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I managed to make it through my teens without ever having a single pimple. That’s not to say I didn’t have an awkward stage — I definitely did. But acne simply wasn’t a part of the equation.
In my twenties, I’d have the very, very occasional, short-lived zit (we’re talking, maybe …twice a year), but for the most part, acne was something I really didn’t have to think about.
And then I turned 35. Right after my birthday, I started breaking out into tiny clusters of painless red bumps. They would go quickly, but they’d also come right back, typically on my cheeks.
They were still very mild, but they were unlike anything I’d ever experienced — and while I obviously wanted them to clear up, I was mostly concerned about why these little breakouts were suddenly affecting me.
A visit to the dermatologist confirmed what I suspected: These bumpy patches were likely hormonal in nature, according to the doctor. She didn’t believe my case warranted a blood test to check hormone levels and instead prescribed me a topical retinoid, but I haven’t used it yet — somehow, things seemed to have cleared up pretty quickly on their own, though I’ll be keeping an eye out for a re-emergence.
So it’s official: Making it through your teens without acne doesn’t necessarily mean you’re set for life. That’s not just something I’ve noticed anecdotally, it’s also backed up by Tiffany Libby, MD, a board-certified dermatologist, who calls adult-onset acne (which is acne that begins after age 25) “relatively common”.
So what’s the deal with adult acne?
“Many of the same factors that bring on acne in adolescents are also the main causes for adult acne like excess oil production, clogged pores, bacteria, and inflammation,” says Dr. Libby. In addition to these, hormonal changes, stress, [and] menstrual cycles can also increase the risk of developing adult-onset acne.”
So when does this typically pop up? “Typically after age 25, but it can start at any age in one’s 30s, 40s, or 50s,” says Dr. Libby. “I commonly see patients presenting to me with adult-onset acne who have even said they’ve never had acne before in their adolescence, and are confused and frustrated why it is presenting now.”
Yup. I understand the confusion and frustration. After all, we were always told acne would be a “teenage thing”. No one ever warned us we may be thinking about acne and wrinkles at the same time.
Who is more likely to experience adult acne?
Women are more likely to experience adult-onset acne, according to Dr. Libby. Delightful!
“This is due to hormonal fluctuations, like those that occur in menses, pregnancy, perimenopause, and menopause, that can increase oil production in the skin,” the dermatologist says.
Is adult acne always hormonal?
Not necessarily.
“[Adult-onset acne] may also be a result of a medication side effect, an undiagnosed medical condition, or for example, a disease called polycystic ovarian syndrome, a hormonal disorder associated with elevated levels of androgens or male hormones, leading to an increase in acne breakouts,” says Dr. Libby, who adds that major hormonal events (think pregnancy, nursing, weaning) could be to blame, as these can affect the skin’s oil production.
The best way to pinpoint the cause of adult-onset acne is to visit a doctor.
Will acne resolve itself without treatment?
If hormonal fluctuations are to blame for the sudden appearance of acne, can those hormones fluctuate right back to where they were before, resetting your skin in the process? As with most things that relate to hormones, this is unpredictable.
“It may or may not resolve without treatment depending on the cause. If it is due to hormones and the hormone imbalances resolve, then the adult-onset acne will likely resolve as well,” says Dr. Libby. “However, if there is another influencing cause at play, it may require further workup and subsequent treatment to adequately address the acne.”
A wait-and-see approach can have risks, though. “Persistent acne can lead to scarring, so it is important to try to seek appropriate treatment before scarring occurs,” warns Dr. Libby.
So what are some effective treatments for adult acne?
The good news? When it comes to treatments, we have options.
According to Dr. Libby, there are topical treatments (like benzoyl peroxide, which targets acne-causing bacteria, and salicylic acid which helps unclog pores). There are also topical retinoids (like tretinoin), which work by increasing the skin’s cell turnover to prevent pores from clogging.
For people with confirmed hormone imbalances, oral medications like spironolactone or birth control pills may be the way to go: They address the imbalances that cause acne.
Adult-onset acne is frustrating — especially when you think you’ve managed to sidestep this particular skin issue, only to discover it can pop up at an unexpected time. But if you’re experiencing this, know that you’re not alone, and treatment options are available.
“You can absolutely develop adult-onset acne without ever having had acne prior as an adolescent,” says Dr. Libby. “Many of the treatments are the same, with a few additional topical and oral options to help regulate hormonal imbalances if that is the cause. The key thing to note is that acne can be successfully treated and it is important to do so prior to scarring which may occur, as scarring may be much more difficult to treat.”
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.