If you're dealing with acne in your 30s, 40s, or beyond, you're not alone—and you're not imagining things. Adult acne is incredibly common, affecting up to 50% of women and 25% of men in their 20s, and often persisting into the 40s and 50s.
I'm Dr. Stephen Suah, a board-certified dermatologist at FoxHall Dermatology in Washington, DC. In my practice, I treat adult acne almost as often as teenage acne, and I understand the frustration it causes. "Shouldn't I have outgrown this by now?" is something I hear constantly.
Today, I want to address why adult acne happens, how it differs from teenage acne, and most importantly—how we can effectively treat it.
WHY AM I STILL GETTING ACNE AS AN ADULT?
Adult acne differs from teenage acne in several key ways:
HORMONAL FACTORS: While teenage acne is driven by puberty-related hormone surges, adult acne often relates to hormonal fluctuations from:
• Menstrual cycles
• Pregnancy and postpartum periods
• Perimenopause and menopause
• Polycystic ovary syndrome (PCOS)
• Hormonal birth control changes
STRESS: Adult life brings unique stressors—career pressures, financial concerns, family responsibilities. Stress increases cortisol, which can trigger oil production and inflammation.
LIFESTYLE FACTORS:
• Hair and skincare products that clog pores
• Makeup (especially heavy foundations)
• Diet (high-glycemic foods, dairy in some people)
• Lack of sleep
• Inconsistent skincare routines
MEDICATIONS: Some medications can trigger acne, including:
• Corticosteroids
• Lithium
• Some seizure medications
• Testosterone or anabolic steroids
WHERE ADULT ACNE TYPICALLY APPEARS
Teenage acne usually affects the forehead, nose, and cheeks (the T-zone). Adult acne, particularly in women, tends to concentrate along the jawline, chin, and lower cheeks—areas influenced by hormonal fluctuations.
This "hormonal pattern" acne often consists of deep, painful cysts rather than the whiteheads and blackheads common in teenage acne.
ADULT ACNE IN DIFFERENT SKIN TONES
As a dermatologist with expertise in treating skin of color, I want to address an important point: acne affects all skin tones, but the aftermath can be dramatically different.
In melanin-rich skin, every pimple can leave behind a dark mark called post-inflammatory hyperpigmentation (PIH). For many of my patients with skin of color, these dark spots are actually more distressing than the active acne itself.
This means that treating adult acne in darker skin requires a dual approach:
1. Treating the active acne
2. Preventing and treating hyperpigmentation
Treatment strategies must be carefully selected to avoid irritation that could worsen PIH.
WHEN OVER-THE-COUNTER PRODUCTS AREN'T ENOUGH
I see many patients who've spent years trying every product at Sephora or the drugstore with minimal improvement. Here's what they don't realize: persistent adult acne often requires prescription-strength treatments.
Over-the-counter products contain lower concentrations of active ingredients and may not penetrate deeply enough to treat the cystic acne common in adults.
PROFESSIONAL TREATMENT OPTIONS FOR ADULT ACNE
At FoxHall Dermatology, we customize treatment plans based on your specific situation. Here are the most effective options:
HORMONAL ACNE IN WOMEN: SPECIAL CONSIDERATIONS
If your acne follows your menstrual cycle, worsens with stress, or concentrates along your jawline, it's likely hormonal. Hormonal acne doesn't mean there's something "wrong" with your hormones. It just means we have an opportunity to focus on the cause: hormonal changes in adulthood, perimenopausal changes, stress and underlying medical conditions like PCOS.
ACNE IN MEN
Men can also experience persistent adult acne, often related to:
• Testosterone levels
• Stress
• Skincare product use (especially hair products and beard oils)
• Occupational exposures
• Anabolic steroid use (for those who use them)
Treatment for men typically focuses on topical and oral medications, along with procedural interventions.
SKINCARE ROUTINE FOR ADULT ACNE
One challenge for adults is balancing acne treatment with anti-aging concerns. You want to treat breakouts without over-drying mature skin.
MORNING ROUTINE:
• Gentle cleanser
• Topical prescription medication (if prescribed)
• Lightweight, non-comedogenic moisturizer with SPF
• Makeup (if worn) should be oil-free and non-comedogenic
EVENING ROUTINE:
• Cleanse thoroughly (double cleanse if wearing makeup)
• Tretinoin or other prescription topical
• Non-comedogenic moisturizer
KEY PRINCIPLES:
• Don't over-cleanse or over-exfoliate (this strips skin and triggers more oil production)
• Always use sunscreen (acne medications increase sun sensitivity)
• Be patient—most treatments take 6-12 weeks to show results
• Don't pick or squeeze (especially true for darker skin tones prone to PIH)
WHAT ABOUT DIET?
The relationship between diet and acne is complex and individual. Some patients notice their acne worsens with:
• High-glycemic foods (white bread, sugary snacks)
• Dairy products
• Whey protein supplements
I recommend keeping a food diary if you suspect dietary triggers, but don't restrict entire food groups without evidence they're affecting your skin.
THE EMOTIONAL IMPACT OF ADULT ACNE
Let's acknowledge something important: adult acne is more than a cosmetic concern. It affects self-esteem, professional confidence, and quality of life.
Many adults tell me they feel embarrassed about having acne at their age or that they're taken less seriously at work because of their skin. These feelings are valid, and they're exactly why seeking professional treatment is so important.
You don't have to "just live with it." Effective treatments exist.
REALISTIC EXPECTATIONS
I always tell patients that treating adult acne requires:
PATIENCE: Most treatments take several weeks to months to show results
CONSISTENCY: Skipping applications or medications sabotages results
CUSTOMIZATION: What worked for your friend may not work for you
MAINTENANCE: Even after clearing, many adults need ongoing maintenance therapy
WHY PROFESSIONAL CARE MAKES A DIFFERENCE
The advantage of seeing a board-certified dermatologist is that we can:
ACCURATE DIAGNOSIS: What looks like acne might actually be rosacea, perioral dermatitis, or folliculitis
ACCESS TO PRESCRIPTION TREATMENTS: The most effective treatments require a prescription
CUSTOMIZED APPROACH: We tailor treatments to your skin type, severity, and lifestyle
TREAT COMPLICATIONS: Address scarring and hyperpigmentation alongside active acne
ADJUST AS NEEDED: We monitor your progress and modify treatments based on results
IF YOU'RE STRUGGLING WITH ADULT ACNE
Don't spend another year battling breakouts on your own. At FoxHall Dermatology, we have extensive experience treating adult acne across all skin types and tones.
Whether you're dealing with hormonal breakouts, persistent cystic acne, or stubborn dark marks from past blemishes, we can help. Same-day appointments are available for acne consultations.
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ABOUT DR. STEPHEN SUAH
Dr. Stephen Suah is a board-certified dermatologist at FoxHall Dermatology in Washington, DC. A Washingtonian Top Doctor (2022-2025), Dr. Suah specializes in treating acne across all skin types, with particular expertise in managing acne and post-inflammatory hyperpigmentation in skin of color.
Schedule your acne consultation: 202-695-1000 | www.foxhalldermatology.net
