Pimples Beyond Puberty — 6 Facts About Adult Acne

If you thought you put puberty behind you years (or decades) ago, you might be extra annoyed to find a pesky pimple or two staring back at you from the bathroom mirror. But rest assured, you won’t be the first person to steal a pimple patch from your teen.

“There’s a belief and a stigma about acne,” says MU Health Care dermatologist Ashley Jenkins, MD. “Many people think only teenagers experience acne, but that couldn’t be farther from the truth.”

In reality, 50% of adults over age 20 experience acne at some point. Whether you’ve discovered a new pimple or your teenage acne never fully cleared up, you might benefit from knowing why it’s happening and what you can do about it. The good news is that there’s a range of available treatment options and one that’s sure to work for you.

Dr. Jenkins shares six key facts about adult acne:

1. Adult Acne Is More Common in Women

There’s no way around it — hormones play a critical role in developing acne. Like most other hormone-related conditions, adult acne occurs more often in women than in men.

During the teen years, both sexes experience hormonal surges with the onset of puberty. But then, male hormones settle down while females still experience monthly hormone fluctuations. Women are roughly twice as likely as men to have adult acne.

The good news is that the risk of adult acne goes down as hormone levels naturally decrease with age. “Fifty percent of women in their 20s have adult acne,” Dr. Jenkins says. “But that number drops to 35% in your 30s and 25% in your 40s.” Once you reach menopause and no longer have monthly hormone fluctuations, acne becomes rare.

The only wild card for women is pregnancy. “Pregnancy improves acne about 50% of the time,” Dr. Jenkins says. “But many other women find that pregnancy worsens breakouts. There is no way to predict how pregnancy will affect your skin.”

2. Many Things Can Cause Adult Acne

Adult acne is a chronic condition influenced by multiple factors in your body. Some people may have it worse than others, but it tends to be an ongoing issue.

“We’re not talking about an occasional breakout because you ate too much chocolate,” Dr. Jenkins says. “There are biological factors at play.”

The most common causes of chronic adult acne include:

• Oil gland secretion: Hormonal changes encourage glands to increase production of sebum — an oily substance that clogs pores and causes acne.
• Sticky cells: Skin cells (keratinocytes) can become sticky and cling to hair follicles to form pimples.
• Shifts in your microbiome: In some people, levels of Propionibacterium acnes bacteria can be too high, which can lead to increased acne and excessive inflammation.
• Inflammation: The three factors above cause increased inflammation, which promotes breakouts.

3. Chronic Adult Acne Could Be a Symptom of an Underlying Condition

In rarer cases, adult acne can be a sign of another health issue, such as:

• High androgen levels (hyperandrogenism): Elevated levels of male sex hormones affect the skin, contributing to excessive sebum production and acne.
• Polycystic ovarian syndrome (PCOS): PCOS is a hormonal condition that commonly causes high androgen levels.
• Insulin resistance: People whose bodies don’t respond well to insulin, such as those with prediabetes or diabetes, tend to have worse acne.
• Chronic stress: Stress can increase inflammation, alter the microbiome and possibly affect sebum production.

4. Diet Can Play a Role in Adult Acne

What you eat can contribute to the condition of your skin, but it’s not the whole picture. “If you think you’re just going to change your diet and never have acne, that’s not true,” Dr. Jenkins says. “But we do know that diet has a role, and studies link some food types to increased acne.”

The American Academy of Dermatology suggests an association between adult acne and specific foods, including:

• Cow’s milk: Hormones in milk may lead to increased oil gland secretion. One study found women who drank two or more glasses of skim milk daily were 44% more likely to have acne than those who didn’t.
• High glycemic index foods: Carbohydrates that raise blood sugar — such as white bread, fries, pastries and sugary drinks — may increase the risk of acne.

Dr. Jenkins adds whey protein to the list of foods that may affect acne. Whey is one of two proteins found in milk. Research suggests there may be an association between acne and whey protein powder — a nutritional supplement commonly added to smoothies and recipes to increase protein intake.

“Whey protein is derived from dairy and behaves similarly,” she says. “Whey protein won’t trigger acne in everyone, and if you aren’t having a problem with it, don’t change your diet. But if you are prone to acne and consume high concentrations of whey protein, it might be something to consider.”

5. Adult Acne Is Treatable

If your acne is only occasional, mild or doesn’t bother you, there’s no need to treat it. But if it is bothersome or chronic, your primary care doctor or a dermatologist can help.

“Primary care doctors are more than equipped to treat most acne and can explore the possibility of underlying issues,” Dr. Jenkins says. “No matter who you see, there are many effective prescription topical and oral medications for chronic acne.”

For mild acne flare-ups, over-the-counter options can offer relief and help prevent breakouts. Dr. Jenkins recommends:

• Adapalene gel (0.1%): This retinoid that you use at night makes your skin cells less sticky. A little goes a long way.
• Pimple patches: A patch can help heal your pimple while keeping you from touching it.
• Products containing benzoyl peroxide: Stick to face wash or gels with no more than 5% benzoyl peroxide. Use a higher strength (10%) on chest and back acne. Be careful with clothing and towels because benzoyl peroxide can permanently stain fabric.

6. Consistency and Patience Are Key to Treating Adult Acne

To reduce adult acne, you’ll need to treat it consistently and then be patient.

“You have to give any new acne regimen three months before you judge whether your skin is responding,” Dr. Jenkins says. “It takes 28 days for skin cells to turn over completely, and we recommend waiting a couple of 28-day cycles to see if the treatment is working.”

Above all, Dr. Jenkins says it’s important to remember that adult acne is common and has causes outside of your control. “The body is complex, and there are many biological and genetic factors at play,” she says. “But we have really good treatments available, and we almost always find one that works.”

Next Steps and Useful Resources

• Want to discuss more? Speak with a dermatologist or primary care provider.