As dermatologists have learned more about the causes of acne in the last twenty years, the established consensus that acne is a skin condition only affecting teenagers has been widely debunked.

Additionally, acne has been redefined as an inflammatory skin condition that can continuously change in severity and location on the body. 

Like other chronic disorders, acne requires ongoing treatment to prevent continued occurrence. While some people with milder forms of acne are able to permanently stop outbreaks with proper treatment, some individuals with moderate to severe acne may continue treatment indefinitely.

Summary

• Acne tends to emerge during our teen years with the rise in hormones associated with puberty. Acne can linger into adulthood, however, and adult acne remains fairly common (about a quarter of women over 40).+
• For the majority of teen acne sufferers, acne will abate by their early twenties. 
• No matter the age, acne can usually be treated with prescription and non-prescription medications, including retinoids that accelerate skin cell turnover, anti-inflammatory medications that improve inflammation, and antibiotics that reduce acne-causing bacteria.

At What Age Does Acne Normally Go Away?  

For many people, acne never completely goes away. In fact, the prevalence of adult acne has risen over the past decade. Acne as you age isn’t a remote problem, and if you’re wondering when acne goes away, here’s the story. 

• Multiple studies indicate that rates of acne among women between 30 and 39 years old are around 35%. 
• Over 26% of women between 40 and 49 years old report the recurrence of acne outbreaks. That’s a quarter of the population!
• Compare these percentages to rates of adolescent acne at 50% and the answer to the question "when does acne stop?" isn't as simple as we once thought.

So when does acne go away with age? Evidence points to a reduction around 20 years old and into most peoples’ early twenties as puberty ends. This is common among those with more moderate acne.

More women than men will have acne at some point in their lives. Women also experience persistent acne at higher rates than men, which is partially attributed to the multiplicity of female hormones.

The continuation of acne and/or relapse of outbreaks throughout adolescence into adulthood is called persistent acne. 

When adults over 25 years old develop acne for the first time, it is called late-onset acne and is often due to a systemic disorder. Persistent acne is much more commonly diagnosed by dermatologists than late-onset acne. 

The differences between adolescent acne and adult persistent acne involve the appearance of comedones and inflammatory lesions, with adults having fewer comedones but often more lesions than teens. 

In addition, adult male acne and adult female acne often have persistent outbreaks on the chin, below the jawline, on the chest, and in the cervical area. Adolescent acne is often confined to just the face and upper back.  

Why Does Acne Sometimes Continue Into Adulthood?

Acne is no longer considered merely a result of diet and adolescent hormones during puberty. The latter is a common trigger for why teens get acne in the first place.

Instead, acne is now viewed as a "manifestation of one or more systemic diseases" that can emerge in adults who never had acne as a teenager!

In fact, some systemic disorders affecting adults who had acne as a teenager can promote the recurrence of acne. The most common medical conditions that are linked to female and male adult acne include:

• Congenital adrenal hyperplasia: a genetic disorder that affects adrenal gland activity, which produce hormones like testosterone and cortisol that are implicated in acne. People with CAH often enter puberty early and have severe acne.
• Seborrhea acne hirsutism androgenetic alopecia syndrome (SAHA): women with SAHA have excess testosterone and other androgens or respond atypically to normal blood levels of androgens, sometimes leading to female adult acne.
• Polycystic ovarian syndrome (PCOS): the ovaries of reproductive aged women produce excess androgens that result in symptoms like weight gain, hirsutism, infertility, and acne. 
• Hyperandrogenism insulin resistance acanthosis nigricans (HAIR-AN) syndrome: a combination of insulin resistance and hyperandrogenism, HAIR-AN symptoms include skin darkening, diabetes, heart disease, and severe acne.
• Synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome: a rare disease with no known cause, SAPHO syndrome is characterized by a combination of joint inflammation, bone inflammation, and acne on the soles of your feet and palms. 

In almost all of these disorders, the presence of excess androgens (like testosterone) in the bloodstream or an over-reactive response in the body is the underlying cause of acne. 

Research suggests that the appearance of acne in SAPHO and pyrogenic arthritis (another rare disorder) is further evidence that acne is truly an inflammatory disorder, not a dietary or strictly hormonal disorder, that could potentially continue into adulthood. 

What Is the Best Treatment for Adult Acne? Preventing Acne From Recurring After Puberty

The reasons behind adult persistent acne are not perfectly understood but are associated with:

• Excess production of androgen hormones (testosterone, dehydroepiandrosterone (DHEA), and dihydrotestosterone (DHT).
• Colonization and growth of bacteria-causing acne (Propionibacterium acnes, or P. acnes, which can inhabit hair follicles and pores)
• Family history of acne
• Acne involving certain subtypes of acne (androgenic, keloidal, or scalp folliculitis)
• A systemic disease involving hormonal imbalances

Dermatologists generally urge teens with mild to moderate acne to seek treatment as soon as possible. Neglecting to treat teenage acne with effective medications can result in permanent scarring. 

Additionally, teenagers with acne should have a blood workup to rule out the presence of a systemic disorder. For many, reducing the use of heavy skin care products can reduce the risk of clogged pores, which can worsen acne and trigger inflammation. 

While prescription acne treatments can reduce the severity of acne outbreaks, these outbreaks often return once treatment stops.

Acne Treatments for Adults and Teens: Oral and Topical Medications

First-line topical treatments or acne products for acne include active ingredients like topical retinoids (retinol, tretinoin, tazarotene), benzoyl peroxide, and salicylic acid. 

Oral pills for acne include antibiotics like tetracycline, erythromycin, and doxycycline. Acne treatment in teen and adult women can also include birth control pills that help to regulate androgen hormones. 

Moderate to severe acne that does not respond to either oral or topical agents may need a combination of oral and topical medications. Acne isn’t always about excess oil, oily skin, and oil production on the skin. If persistent acne or late-onset acne is caused by a systemic disorder like those above, treatment methods often involve a combination of hormonal therapy and oral antibiotics. 

The Future of Acne Treatments for Teens and Adults

Dermatologists expect more effective new acne treatments may soon hit the market.

Clinical trials involving the use of topicals containing insulin growth factor-1 inhibitors and coenzyme-A carboxylase inhibitors to control sebum are promising.

Alternative pharmaceuticals called selective RAR-agonists are also being investigated to treat severe types of cystic acne.

Work with a Board Certified Dermatologist––Online

Nava MD helps teens and adults alike access prescription acne treatments from home, with online visits, free shipping, and ongoing access to their doctor.

If approved, our dermatologists prescribe and ship personalized prescription formulas for acne (and even acne scars) containing the most effective, tried-and-true ingredients, like tretinoin, niacinamide, and azelaic acid among others.

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References

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577330/

https://piel-l.org/blog/wp-content/uploads/2011/04/Global-alliance.pdf

https://www.tandfonline.com/doi/abs/10.1080/14656566.2019.1584182

https://pubmed.ncbi.nlm.nih.gov/19268109/

https://www.nomidalliance.org/papa.php

https://www.aafp.org/pubs/afp/issues/2000/0115/p357.html