Understanding the Causes of Adult Acne

By Maggie Staszcuk

Acne can be a distressing condition, especially when it surfaces in adulthood. Characterized by open and closed comedones, papules, and pustules, it is one of the most common skin diseases in the world. Although adolescents traditionally suffer from acne lesions, Yale Medicine points out that acne lesions still occur in over 25 percent of women and 12 percent of men in their 40s. In fact, one of the most common reasons adult women see a dermatologist is for acne. 

Although many of the factors that cause acne lesions are the same across all age groups, there are some differences between adult acne and adolescent acne. Adult acne can be classified into three groups:  

1. Persistent acne 
2. Late-onset acne 
3. Relapsing acne 

Persistent acne develops in adolescence and continues into adulthood. Late-onset acne develops for the first time after the age of 25. Relapsing acne describes acne that resolves and then returns. 

Traditionally, acne is caused by excess sebum, dead cell buildup, and bacteria proliferation. These factors contribute to acne for both adolescents and adults, but there are other things that could be contributing to acne breakouts in adults, such as stress, hormone imbalance, medications, diet, and lifestyle.  

Stress 

An increase in stress stimulates androgens, the male hormone responsible for sebum production, which may lead to acne formation. Stress also increases cortisol levels, which stimulate sebum production and can cause inflammation.  

Hormones 

Hormone fluctuations can cause inflammation, sebum production, an increase in the C-acnes bacterium, and hyperkeratinization, which can lead to clogged pores. All of this and more may be the result of menstruation, menopause, PCOS, thyroid disease, and other hormone conditions. 

Medications 

Adults are more likely to be prescribed medications than adolescents, and are subsequently at a higher risk of developing drug-related acne. Corticosteroids, oral contraceptives, and vitamin B12 are common medication acne triggers, to name a few. However, it is important to note that not everyone will experience acne as a side effect of their medications. Therefore, it is crucial that the client consults with their physician before discontinuing any medications. 

Diet and Lifestyle 

Many factors such as smoking, alcohol consumption, skin care, and stress can have a direct effect on the skin. Smoking is known to increase retention hyperkeratosis and form comedones in the skin. One study out of Italy has named atypical post-adolescent acne, or APAA, as “smoker’s acne.” Alcohol can also have detrimental effects on the skin, causing dehydration and inflammation. For some, it can influence hormone levels too. Some skin care ingredients can be comedogenic, and clients who may overuse active, acne-fighting products can exacerbate their symptoms and make things worse.