According to the International Journal of Cosmetic Science, cases of adult acne are increasing—so much so that in 2004, the journal called post-adolescent acne an epidemic. 
How bad is it? Once considered a teen rite of passage, alongside unbridled angst and prom, acne now affects 25% of adult men and 50% of adult women at some point after the age of 25. [1,2]
Adding insult to injury, if you suffer from adult acne on your face, there’s a 33% chance that you’ll also experience clogged pores on your back and neck—no-so-cutely coined “backne.”
For some, adult acne might mean a few pimples along the jawline. But, for others, the struggle can turn cystic, lasting into their thirties, forties, and beyond. The problem isn’t superficial, either. Adult acne can lead to depression and social anxiety in the same way that it can for teens. 
What is Acne, Anyway?
Our skin is covered in hundreds of thousands of tiny hair follicles, commonly called pores. These follicles also produce sebum, otherwise known as oil.
Most frequently seen on the face, back, neck, and chest, sometimes follicles will produce too many cells. This creates a blockage that traps sebum inside the pore. When sebum is trapped, bacteria begin to grow, causing acne.
According to Acne.org, acne isn’t as simple as plain ol’ pimples, and instead, can be broken down into different categories depending on what’s going on inside your pores: 
- Non-Inflammatory Acne: When a pore becomes plugged, it’s called a micro-comedone. These can spontaneously heal, or turn into either what’s called a whitehead or a blackhead. Both are non-inflamed skin blemishes. The only difference is that blackheads occur when the plugged pore remains slightly open on the surface, allowing the skin’s melanin to oxidize, which causes their darker color.
- Inflammatory acne: If a non-inflamed pore can’t release its contents to the surface, something’s gotta give. Most often, that’s the pore’s wall. This can be caused by the natural buildup of pressure alone, but is almost guaranteed if you squeeze or pick at your skin. A ruptured pore will become inflamed and may even engulf neighboring follicles, causing temporary redness and permanent scarring.
For most adults experiencing acne the problem stops at pimples, technically called papules and pustules. However, inflammatory acne can grow into lesions, called cysts, that are incredibly painful and last for weeks or even months.
Adult Acne vs. Adult Onset Acne
All acne might be due to extra cells clogging up those follicles, but what causes some people to experience it only in their teens, while others will be surprised by their first outbreak of pimples after they turn 30?
It’s difficult to pin down a single cause for clogged pores. However, before attempting to determine what’s behind any specific case of acne in adults, dermatologists first determine whether it’s considered adult acne or adult onset acne:
- Men more frequently experience what’s called adult acne—a stubborn case of acne that’s held on past adolescence.
- Due to the hormonal fluctuations that come with menstruation, women are more likely to experience adult onset acne. This is acne that occurs on skin that was previously unblemished. Men can experience adult onset acne as well, but the affliction is more often linked to prolonged skin irritation or a pore-clogging facial product.
Understanding the difference is important, because those experiencing adult onset acne should first look at what might have changed, be it hormonal fluctuations or skin care products, before attempting topical treatments.
What Can Cause Adult Onset Acne?
Some experts claim that the nearly 200% increase in cases of adult acne can be boiled down to diet and stress.  Others link adult acne to genetic predispositions and fluctuating hormones.
Here’s an explanation of factors dermatologists consider the most suspect causes of adult acne:
“Comedogenic” means any ingredient that tends to clog your pores. Acne.org provides a complete list of which ingredients to avoid. These ingredients tend to show up in anti-aging products, so if you’ve started to experience acne after switching up your skincare routine, check the label for any of those listed. Remember, comedogenic doesn’t mean that they’re bad for all skin types, just for those who are acne-prone.
While no one is completely sure what causes acne, we know that it’s at least partially caused by hormones. That’s because acne doesn’t start until the body starts producing certain hormones during puberty. Both testosterone and estrogen can be responsible, which is why those who experience a moderate to severe onset of acne in adulthood should consult their doctor to check for what might be causing their hormones to start surging.
One such potential cause for hormonal shifts in women is polycystic ovary syndrome (PCOS), which is basically a buildup of fluid in an ovary. Acne caused by PCOS is generally accompanied by abnormal hair growth on your face and neck, along with potential weight gain. Don’t worry, PCOS is totally treatable! However, if you think it might be the cause of your acne, it’s important to see your doctor to help prevent future problems.
According to the American Academy of Dermatology, women can also expect adult onset acne when switching birth control prescriptions or at the onset of menopause. (Just keeps getting better, doesn’t it?) Again, if either of these situations applies to you, be sure to visit your doctor to ensure that all of your hormonal levels are within a normal and healthy range.
Finally, stress can also be a culprit of adult onset acne. That’s because even low-level changes in stress can create spikes in the hormone cortisol, which contributes to breakouts.
Diet and Food Allergies
Research suggests the spike in insulin caused by starchy, sugary foods and drinks with a high glycemic index (GI) could lead to acne by way of making your body produce higher than normal amounts of pore-clogging sebum. 
Higher alcohol consumption, in particular, has been linked with adult acne flare ups. That’s because alcohol both contributes to sugar spikes and can alter your body’s healthy hormone levels, leading to breakouts. 
Sometimes it’s as simple as your genes. While scientists are still in the dark as to why the predisposition for acne survives as a trait, genetics are definitely involved. The bottom line is that if your parents suffered from adult acne, you likely will too.
What Makes Adult Acne Go Away?
Depending on the severity of your acne, you might need to try several different methods, or combinations of treatments, before seeing results.
But, first thing’s first—if your acne has only just started, be sure to look at what recent changes could be the cause.
Have you just switched laundry detergents, skin care products, or brands of shampoo and conditioner? Do you have a new hairstyle that might transfer products to your skin? Are you drinking more coffee or milk than normal? Are you under a ridiculous amount of stress or not getting enough sleep?
Addressing potential causes before piling on topical treatments is important, as anything you put on your skin could mask the problem while causing even more irritation. Additionally, be sure that your pillow cases are being frequently washed and your hands are kept off your face to avoid further spreading any bacteria.
If your acne problem persists beyond correcting any recent changes to your diet, products, or routine, your first stop is considering over-the-counter topical treatments. These include antibacterial gels or cleansers, peels, dermabrasion, retinoids (lotions containing a group of vitamin A-derived compounds), or creams containing benzoyl peroxide.
Many hard-hitting topical acne products focus on blasting bacteria with benzoyl peroxide, since the substance delivers acne-fighting oxygen deep into your pores. If you’re unsure which products to pick, you can browse HighYa’s reviews of acne-related products—including Proactiv Plus and Murad Advanced Breakout Control. Proactiv Plus receives middling reviews due to reports of less-than-awesome customer services.
Alternately, I’m a big fan of Acne.org, having used their regimens for several years and even going so far as to pay for overseas shipping. While I found it to be less so than Proactiv, note that the stuff is still pretty drying and can irritate sensitive skin.
Other over-the-counter products focus on sloughing off dead skin instead of killing bacteria. Because acne-prone skin is so prone to irritation, those interested in this method will want a chemical exfoliant instead of a manual one. You can learn about your options in “AHA or BHA: What’s The Best Chemical Exfoliant For Your Skin Type?”
Once over-the-counter treatments fall short of fixing your acne, it’s time to seek the help of a professional. Too many people suffer unnecessarily for prolonged periods before seeking out the advice of a dermatologist, but there’s a range of treatments that are gentle, effective, and potentially covered by your health insurance. These include topical antibiotics, prescription-strength retinoids, and even cortisone shots to deflate a particularly painful cyst.
Alternatively, your doctor may choose to suggest switching birth control formulas or a hormone-blocking medication, such as spironolactone.
If your acne persists, there’s a chance that your dermatologist might suggest Accutane. This has some pretty serious side effects, including severely dry skin and temporary arthritis. Additionally, those prescribed Accutane are required to take blood tests once a month. There are also myths that Accutane causes depression. However, there’s no scientific evidence to support this view—plus, it’s not like cystic acne keeps you singing about the sunny side of life, either.
Bottom Line on Beating Adult Acne
Unfortunately, about 30% of patients who take Accutane only experience remission for several years before having to give it another go. I was one of those unlucky few and, even after two courses, saw a recurrence of adult acne again in my early thirties. (Thanks, Mom and Dad!)
Several years ago, I was fed up with the cycle of clear skin giving way to more cystic acne, and was determined to find a solution that wasn’t wearing a paper bag. So, I did my research in hopes of finding a dermatologist who specialized in acne (surprisingly, many don’t), and learned that I’d lucked out: Dr. Tanghetti, an acne specialist listed as one of the AAD’s “Best Doctors in America” was close by.
What finally wiped out my adult acne was a two-year course of Spironolactone, a hormone blocker that works at the follicle. While it does come with risks and also requires frequent lab tests, most acne sufferers would consider those a walk in the park when compared with ongoing lesions and cysts.
My point isn’t that Spironolactone is the right treatment for everyone who suffers from adult acne, but that, more often than not, what works for you is going to take some trial and error. That, in my opinion, is all the more reason to start off by seeing a dermatologist early and often. And remember, not all derms specialize in acne! Use Yelp.com or search online for one in your area who does.
More on Skincare:
- Learning to Take Great Care of Your Skin
- Are You Using the Wrong Cleanser for Your Skin?
- Stop Wasting Your Skincare Products
- Knaggs HE, et al. "Post-adolescent acne." International Journal of Cosmetic Science. 2004
- Cunliffe WJ, Goulden V and Stables GI. "Prevalence of Facial Acne in Adults." Journal of the American Academy of Dermatology. 1999
- “Depression from Adult Acne; Link Between Acne and Being Depresse.”
- “What is acne?”
- Sturgis, India (2016, January 18). “The rise of adult acne is 'like an epidemic'.”
- Emanuele MA. “The endocrine system: alcohol alters critical hormonal balance.” Division of Endocrinology and Metabolism, Loyola University Medical School, Maywood, Illinois, USA. Alcohol Health Res World. 1997