News & Events

Adult acne 101

By Rhonda Mann, Tufts Medical Center Staff 

Dr. Clarissa Yang is the Chief of Dermatology The teenage years and acne go hand in hand – so why are you still breaking out into your 30s and 40s?  Like it or not, pimples can occur well into adulthood, even for those of us who never endured acne as a teen. Women are more prone to adult breakouts compared to men. In fact, a Rutgers Robert Wood Johnson Medical School study finds about half of women in their 20s, one-third of women in their 30s and one-quarter of women in their 40s will be bothered by breakouts.

“Adult-onset acne is more prevalent in women and more likely to appear along the jawline than in the “T-zone” of the forehead, nose and chin,” said Clarissa Yang, MD, Chief of Dermatology at Tufts Medical Center. “Jawline acne in women can suggest a hormonal imbalance.” 

Hormonal imbalance 

The hormonal imbalance that results in jawline acne is thought to be caused by a relative increase in androgen levels, explained Dr. Yang.  Androgens are male hormones which can result in increased oil gland production and clogging of pores. 

Some women with jawline breakouts may find they have an underlying condition called Polycystic Ovary Syndrome (PCOS) with irregular periods, ovarian cysts, weight gain, facial hair, and/or thinning of the hair on their heads.  Other women might have imbalances from going on or off of hormonal therapies such as birth control pills or other hormonal shifts such as pregnancy or menopause.

Food and acne

You’ve likely heard that eating chocolate can lead to acne. But is this fact or fiction? A new study presented to the European Academy of Dermatology and Venereology in October looked at almost 7,000 people across six different countries in Europe. Their research showed that dairy and sugar are among the greatest factors associated with acne. In this analysis, more people with acne consume dairy products (48.2%) compared to those who don’t (38.8%). People who regularly eat soda, pastries, chocolates and other sweets were also more likely to suffer from acne. 

Other causes and treatments

The good news is not all adult breakouts are the result of hormonal issues. In fact, many can be resolved with some simple changes to routine.

Are you using the wrong products? If you have naturally oily skin, you should be looking for skin-care products labeled “oil-free”, “non-comedogenic”, or “water based.” Products like these are less likely to clog your pores.

When you have a breakout, it’s natural to want to wash your face – a lot! Over-washing your face can make acne worse according to Dr. Yang. “If you wash your face too often, you can breakdown the skin barrier and allow external agents such as bacteria and irritants to cause inflammation. Your skin may try overcompensate for the dryness by producing even more oil which may cause more acne.”

Stress, poor sleep habits, and diet can also contribute to acne flare-ups. If you think one of those issues is the culprit, keep a log of your breakouts and talk with a dermatologist.

Breakout busters

“While breakouts can be frustrating for many women, regardless of their age, we have a wide spectrum of treatments that work,” said Dr. Yang. If the proper washing regime and products aren’t enough there are oral prescriptions and medications that treat the causes of acne. Additionally for patients with hormonal acne, there are FDA approved oral contraceptives that contain less acne causing progesterone components such as norgestimate, norethindrone acetate or drospirenone. The Pill can help by regulating hormones and menstrual periods, clearing up skin within three to six months according to some research, but could also have side effects, including increasing the risk of heart disease, blood clots and stroke in women who smoke. Another option is a prescription diuretic called spironolactone, which can block the effects of androgen in women.

Retinoids, a drug derivative of Vitamin A, can also help, explained Dr. Yang. Retinoid creams can attack acne by decreasing oil gland production, regulating the way the skin sheds from the hair follicle, and unclogging pores. In severe cases, retinoids can be taken in pill form, known as isotretinoin or Accutane. This medication should only be used when acne is severe and should never be used in women who are trying to become pregnant, as the risk of severe birth defects is extremely high. 

Chemical peels and light-based treatments can also be helpful, but are not typically covered by insurance.


Updated January 2020 

The above content is provided for educational purposes by Tufts Medical Center. It is free for educational use.  For information about your own health, contact your physician.