dermatology

A study conducted in Korea and published in 2011 in the International Journal of Dermatology found that when teens have their first acne breakouts, these occur in the same locations for males and females, except that teen males have more acne on the neck and chest.6

Adult acne

International Journal of Science and Research

A study of adult acne sufferers aged 26 to 45 in India, which was published in 2013 in the International Journal of Science and Research, described the most common sites of acne in adults:

The most common site of involvement was cheeks 80% followed by chin 66%, [jaw] 52%, forehead 48% and nose 16%. [Acne on the trunk (torso) of the body] was rare and was seen in only 6% of the patients. Nature of the skin was dry in 54% and oily in 46%.7

Differences in Symptoms Between Teen and Adult Acne

Sex Differences Between Teen and Adult Acne

  • Teen acne: More common in males.
  • Adult acne: Normally equally common in both sexes, but more common in females if it is late-onset acne.

Expand to read details of studies


Teen and adult acne

Acta Dermato-Venereologica

According to the same large Chinese study discussed above, from the late teens to the early twenties, more males than females have acne. After age 30, however, more females than males have acne.3

The researchers also found that males and females are equally affected by persistent acne, but the majority of late-onset acne sufferers are women. Two other studies which were mentioned above--one conducted in Korea and the other in India--also agree that when we look at adult acne overall, it is more likely to affect women than men.3,6,7

Sex Differences in Teen and Adult Acne

Differences in Causes of Teen and Adult Acne

Despite the differences in their symptoms, teen and adult acne typically share the same causes:

  • Hormonal imbalance
  • Family history
  • Diet

Smoking and alcohol consumption show a much weaker potential connection.3,8,9

Let's take a closer look at each potential cause, starting with hormonal imbalance.

Hormonal imbalance

In both teens and adults, an increase in the level of androgens (male hormones present in both males and females) in the body must occur for acne to form. This increase in androgens may be caused by:

  • Teen acne: Males and females: Puberty or poor diet. Females only: Poly-cystic ovary syndrome or pregnancy.
  • Adult acne: Males and females: Ongoing hormonal imbalance or poor diet. Females only: Pregnancy or poly-cystic ovary syndrome.

The increased androgen levels stimulate the growth of skin oil glands under the skin, resulting in increased production of skin oil (sebum), which can lead to a cascade involving acne bacteria (P. acnes) and inflammation, and ultimately acne.10

An Increase in Androgens Lead to An Increase in Acne

Family history

The following British Journal of Dermatology article sums it up. If acne runs in your family, you are more likely to suffer with it as well.

British Journal of Dermatology

Both teens and adults are much more likely to develop more severe acne, and teens are likely to develop acne earlier, if they have at least one first-degree family relative (a parent, sibling, or child) with acne. According to an overview article published in 2012 in the British Journal of Dermatology, "Acne occurs earlier and is more severe in those with a positive family history."11

Several research groups have investigated the role of genetic (hereditary) factors in both teen and adult acne by studying pairs of twins at different ages. Identical twins are exactly the same genetically, whereas non-identical twins are genetically similar as a pair of siblings who are not twins.

Expand to read details of studies


Teen acne

British Journal of Dermatology

One study of twins, published in 1988 in the British Journal of Dermatology, compared production of sebum and severity of acne in teens 12 - 18 years old.12 The researchers found the following.

- Identical twins: Same rates of sebum production, different degrees of acne severity

- Non-identical twins: Different rates of sebum production, different degrees of acne severity

The authors concluded that genetic factors control sebum production, since genetically identical twins displayed essentially the same rate of sebum production. However, since even genetically identical twins showed different degrees of acne severity, the researchers deduced that environmental factors must also affect the development of acne lesions.12

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Another study on teens, published in 2005 also in the British Journal of Dermatology, compared the severity of acne in 778 pairs of twins.13 Each teen was examined at three different ages:

- Age 12: Checked for acne on the face, chest, and back

- Age 14: Checked for acne on the face, chest, and back

- Age 16: Checked for acne on the face

The authors reported that severity of acne at all sites and ages was strongly influenced by genetic factors, but was also affected by environmental factors. Genetics played a particularly large role in:

  • Acne on the back
  • Acne on the face in 14-year-old girls13

Adult acne

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A third twin study published in 2002 in the Journal of Investigative Dermatology examined the impact of genetic and environmental factors on adult acne in the United Kingdom. The researchers examined 458 pairs of identical and 1099 pairs of non-identical twins, all women with an average age of 46 years. The authors concluded that adult acne possesses a strong genetic basis, since the vast majority of the differences in acne severity between different people in the study could be explained by family history.14

Diet

In both teens and adults, diet is the third most frequently implicated factor by scientists in acne development and severity.9 However, research is still trickling in, and no firm conclusions can yet be made.

Diet suspect #1: Food with a high glycemic load

  • Teen acne: Sugary foods may increase skin oil (sebum) production and teen acne.
  • Adult acne: Sugary foods may increase sebum production and adult acne.

For both teens and adults, food that possesses a high glycemic load (cause spikes in blood sugar) may contribute to acne development. Examples of such foods include white bread, white rice, pasta, soda, or candy. Some foods with a low glycemic load include fish/meat, vegetables, nuts, or oils.

Eating high-glycemic load food increases the production of a hormone called insulin in the body. Because insulin is a "master" hormone, which controls other hormones, it increases the amount of male hormones (androgens) in the blood. As discussed above, an increase in androgens possibly leads to increased sebum production and acne.15

High Glycemic Diet May Increase Acne

Diet suspect #2: Dairy products

  • Teen acne: There might be a weak connection between dairy (milk products) and teen acne, but the science is still not in on this.
  • Adult acne: There might be a weak connection between dairy and adult acne, but the science is still not in.

There is still no strong evidence linking any dairy products to teen or adult acne. The studies that we will discuss below are based on questionnaires, which are prone to error. In order to show that dairy products cause acne, researchers will need to conduct a randomized controlled trial. This is a type of experiment in which half of the patients are randomly assigned to a group which consumes dairy products, and half of the patients are assigned to a group which does not. At the end of the experiment, the researchers compare the acne between the two groups. Until such an experiment is performed, the evidence for the role of dairy products in teen and adult acne will remain unconvincing.15,16

Expand to read details of studies


Teen acne

Journal of the American Academy of Dermatology

A study published in 2008 in the Journal of the American Academy of Dermatology examined the association between dairy intake and teen acne in boys and girls aged 9 - 15 years. The researchers found a link between drinking skim milk and teen acne. This link was stronger in girls than in boys. The authors suggested that the difference between boys and girls that was responsible for this may be that girls at this age are at a biologically more advanced stage of maturation.17

Both teen and adult acne

BMC Dermatology

Another study published in 2012 in the journal BMC Dermatology investigated the connection between ingesting dairy products and acne in Malaysian teens and adults aged 18 - 30. The authors found:

- A link between frequency of drinking milk and acne

- A link between frequency of eating ice cream and acne

- No link between frequency of eating fermented dairy products (yogurt, cheese) and acne16

The researchers reported that young adults who drank milk or ate ice cream at least once per week were four times as likely to have acne as those who did not.16

Smoking

  • Teen acne: Smoking may be linked to teen acne, but the evidence is contradictory.
  • Adult acne: Smoking may be linked to adult acne, but the evidence is contradictory.

For both teens and adults, the link between cigarette smoking and acne remains controversial. Despite studies establishing a positive association between the two,18,19 a few studies have reported no association or even claimed that cigarette smoking offers some sort of protection against acne in both teens and adults.20

Expand to read details of studies showing a link between smoking and acne


Teen acne

Acta Dermato-Venereologica

The large Chinese study mentioned earlierfound a link between being a smoker or ex-smoker and having teen acne.3

Adult acne

Dermato-Endocrinology

A study published in 2009 in the journal Dermato-Endocrinology examined symptoms of adult acne and any possible correlation with cigarette smoking in women aged 25 - 50 years. The authors found that cases of smoking were strongly linked with adult acne.18

Annals of Dermatology

Another study, published in 2014 in the Annals of Dermatology, examined 23 men and 27 women aged 25 - 45 years and also reported a possible link between cigarette smoking and adult acne.19

Expand to read details of studies showing no link between smoking and acne


Teen acne

Dermatology

On the other hand, a report published in 2015 in the journal Dermatology investigated the link between smoking and teen acne in French youth aged 15 - 24. The researchers found no evidence that smoking more than 10 cigarettes per day causes teen acne. In fact, their results seemed to suggest that smoking offered some kind of protection against severe acne.20 The authors wrote:

In comparing the smoking habits of individuals reporting to have acne with those reporting not to have acne, tobacco smoking was associated with no acne. Tobacco smoking seems to impact on acne by helping to prevent severe acne.20

Adult acne

Acta Dermato-Venereologica

The large Chinese study also found no connection between smoking and having adult acne.3

In the studies which support the view that cigarettes play a role in acne development and severity, there is still no consensus on the mechanism by which this might occur. There are currently two hypotheses, however, regarding how cigarettes may cause acne.

  1. Nicotine in cigarettes causes the blood vessels, which supply blood to the sebaceous glands, to narrow. Blood flow is important for the body to be able to fight bacteria which can grow on the sebum. By decreasing blood supply to the sebaceous glands, cigarettes may allow for the bacteria that is associated with acne to grow and multiply.21
  2. Smoking cigarettes may change the chemical makeup of sebum, making acne more severe.21

Alcohol

  • Teen acne: Drinking alcohol might be linked with teen acne, but the evidence is limited.
  • Adult acne: Drinking alcohol probably does not cause adult acne.

Expand to read details of studies


Teen acne

Acta Dermato-Venereologica

The large Chinese study discussed above found a connection between being a mild to heavy drinker and having teen acne.3

Adult acne

Acta Dermato-Venereologica

However, the same study found no connection between drinking alcohol and having adult acne in Chinese subjects.3

Factors in Teen and Adult Acne

In Conclusion

In conclusion, teen and adult acne differ in location and type of breakouts and in which sex is more likely to be affected. The causes of teen and adult acne appear to be similar and are still under debate.

References:

  1. 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
  2. Tangetti, E. A. The role of inflammation in the pathology of acne. J Clin Aesthet Dermatol 6, 27 - 35 (2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780801/
  3. 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
  4. Tom, W. L. & Barrio, R. New insight into adolescent acne. Curr Opin Pediatr 20, 436 - 40 (2008). https://www.ncbi.nlm.nih.gov/pubmed/18622200
  5. Khunger, N. & Kumar, C. A clinico-epidemiological study of adult acne: Is it different from adolescent acne? Indian J Dermatol Venereol Leprol 78, 335 - 341 (2012). http://www.ijdvl.com/article.asp?issn=0378-6323;year=2012;volume=78;issue=3;spage=335;epage=341;aulast=Khunger
  6. 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
  7. Swathi, G. & Mamatha, S. K. A clinico-epidemiological study of acne in adults. Int J Science Res 11, 822 - 825 (2013). https://www.ncbi.nlm.nih.gov/pubmed/22565434
  8. 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
  9. Youssef, E. M. & Youssef, E. K. Diet and Acne in Upper Egypt. Am J Dermatol Venereol 3, 13 - 22 (2014). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836431/
  10. Dawson, A. L. & Dellavalle, R. P. Acne vulgaris. Br Med J 346, f2634 (2013). https://www.ncbi.nlm.nih.gov/pubmed/23657180
  11. Bhate, K. & Williams, H. C. Epidemiology of acne vulgaris. Br J Dermatol 168, 474 - 485 (2012). https://www.ncbi.nlm.nih.gov/pubmed/23210645
  12. Walton, S. et al. 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
  13. Evans, D. M. et al. Teenage acne is influenced by genetic factors. Br J Dermatol 152, 579 - 581 (2005). https://www.ncbi.nlm.nih.gov/pubmed/15787839
  14. Bataille, V. et al. The Influence of Genetics and Environmental Factors in the Pathogenesis of Acne: A Twin Study of Acne in Women. J Investig Dermatol 119, 1317 - 1322 (2002). https://www.ncbi.nlm.nih.gov/pubmed/12485434
  15. Tsoy, N. O. Effect of milk and dairy products upon severity of acne for young people. World Appl Sci J 24, 403 - 407 (2013). https://pdfs.semanticscholar.org/fbbc/8bbfecee0b2efbfb2d7579550e8db6a068ab.pdf

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