As we age, our skincare journey takes unexpected turns. Breakouts are no longer only for people going through puberty. Late-onset breakouts have become a perplexing reality for many women.

We asked Curology’s team of licensed dermatology providers to unpack adult acne, unraveling the causes behind these unexpected eruptions and shedding light on the unique challenges faced by women navigating skincare in later stages of life.

The hormonal roller coaster

Acne isn’t just a teenage issue. Hormonal fluctuations can cause breakouts in many women well into their 40s, 50s, and beyond.

The delicate balance between estrogen and androgens plays a role in skin health.¹ After menopause, when estrogen levels plummet and androgens decrease more gradually, this imbalance can contribute to changes in skin condition, including increased susceptibility to acne development in some women.²

Hormonal acne’s target areas

While teenage acne typically manifests on the forehead, nose, and cheeks, hormonal acne in adult women is traditionally described as breakouts that occur on the lower third of the face, particularly around the mouth, chin, and jawline.³ It may also extend to the neck and chest.⁴

While hormonal acne is classically thought of as inflammatory, a recent study showed that acne in adult women is more commonly a mix of inflammatory breakouts mixed with whiteheads and comedones that may appear in all facial zones.⁵

Causes of acne in older women

Lifestyle factors, including diet, stress, and inadequate skincare routines, can significantly impact acne in older women.⁶ Here we dive deeper into the main causes of acne in older women.

Stress 

Modern life brings with it the unavoidable presence of stress, which can exert a notable influence on the health of our sensitive skin. When confronted with stress, our bodies unleash hormones such as cortisol and androgens.⁷ Although crucial for survival, these hormones can also stimulate heightened oil production and skin inflammation, potentially contributing to female acne breakouts or exacerbating pre-existing conditions.⁸ 

Sleep

Sleep is crucial for maintaining skin health.⁹ During sleep, our skin undergoes a period of regeneration and repair, essential for optimal functioning.¹⁰ When we deprive ourselves of adequate sleep or disrupt our sleep patterns, we interfere with this vital process, leading to a weakened skin barrier, increased oxidative stress, and inflammation—all of which can exacerbate acne.¹¹

Smoking 

Smoking exerts numerous harmful effects on both the body and skin. While the relationship between acne and smoking lacks clear evidence of causation, available research indicates that smoking may exacerbate existing acne.¹² Quitting smoking, on the other hand, has been associated with relief from acne symptoms. 

Smoking robs your skin of essential nutrients, diminishes your complexion, and hastens the aging process.¹³ It also lessens blood flow to the skin’s surface and impedes wound healing.¹⁴ Giving up smoking allows oxygen levels to normalize, facilitating a faster healing process for acne-related blemishes, discoloration, and marks.¹⁵

Diet

Numerous studies have suggested a connection between a high-glycemic diet and adult acne.¹⁶ Foods with a high glycemic index, such as refined carbohydrates and sugary snacks, can lead to increased insulin levels, triggering inflammation and potentially exacerbating acne.¹⁷

Additionally, dairy products like milk, sugary drinks, and fatty/sugary foods, may be linked to adult acne—although larger studies are needed for confirmation.¹⁸

Skincare habits and products

Hormonal fluctuations, especially during adolescence and menopause, influence skincare needs significantly.¹⁹ For those entering menopause, adapting to drier skin is vital, necessitating hydration-focused products.²⁰ Consulting with a dermatologist can provide personalized recommendations based on your specific skin concerns.

Air pollution

Air pollution, particularly particulate matter, ozone, and PAHs (polycyclic aromatic hydrocarbons), can significantly contribute to skin aging, acne, psoriasis, atopic dermatitis, and other conditions.²¹ These pollutants enter the skin through direct contact, inhalation, and ingestion. Studies suggest a link between air pollution and inflammatory acne.²² 

Climate

Climate is also important to consider when managing acne. Higher temperatures contribute to increased sebum production, leading to a higher likelihood of acne flare-ups.²³ This connection emphasizes the need for tailored skincare in hotter climates.

In arid or dry climates, maintaining skin hydration is paramount. Emphasize the use of hydrating cleansers, moisturizers, and serums to combat dryness. Products containing hyaluronic acid and glycerin can be particularly effective in retaining moisture.²⁴

Regardless of climate, UV radiation poses a constant threat to the skin.²⁵ A broad-spectrum sunscreen with SPF 30+* should be a part of all daily skincare routines. UV protection is essential in preventing premature aging and minimizing the risk of skin issues exacerbated by sun exposure.²⁶

Treatment options

Though there are many causes of acne in older women, there are also many treatment options and strategies that can help you avoid breakouts. 

Skincare

To fortify the skin’s barrier against pollution-induced damage, cleansing is a fundamental step, followed by the application of antioxidant-rich formulations like serums and moisturizers.²⁷ Daily use of sunscreen safeguards against UV radiation.²⁸ 

To combat free radicals, consider incorporating antioxidants like vitamins C and E into your diet or skincare routine, which can help neutralize their harmful effects.²⁹ 

Topical treatments

Topical treatments, including retinoids, benzoyl peroxide, and salicylic acid, can effectively unclog pores, alleviate inflammation, and thwart the development of new breakouts.³⁰ Prescription retinoids like tretinoin and adapalene are valuable for adult skin dealing with acne. These ingredients promote cell turnover, addressing both acne and the signs of aging.³¹ 

Another great topical treatment is hyaluronic acid, a hydrating powerhouse that benefits skin by retaining moisture.³² A gradual introduction of skincare products is recommended to minimize potential irritation. 

Lifestyle changes

Adopting healthier lifestyle practices may play a crucial role in managing and preventing acne-related concerns in this demographic. For some women, lifestyle modifications, such as steering clear of stress, dairy products, and sugar, which can trigger acne, may also yield positive outcomes.³³

Oral medications, such as birth control pills, spironolactone, and antibiotics, are also options to help balance hormones, curb sebum production, and combat bacteria.³⁴

Let Curology help solve your concerns with acne

Late-onset acne may be a surprising twist in the journey of aging, but armed with knowledge, you can conquer it. From stress management to personalized skincare** plans, the holistic approach outlined in this article empowers you to take charge of your skin health.

Get your personalized skincare routine with Curology

Get your personalized skincare routine with Curology

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Connect with a licensed dermatology provider at Curology for personalized skincare plans designed to target adult acne and enhance overall skin health. Contact us today*** and discover how tailored solutions can revolutionize your skincare routine.

Curology provides educational resources to help users understand the science behind acne and the rationale behind their prescribed treatments.

P.S. We did the homework so you don’t have to:

1. Khunger, N. and Mehrotra, K. Menopausal Acne – Challenges And Solutions. Int J Womens Health. (2019, October 29).

2. Khunger, N. and Mehrotra, K. Menopausal Acne – Challenges And Solutions. Int J Womens Health. Ibid.

3. Khunger, N. and Mehrotra, K. Menopausal Acne – Challenges And Solutions. Int J Womens Health. Ibid.

4. Khunger, N. and Mehrotra, K. Menopausal Acne – Challenges And Solutions. Int J Womens Health. Ibid.

5. Zeichner, J.A., et al. Emerging Issues in Adult Female Acne. Journal of Clinical and Aesthetic Dermatology. (2017, January 1).

6. Zeichner, J.A., et al. Emerging Issues in Adult Female Acne. Journal of Clinical and Aesthetic Dermatology. Ibid.

7. Zari, S. and Alrahmani, D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. (2017, December 5).

8. Zari, S. and Alrahmani, D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. Ibid.

9. Lyons, A.B., et al. Circadian Rhythm and the Skin: A Review of the Literature. J Clin Aesthet Dermatol. (2019, September 1).

10. Lyons, A.B., et al. Circadian Rhythm and the Skin: A Review of the Literature. J Clin Aesthet Dermatol. Ibid.

11. Schrom, K.P., et al. Acne Severity and Sleep Quality in Adults. Clocks Sleep. (2019, December 6).

12. Schäfer, T., et al. Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol. (2001, July 1).

13. Yazdanparast, T., et al. Cigarettes Smoking and Skin: A Comparison Study of the Biophysical Properties of Skin in Smokers and Non-Smokers. Tanaffos. (February 2019).

14. Capitanio, B., et al. Acne and smoking. Dermatoendocrinol. (May-June 2009). 

15. Yazdanparast, T., et al. Cigarettes Smoking and Skin: A Comparison Study of the Biophysical Properties of Skin in Smokers and Non-Smokers. Ibid.

16. Pappas, A. The relationship of diet and acne. Dermatoendocrinol. (September-October 2019).

17. Pappas, A. The relationship of diet and acne. Dermatoendocrinol. Ibid.

18. Penso, L., et al. Association Between Adult Acne and Dietary Behaviors. JAMA Dermatol. (2020, June 10).

19. Lephart, E.D. and Naftolin, F. Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin. Dermatol Ther (Heidelb). (2020, November 26).

20. Lephart, E.D. and Naftolin, F. Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin. Dermatol Ther (Heidelb). Ibid.

21. Manisalidis, I., et al. Environmental and Health Impacts of Air Pollution: A Review. Front Public Health. (2020, February 20).

22. Manisalidis, I., et al. Environmental and Health Impacts of Air Pollution: A Review. Front Public Health. Ibid.

23. Kim,S., et al. Influence of exposure to summer environments on skin properties. J Eur Acad Dermatol Venereol. (November 2019).

24. Milani, M. and Sparavigna, A. The 24-hour skin hydration and barrier function effects of a hyaluronic 1%, glycerin 5%, and Centella asiatica stem cells extract moisturizing fluid: an intra-subject, randomized, assessor-blind study. Clin Cosmet Investig Dermatol. (2017, August 11).

25. American Academy of Dermatology Association. Sunscreen FAQs. (2023, October 19).

26. American Academy of Dermatology Association. Sunscreen FAQs. Ibid.

27. Roberts, W. Air pollution and skin disorders. Int J Womens Dermatol. (2020, November 25).

28. Roberts, W. Air pollution and skin disorders. Int J Womens Dermatol. Ibid.

29. Roberts, W. Air pollution and skin disorders. Int J Womens Dermatol. Ibid.

30. Zaenglein, A.L., et al. Guidelines of care for the management of acne vulgaris. JAAD. (May 2016).

31. Motamedi, M., et al. A Clinician’s Guide to Topical Retinoids. J Cutan Med Surg. (2021, July 22).

32. Milani, M. and Sparavigna, A. The 24-hour skin hydration and barrier function effects of a hyaluronic 1%, glycerin 5%, and Centella asiatica stem cells extract moisturizing fluid: an intra-subject, randomized, assessor-blind study. Clin Cosmet Investig Dermatol. Ibid.

33. Zeichner, J.A., et al. Emerging Issues in Adult Female Acne. Journal of Clinical and Aesthetic Dermatology. Ibid.

34. Tan, A.U., et al. A review of diagnosis and treatment of acne in adult female patients. International Journal of Women’s Dermatology. (June 2018).

35. Zeichner, J.A., et al. Emerging Issues in Adult Female Acne. Journal of Clinical and Aesthetic Dermatology. Ibid.

36. Zeichner, J.A., et al. Emerging Issues in Adult Female Acne. Journal of Clinical and Aesthetic Dermatology. Ibid.

37. American Academy of Dermatology Association. I have acne! Is it okay to wear makeup?. (n.d.).

38. Manisalidis, I., et al. Environmental and Health Impacts of Air Pollution: A Review. Front Public Health. Ibid.

Kristen Jokela is a certified Family Nurse Practitioner at Curology. She obtained her Master of Science in Nursing at the University of South Florida in Tampa, FL.

*Sunscreen cannot prevent all harm from UV rays.

**Restrictions apply. See website for full details and important safety information.

***Cancel anytime. Subject to consultation. Results may vary.

Always consult with a healthcare professional or dermatologist for personalized advice and treatment options tailored to your specific situation.

Written by

Curology Team

Medically reviewed by

Kristen Jokela, NP-C