Adult acne is acne that continues past the teenage years or starts for the first time in your twenties, thirties or later. In women it is often linked to hormones, and typically shows up as deeper, tender spots along the jawline, chin and neck that flare before a period. A doctor’s job is to work out what is driving it, check for an underlying cause such as polycystic ovary syndrome, and match the treatment to the skin you have now.
Acne is one of the most common conditions we see within our skin work, and it is far more common in adults than many people realise. You are not doing anything wrong, and it is treatable.
What does hormonal acne look like?
“Hormonal acne” is not a separate diagnosis, but there is a recognisable pattern that points to hormones playing a bigger role:
- Spots mainly on the lower face: jawline, chin, around the mouth and down onto the neck
- Deeper, sore, red lumps rather than lots of small blackheads
- Flares in the week or so before a period
- Acne that started or worsened after stopping or changing hormonal contraception, after pregnancy, or around perimenopause
Hormones do not usually need to be “abnormal” for this to happen. In many women, hormone levels are within the normal range, but the skin’s oil glands are more sensitive to them.
What else can cause acne in adults?
Hormones are often only part of the picture. A doctor will also think about:
- Skincare and make-up: heavy, oily or occlusive products can block pores
- Friction and pressure: masks, phones, helmets and chin straps
- Stress and sleep: both can make existing acne flare
- Some medicines: certain prescription medicines and supplements can trigger or worsen acne, so it is worth bringing a list
- Look-alike conditions: rosacea, perioral dermatitis and folliculitis can all be mistaken for acne and are treated differently
Our acne page explains the different types in more detail.
Related readingAcne scarring: why the assessment matters more than the deviceRead the article →When could acne be a sign of something else?
The most common underlying condition we look for is polycystic ovary syndrome (PCOS). It affects around one in ten women in the UK, and acne can be one of its features. Other signs include:
- Irregular, infrequent or absent periods
- Extra hair growth on the face, chest or tummy
- Thinning hair on the scalp
- Difficulty managing weight
- Difficulty getting pregnant
If these sound familiar, we may suggest blood tests and, sometimes, a pelvic ultrasound. Diagnosing PCOS matters beyond the skin, because it is linked with longer-term health risks that are worth keeping an eye on. This is where our women’s health work and skin care overlap.
What treatments are available?
NICE guidance recommends that acne treatment is matched to its severity, and that treatments are given a fair trial, usually around 12 weeks, before deciding whether they are working. Options include:
Topical treatments
Creams and gels applied to the skin are the foundation for most people. Some are available over the counter; others are prescription treatments that we can discuss at your appointment.
Tablets
For more widespread or stubborn acne, a course of tablets alongside topical treatment may be appropriate for a limited period.
Hormonal treatment
For some women, hormone therapy options can help, particularly when acne follows the menstrual cycle. Whether this is suitable depends on your medical history, and it is a conversation to have with a doctor, not a decision to make from a website.
Supporting treatments
Once acne is under control, medical-grade skincare and carefully chosen chemical peels can help with oiliness, texture and the marks spots leave behind. These support medical treatment; they do not replace it.
For severe acne, or acne that is scarring, NICE recommends referral to a consultant dermatologist, who can consider specialist-only treatment. We can refer you, through the NHS or privately.
When to see a doctor sooner
Please do not wait if:
- Your acne is leaving scars or dark marks, because early treatment helps prevent permanent change. Our article on acne scarring explains why
- You have large, painful lumps or cysts deep under the skin
- Acne has appeared suddenly alongside a deepening voice, rapid new hair growth or other changes in your body. This is uncommon, but it needs a prompt medical assessment
- Your skin is affecting your mood, confidence or daily life
If you are feeling very low or having thoughts of harming yourself, please speak to your GP today, call NHS 111, or call 999 in an emergency. You can also call Samaritans on 116 123 at any time.
This list is not exhaustive. If you are not sure about something, see a doctor.
How we approach this at Aarva
Your appointment is with a doctor. We ask about when the acne started, your cycle, contraception, pregnancies, skincare, medicines and what you have tried before. We examine your skin and use our AURA 3D skin analysis to record the pattern of spots, redness and marks, which makes it easier to track progress honestly over time.
If the history suggests PCOS or another cause, we will discuss sensible tests. You leave with a written treatment plan with clear pricing. There is no pressure to book on the day, and if a treatment is unlikely to help, we will tell you. You can read more about the process on our what to expect page, or meet our doctors. For more on acne and the rest of our care, see our skin page.
Questions patients ask
Is adult acne always hormonal?
No. Hormones often play a part, particularly in women with spots along the jawline that flare before a period, but skincare products, friction, stress, some medicines and look-alike conditions can all be involved. A doctor’s assessment helps separate these.
Do I need blood tests for acne?
Not usually. Most adult acne does not need blood tests. We suggest them when there are other signs of a hormonal condition such as polycystic ovary syndrome, for example irregular periods or extra hair growth.
How long does acne treatment take to work?
Most acne treatments take around 8 to 12 weeks to show a clear benefit, and acne can sometimes seem a little worse in the first few weeks. We review progress at agreed points rather than changing things too quickly.
Can I treat acne scars at the same time?
It is usually better to get active acne under control first. Treating scarring while new spots are still forming can mean new scars keep appearing. Once acne is settled, we can assess scarring and discuss options.
If adult acne is wearing you down, a doctor can help you understand what is driving it. You can book a consultation, or use find your starting point if you are not sure which appointment you need.
This article is general information and does not replace a consultation with a doctor.
