Why am I still getting acne in my 30s or 40s?
Acne is not only a teenage condition. It may continue from adolescence, return after years of clearer skin or appear for the first time in adulthood. The British Association of Dermatologists confirms that acne can begin in the late twenties and beyond.[1]
Adult acne is treatable, but the best plan depends on the type and severity of spots, scarring risk, previous treatment, pregnancy plans and whether another condition could be contributing. Persistent adult acne is not a sign that your skin is dirty or that you have failed at skincare.
Why can acne continue into adulthood?
Acne develops when oil-producing glands, blocked pores and inflammation interact. These glands may be particularly sensitive to hormones even when hormone levels are within the normal range.[1]
The NHS lists hormonal changes—including periods, pregnancy and menopause—as possible contributors. Some medicines and oily skin or hair products can also play a part.[2]
Adult acne can affect anyone. Jawline acne alone cannot prove that a hormonal problem is present.
Could a hormonal condition be involved?
Most adults with acne do not need an extensive hormone panel. However, speak to a GP if acne begins suddenly or is accompanied by symptoms such as:
irregular or absent periods;
new coarse facial or body hair;
thinning scalp hair;
unexplained weight changes; or
difficulty becoming pregnant.
These features can suggest an underlying hormonal condition. Tell the clinician about contraception, menopause symptoms, supplements, anabolic steroids and other medicines. Do not stop prescribed medicine without advice.
Pregnancy, breastfeeding or plans to conceive also change which acne treatments are suitable. Mention these before using a retinoid cream or taking any prescription medicine.
Is it definitely acne?
Not every adult facial eruption is acne. Rosacea can cause redness, flushing and acne-like bumps but usually does not produce blackheads. Perioral dermatitis often creates small bumps around the mouth, nose or eyes. Folliculitis and shaving-related ingrown hairs can also resemble acne.
A useful assessment looks at the types of spots, their distribution, symptoms and treatment history. Seek review if a rash burns, itches, affects the eyes or behaves unlike previous acne.
What skincare helps adult acne?
Keep the routine simple enough to use consistently:
wash gently twice daily rather than scrubbing;
remove make-up before bed;
choose products labelled non-comedogenic;
use moisturiser if treatment causes dryness; and
avoid picking or squeezing spots because this increases the risk of marks and scars.[1,2]
Starting several active products together can cause irritation without showing which one helps. BAD advises expecting to use acne treatment for at least 12 weeks before seeing much improvement.[1]
Flat colour changes after spots are different from indented or raised scars. Control new inflammation while minimising irritation; established scarring may need a separate plan.
Which medical treatments are used?
NICE recommends choosing treatment according to severity and individual circumstances. First-line options usually combine treatments that work in different ways, such as a topical retinoid with benzoyl peroxide, or other suitable topical combinations. Moderate to severe inflammatory acne may need an oral antibiotic together with a topical treatment; an oral antibiotic should not be used alone.[3]
Treatment is normally reviewed at 12 weeks, considering new spots, pain, scarring, side effects and how manageable the routine has been.
Hormonal options may be considered for suitable women. NICE advises considering the combined oral contraceptive pill rather than a progestogen-only pill when a person with acne wants hormonal contraception.[3] The choice depends on medical history and contraceptive needs.
Spironolactone is sometimes used off-label for persistent acne in adult women. In the UK SAFA trial, improvement was greater at 24 weeks than at 12 weeks, supporting it as a possible alternative to repeated oral antibiotics.[4] It requires individual assessment, including pregnancy plans, other medicines, kidney function and possible side effects.
When should I ask for specialist assessment?
Arrange medical review sooner if you have deep painful lumps, developing scars, persistent colour changes or significant effects on confidence or mental health. NICE recommends considering specialist referral when mild to moderate acne has not responded to two different completed 12-week courses, or moderate to severe acne has not responded to treatment that included an oral antibiotic.[3]
Referral may also be appropriate for diagnostic uncertainty, nodulocystic acne, developing scars or persistent psychological distress. A private assessment does not guarantee a particular medicine.
If your current treatment has reached the review point, see what happens when acne treatment has not worked after 12 weeks.
Does adult acne mean I need isotretinoin?
No. Isotretinoin is considered for severe acne that is resistant to adequate standard treatment, particularly when permanent scarring is a risk. Adult age alone does not establish suitability.[3]
Current MHRA measures require initiation by a lead prescriber with expertise in systemic retinoids. The first appointment should be in person; later follow-up may be remote when appropriate. Mental health and sexual function are assessed before treatment and monitored during it. Anyone who could become pregnant must follow the Pregnancy Prevention Programme because isotretinoin can seriously harm an unborn baby.[5]
The prescriber must confirm that isotretinoin is clinically indicated and that there is no other appropriate effective treatment. The decision should follow a balanced discussion of alternatives, risks and monitoring—not a promise made before assessment.[5,6]
When is adult acne urgent?
Seek same-day medical help for a sudden severe eruption with painful or ulcerating spots, fever or feeling very unwell. Hot, rapidly spreading swollen skin may indicate infection. Call 999 for breathing difficulty or swelling of the lips, tongue or throat.
If acne is linked to thoughts of self-harm or immediate danger, seek urgent mental-health support through NHS 111, a local crisis service or 999 in an emergency.
Frequently asked questions
Is jawline acne always hormonal?
No. Jawline distribution can occur in adult acne, but location alone does not diagnose a hormonal disorder. Menstrual pattern, other symptoms, medicines and examination provide more useful clues.
Can menopause cause acne?
Hormonal changes around menopause can contribute to acne, according to the NHS.[2] New facial bumps can also be rosacea or another condition, so assessment is useful if the diagnosis is unclear.
Taking the next step
If adult acne is persistent, painful, scarring or affecting your wellbeing, you can speak to your GP or use mySkinDoc’s remote consultation service for assessment of your history and photographs. An in-person examination, tests or another referral pathway may sometimes be required. The purpose is to identify suitable next steps rather than to obtain a predetermined prescription.
References
Sources checked on 17 October 2026.
