Acne in adult women: why it appears after 25

How common is acne in adult women?

Acne is common in adults. In a British study of 749 people over 25 years old examined by dermatologists, clinically significant facial acne was detected in 12% of women and 3% of men, and isolated lesions in 54% of women and 40% of men. The frequency decreased noticeably only after 44 years.

According to the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, in 2022–2024, the incidence of acne in adults increased by 12%, and in absolute numbers, mainly adult patients turn to specialists for acne. Among patients with acne in one of the centers' branches, 59.9% were women. In 19.7% of patients, the disease first appeared after 18 years of age, and two thirds of them were women.

Breakouts after 25 years are common and do not mean that skin care is incorrect.

How adult acne differs from teenage acne

Dermatologists distinguish two options. Persistent acne begins in adolescence and persists into adulthood. Later, acne first appears in adulthood.

It has long been believed that in adult women, rashes are localized mainly in the chin area, along the lower jaw line and on the neck. This picture does occur: inflammatory elements in the lower third of the face and closed comedones (small white nodules under the skin). However, in a large international study, most women also had lesions on the cheeks, forehead, and temples, as in adolescents. Rashes localized not only in the chin area, but also in different areas of the face, may be associated with hormonal disorders.

Treatment-important difference: Adult patients' skin tends to be drier and more sensitive. Products that were well tolerated during adolescence may cause peeling and irritation.

Hormones: when acne is a reason to go to the gynaecologist

The sebaceous glands are sensitive to androgens (male sex hormones, which are produced in small quantities by every woman). Therefore, rashes often worsen before menstruation and may appear after cessation of hormonal contraception.

One of the common causes of hyperandrogenism (excess androgens) in women: polycystic ovary syndrome (PCOS). At the same time, international recommendations for PCOS in 2023 specify that acne itself weakly indicates hormonal disorders; a combination of signs is more indicative. Discuss this with a gynaecologist-endocrinologist if, along with acne, you have:

• Irregular menstrual cycles or prolonged delays
• Hirsutism: growth of coarse, dark hair on the chin, upper lip, chest or abdomen
• Noticeable thinning of hair at the crown and parting
• Sudden weight gain, difficulty conceiving
• The rash appeared suddenly and progressed rapidly

Diet, stress, smoking: what's proven

Dairy products. According to a meta-analysis, acne was slightly more common in people who consumed dairy products. This is a statistical association, not a proven cause, and was attenuated after controlling for other factors, and the studies were conducted in children, adolescents and young adults under 30 years of age. There is no reason to eliminate dairy products for everyone, but if you notice such a connection, tell your doctor.

Sweets and fast carbohydrates. In a randomized trial, acne patients on a low glycemic load diet (more protein, less fast carbohydrates) had fewer breakouts over 12 weeks than those in the control group. The study involved men from 15 to 25 years old, which makes the result unreliable for women.

Smoking. According to an Italian study, non-inflammatory acne (comedones) is more common in women who smoke, especially if the acne occurred during adolescence.

Stress. In a small study, students' rashes increased during exam periods, and were more noticeable the higher their stress levels. The mechanism of this connection continues to be studied.

The American Academy of Dermatology concluded in its 2024 guidelines that there is insufficient evidence to recommend any diet for the treatment of acne. Diet can influence the progression of acne, but treatment is not a substitute.

Cosmetics and habits that support breakouts

• Thick creams, oils and foundations that clog pores. Choose products labeled "non-comedogenic" and discuss your daily care routine with your doctor.
• Aggressive cleansing: scrubs, alcohol-containing lotions, frequent washing. Skin becomes irritated and inflammation lasts longer
• The habit of touching the face, resting the chin on the hand, frequent contact of the phone with the skin of the cheek
• Squeezing: promotes the formation of spots (post-inflammatory pigmentation) and scars

The latter is especially important for adult skin: inflammatory elements often leave behind post-inflammatory hyperpigmentation, which lasts for months. Often it bothers patients more than the rash itself.

How acne is treated in adults

The treatment plan depends on which elements predominate (comedones, inflammatory papules, deep nodes), how many there are, whether there are scars and signs of hormonal disorders, whether pregnancy is planned.

According to the 2024 recommendations of the American Academy of Dermatology, the basis of treatment: topical agents. These are retinoids for external use, benzoyl peroxide, external antibiotics in combination with other agents, azelaic and salicylic acids. For moderate to severe acne, the doctor may prescribe systemic therapy: short course antibiotics, hormonal therapy in women, systemic retinoids. Many of these drugs are contraindicated during pregnancy, so you should tell your doctor right away if you are planning a pregnancy.

Procedures (peelings, cleansing, hardware methods) were not rated in the same recommendations due to lack of research. They are used as an addition to the main treatment, for example to correct post-inflammatory hyperpigmentation, but not instead of it. The result of treatment is usually assessed no earlier than after 2–3 months of regular therapy.

When it's time to see a doctor

• Rash persists for several months despite care
• Painful deep nodes appear
• Pigmentation spots or scars remain
• Acne is combined with cycle disorders, excess hair growth, hair loss
• Rashes significantly affect well-being and quality of life: according to recommendations, psychological stress serves as the basis for active treatment

A good place to start is with a dermatologist. If upon examination there is a suspicion of a hormonal cause, he will refer you to a gynaecologist-endocrinologist.

Clinic servicesAcne Treatment · Consultation with a dermatologist · Consultation with a gynaecologist