What causes acne in adults and why it persists
.png)
Acne is often thought of as something you grow out of, but for many people, breakouts continue well into adulthood.1,2 If you're cleansing gently, avoiding harsh products and still seeing breakouts, you're not imagining it. Adult acne has its own patterns and understanding them can make it easier to know what's within your control and when it's worth seeking help.2,3
What actually happens in acne-prone skin
Acne develops when hair follicles become blocked with excess oil (sebum) and dead skin cells, creating an environment where bacteria can multiply and trigger inflammation.3,4
What tends to change in adulthood is what's driving it. Adult acne is generally classed as acne occurring after the age of 25. It's more commonly reported in women, though it affects men too, and it tends to follow one of two patterns: acne that never fully resolved after adolescence, or acne that appears for the first time later in life.3
Common causes of acne in adults
Androgens, a group of hormones present in everyone (including testosterone), stimulate the sebaceous glands to produce more oil and can make skin cells inside hair follicles stickier, increasing the chance of blocked pores.5 How this plays out can differ from person to person.
In men, fluctuating testosterone levels, testosterone replacement therapy, or the use of anabolic steroids or certain bodybuilding supplements can increase androgen activity and drive stubborn, often treatment-resistant breakouts.5,6
In women, shifts around the menstrual cycle, pregnancy, perimenopause, or conditions such as polycystic ovary syndrome (PCOS) can have a similar effect, often leading to breakouts concentrated along the jawline and lower face.7,8
Stress
Stress doesn't cause acne on its own, but it can make it worse. Elevated stress hormones such as cortisol are associated with increased oil production in the skin, which can intensify existing breakouts.9
Medications and supplements
Certain medications and supplements with hormonal activity can contribute to adult breakouts. This is one of the reasons a doctor will often ask about your full medication history when acne is proving difficult to manage.6
Skincare and cosmetic habits
Heavier, oil-based or pore-clogging skincare and makeup products can worsen breakouts, particularly in adult skin that may already be more sensitive than it was in the teenage years.4
Genetics and family history
A family history of acne can increase the likelihood of experiencing it as an adult, regardless of how consistent your skincare routine is.3
Why adult acne can be so persistent
Adult acne, particularly the hormonally driven kind, tends to be more resistant to conventional, over-the-counter treatments than teenage acne.6,8 That's because hormones act on the skin from the inside, so topical products targeting surface oil and bacteria often only provide partial relief. Breakouts can return in a cyclical pattern even with a consistent skincare routine.7,8
When to see a doctor
If your acne is ongoing, resistant to over-the-counter products, causing scarring, or affecting your confidence, it's worth speaking with a doctor. They can help assess whether hormonal or other underlying factors may be contributing and talk through your options.1,3,4
Clearing things up
Adult acne isn't a sign that your skincare routine has failed you. More often, it's a sign that something else, frequently hormonal, is going on beneath the surface. Understanding the difference between what you can manage day-to-day and what you should seek support for is usually the first step toward getting your skin and your confidence, back on track.
References:
1. DermNet New Zealand. Adult acne.
2. Harvard Health Publishing. Adult acne: Understanding underlying causes and banishing breakouts. 2019.
3. Efficacy and Safety of Hormonal Therapies for Acne: A Narrative Review. PMC. 2024.
4. Huang T, Krassas G, Cook D. Acne: best practice management. Australian Family Physician. 2010.
5. UPMC HealthBeat. The Link Between Acne & Testosterone. 2016.
6. WebMD. Acne in Men: Causes and Treatments.
7. Holzmann R, Shakery K. Postadolescent acne in females. Skin Pharmacol Physiol. 2014;27(Suppl 1):3–8.
8. Dréno B, Layton A, Zouboulis CC, et al. Adult female acne: a new paradigm. J Eur Acad Dermatol Venereol. 2013;27(9):1063–70.
9. Evaluation of Hormonal Factors in Acne Vulgaris and the Course of Acne Vulgaris Treatment with Contraceptive-Based Therapies in Young Adult Women. PMC.
Disclaimer: This information is not intended to be used as medical advice or a substitute for your own practitioner's advice, nor is it intended to be used for diagnosis or treatment for any illness/disease.
