Adult acne is common, frustrating, and often misunderstood. It is not simply teenage acne that never went away. In many people it behaves differently, has different drivers, and requires a different approach to get consistent control.
Teenage acne is frequently dominated by puberty related oil production and comedone formation. Adult acne can still involve those, but more often it is influenced by a combination of:
• Hormonal signalling and androgen sensitivity
• Inflammation and immune response
• Skin barrier disruption
• Stress and cortisol effects
• Lifestyle factors including sleep, training routines, and diet in some individuals
• Product related occlusion and irritation
• Shaving related follicular irritation in men
This is why two people can have “acne” that looks similar but needs a very different plan.
Adult acne is often described as hormonal, but that does not always mean abnormal hormone levels on a test. Many cases are driven by how sensitive the skin is to normal levels of androgens, and how sebaceous glands respond.
In practical terms, hormones can increase oil production and change how cells shed inside pores. This increases congestion, and once a pore is blocked, inflammation escalates quickly.
Adult acne tends to be more inflammatory. Lesions are often deeper, more tender and slower to resolve. The longer inflammation persists, the higher the risk of:
• Post inflammatory redness
• Post inflammatory hyperpigmentation
• Persistent marks
• True scarring
This is one reason why adult acne can feel more severe, even when there are fewer actual pimples.
Adult acne commonly appears in the lower face, especially:
• Jawline
• Chin
• Neck
• Lower cheeks
That pattern is common, but it is not a rule. Adults can still get forehead and central face acne, particularly when sweat, hair products, occlusive skincare, masks, or friction are involved.
In men, acne can overlap with folliculitis and shaving related irritation, which changes the management.
Many adults with acne are also using harsh products because they are trying to dry their skin out. This often backfires. Stripping the barrier increases irritation, increases inflammation, and can worsen breakouts over time.
Acne prone skin still needs barrier support. The goal is calm, consistent control, not aggressive “scorch the earth” routines.
Adult skin generally heals more slowly than teenage skin. Combine that with deeper inflammation, and you get a higher risk of lingering marks.
There are two broad categories of “acne marks” people talk about:
• Red or brown marks that fade over time
• True scarring, where the collagen structure has been altered
The difference matters because the solutions are different. Marks can improve with time and targeted skincare. Scars often need procedural treatment.
A proper approach focuses on four pillars:
For many people this involves a mix of topical actives, sometimes prescription medication, and in selected cases procedural treatments to reduce scarring and improve texture once acne is under control.
If acne is painful, persistent, scarring, or impacting confidence, it is worth addressing properly. The earlier inflammatory acne is controlled, the lower the risk of long term scarring and pigment.
A consultation helps determine what type of acne you have, what is driving it, and what is realistic for your skin. The goal is not perfection. The goal is stable control and healthier skin long term.
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Written by Dr Brandon Kober-Brown MBBS, ProfDipMensHlth, GCCM
Registered Medical Practitioner (General Registration) MED0002581903
Disclaimer: This article is intended for general educational purposes only and should not be taken as personal medical advice. It is not a substitute for a consultation with a registered medical professional.
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