What’s the deal with adult acne?

One-third of women suffer from acne as an adult.

May 7, 2020


Acne is one of the most common reasons people see a dermatologist (a doctor who specializes in skin, hair and nails). Every day I see several patients with acne, and not just teenagers. Many are adult women.

In fact, about 35% of women suffer from acne as an adult (myself included), which just isn’t fair — to be fighting acne and wrinkles at the same time. So why do we get acne? The theory is that most adult female acne is related to changing hormones.

If you think about it, women’s hormones change often. On top of monthly hormonal shifts, there are shifts related to birth control, pregnancy, after pregnancy, pre-menopause and menopause. Given all this, it’s a wonder that anyone has clear skin.

Many treatment options

Fortunately, there are many treatment options for acne. When considering the right ones for adult women, it’s important to remember two things. Our skin is aging and traditional acne medications may be too harsh.

Topical treatments

Topical treatments are applied to the skin. One topical, Retin-A (tretinoin), is very good for light acne and anti-aging — a win-win. I’m careful to prescribe the right strength because it can dry and irritate the skin. So I usually start with a low strength.

I suggest applying a small amount over a moisturizer every other night or every third night. Use Retin-A only at night because sunlight inactivates it. Also, because Retin-A makes your skin very sensitive to the sun, it's important to wear sun protection during the day.

Other topical treatments commonly used for acne are antibiotics and medicated washes. Those that contain salicylic and/or glycolic acid are my favorites for mature skin.

Oral medications

If your acne is cystic (big, red and deep bumps), leaves scars or is more severe, oral medications can help. For example, antibiotics can help clear the skin. Creams are then used to keep the skin clear because oral antibiotics shouldn’t be used long term.

If longer-term treatment is needed, spironolactone can be very helpful. It’s a blood pressure medication that’s also used for acne. It works by blocking the effect of male hormones. Women have male hormones too. In fact, they’re part of the reason we get acne.

Spironolactone works well for some women. But it’s not a cure. It only works when it’s being taken.

Which leads me to the most powerful medication for acne, isotretinoin (commonly called Accutane). Accutane is our only cure for acne. Most people who finish a course of Accutane no longer have acne.

Accutane can be difficult in that it requires regular office visits and lab tests. But it can be life-changing for people whose acne is severe, leaves scars, resists other treatments or lasts for years. I often prescribe Accutane for teenage and adult patients.

Schedule a consultation

If acne is a concern for you, there are many ways we can help. To schedule an appointment with Dr. Erin Moore, call 1-206-860-4605.


By Erin Moore, MD

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The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs.