Key takeaways
- Adult acne is common and isn't caused by poor hygiene.
- Benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline have strong recommendations.
- Spironolactone and combined oral contraceptives can help some women. Isotretinoin is recommended for severe or scarring acne.
- Treat early to prevent scars and dark marks, and give each plan about two to three months.
Acne doesn't stop at 20
Acne is often thought of as a teenage problem, but many adults, particularly women, have breakouts that persist or start for the first time in their twenties, thirties or later. Adult acne often clusters along the jawline, chin and neck. Dr. Nathan has written for Harvard Health about how adult acne can take a real emotional toll, and why it deserves proper treatment rather than a shrug.1
Acne happens when hair follicles become clogged with oil and skin cells, and bacteria and inflammation follow. Hormones, genetics and some medicines and products play a part. Dirt doesn't, and scrubbing harder usually makes things worse.2
What the guideline recommends
In 2024 the American Academy of Dermatology published updated guidelines of care for acne, based on a systematic review of the evidence.3
Strong recommendations for:
- benzoyl peroxide
- topical retinoids, such as adapalene and tretinoin
- topical antibiotics, such as clindamycin, used with benzoyl peroxide
- oral doxycycline
- oral isotretinoin for severe acne, acne causing scarring or significant distress, and acne that hasn't responded to other treatment
Conditional recommendations for topical clascoterone, salicylic acid and azelaic acid; oral minocycline and sarecycline; and, for some women, combined oral contraceptives and spironolactone.3
How a plan comes together
The guideline's good-practice advice shapes most plans:3
- Combine treatments that work in different ways. A retinoid plus benzoyl peroxide is a common base.
- Limit antibiotics. Keep oral antibiotic courses as short as possible, and always pair them with a topical treatment, such as benzoyl peroxide, to lower the risk of resistance.
- Treat big, painful spots directly. A small steroid injection can calm a large nodule quickly.
Most treatments take 8 to 12 weeks to show their full effect. Retinoids can cause dryness and irritation at first. Starting every other night and using a gentle moisturizer helps.
Hormonal options for women
For women whose acne flares with their cycle or sits along the jaw, spironolactone or a combined oral contraceptive may help. Both have conditional recommendations.3 Each has its own considerations, including blood pressure, blood clot risk and pregnancy plans, so the choice is made together.
When isotretinoin makes sense
Isotretinoin is the most effective treatment for severe acne and acne that scars, and the guideline strongly recommends it in those situations.3 It causes serious birth defects, so in the U.S. it's prescribed through a strict pregnancy-prevention program called iPLEDGE. It also needs regular follow-up. Questions about mood and other side effects deserve an open conversation before you start and during treatment.
Marks and scars
On brown and Black skin, acne often leaves dark marks (post-inflammatory hyperpigmentation) that can last longer than the spots. Treating acne early, using sunscreen every day and avoiding picking all help. Once acne is controlled, scars can be treated with procedures such as fractional laser. Laser medicine is one of Dr. Nathan's research interests, and she has published on laser treatment for acne.
When to see a doctor
See a dermatologist if acne leaves scars or dark marks, hasn't improved after 2 to 3 months of consistent over-the-counter treatment, or affects your mood or confidence. Sudden severe acne with fever or joint pain needs prompt care.
Sources
- Nathan N. Adult female acne: Why it happens and the emotional toll. Harvard Health Blog, Harvard Health Publishing. June 27, 2022. View source (opens in a new tab)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Acne. View source (opens in a new tab)
- Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30. doi:10.1016/j.jaad.2023.12.017 View source (opens in a new tab)
This article is general education for adults and isn't a substitute for personal medical advice. In an emergency, call 911.