Adult Acne in Your 20s, 30s & 40s: Understanding Causes & Effective Treatments

You’d think pimples were something you left behind with teenage angst and exam stress – but dermatologists say it’s common to develop acne in your 20s to 40s and beyond, even if your teenage skin was clear. “Many adults come to me saying, ‘I thought I left pimples behind in my teenage years – why is this happening now?’” said Dr Angeline Yong, founder of Angeline Yong Dermatology and Sskins Medispa. “That sense of frustration can be as hard to manage as the acne itself.” Unlike teenage breakouts, which are mainly driven by hormonal fluctuation, the causes of adult acne are more complex and “still not as well understood”, added Dr Sarah Too, medical director of Astria Medical Aesthetics. “Adult acne is also seen to be more cyclical compared to the consistent breakouts in teens.” “The good news is that with tailored treatments and the right skincare, it can be effectively managed – even in adulthood,” said Dr Yong. WHAT CAUSES ADULT ACNE 1. HORMONAL AND MEDICAL FACTORS “Teenage acne is largely driven by puberty-related hormone surges, particularly androgens, which stimulate excess oil production and make the skin more prone to clogged pores,” explained Dr Yong. “In adults, fluctuations related to the menstrual cycle such as oestrogen dominance, pregnancy, post-partum shifts, or perimenopause can all spark new breakouts. Conditions like polycystic ovary syndrome (PCOS) may also surface later in adulthood and contribute to acne,” she continued. Men with high testosterone levels are also prone to “deeper, cystic, nodular breakouts”, noted Dr Too. Once hormone levels stabilise after adolescence, flare-ups usually ease, which is why adult acne is more common among women. Certain medications can also aggravate the skin. “Steroids, anti-seizure drugs, or even supplements like high-dose vitamin B12 may cause or worsen acne,” said Dr Yong. 2. STRESS “When we’re under pressure, the level of cortisol (the stress hormone) increases, stimulating oil glands and fuelling inflammation,” explained Dr Yong. This makes pores more likely to clog, and existing breakouts become more persistent. Her advice: Treat stress as seriously as skincare. “Good sleep, rest, meditation and self-care really help the skin respond better to treatment.” 3. LIFESTYLE HABITS From your diet to phone hygiene, small daily habits can make a big difference. “High-glycaemic foods like char kway teow or chicken rice can spike blood sugar and increase insulin and Insulin-like Growth Factor 1 (IGF-1), which stimulate excess oil and clog pores,” said Dr Too. “Dairy and sugary drinks like milk coffee and bubble tea also boost oil production and inflammation.” While blue light from screens hasn’t been proven to cause acne, it may worsen inflammation and accelerate premature ageing. The bigger issue, says Dr Too, is constant phone-to-cheek contact: “It can trigger localised breakouts through friction, pressure and bacteria transfer.” To minimise flare-ups, try to keep your phone away from your face as much as possible, and clean it regularly. Exercise can help regulate hormones and reduce stress – but sweat left on the skin too long can lead to breakouts, especially "bacne" or "back acne". “Cleanse your face and body after workouts, change out of tight clothes and avoid heavy makeup,” advised Dr Too. “Products with salicylic acid or benzoyl peroxide can help prevent post-workout breakouts. I also like to use hypochlorous acid sprays after a workout to gently sanitise the skin.” HOW BREAKOUTS CHANGE WITH AGE Dr Yong explains how acne evolves with age. In your 20s: “Breakouts are still influenced by residual hormonal surges,” she said. “Stress from studying, starting your career, or irregular sleep, can also trigger flare-ups.” Acne appears along the lower cheeks and jawline, though oily T-zone pimples remain common. In your 30s: “Hormonal fluctuations remain a strong driver, but lifestyle stress, lack of sleep, and early signs of skin ageing start to play a bigger role.” The skin barrier becomes more sensitive, leading to deeper, more painful nodules around the jawline, chin, and neck. In your 40s and beyond: “Acne is less about excess oil and more about hormonal changes, such as perimenopause, or inflammatory triggers.” The skin becomes less resilient and flare-ups tend to be cystic, slow to heal, and more likely to leave dark marks or scars. Both doctors are seeing a steady rise in adult acne cases locally, especially among women. “Our hot, humid climate means sweat and oil production are naturally higher, which can clog pores,” said Dr Yong. “On top of that, periodic haze and rising air pollution can expose the skin to fine particles and oxidative stress, which can worsen breakouts.” Dr Too points to another factor. “The ideal of achieving flawless ‘glass skin’ has made people more conscious about their complexion. This often makes individuals feel uncomfortable in their own skin, prompting many to seek treatments,” she shared. On a similar note, Dr Yong warns against “skincare acne” – flare-ups caused by overloading on trending products. “People are layering multiple acids, retinoids, scrubs and masks without guidance," said Dr Yong. “The result? A compromised skin barrier that becomes red, sensitive, and ironically, more prone to breakouts.” For such cases, she recommends a "reset". “Strip back to a gentle cleanser, light non-comedogenic moisturiser, and sunscreen.” Once the skin calms, reintroduce actives slowly, one at a time – ideally with guidance from a dermatologist. TREATING ACNE AT HOME Mild acne can often be managed with over-the-counter products. Both experts recommend starting with a few proven ingredients: Retinoids: Dr Too’s top pick, retinoids help reduce sebum production and boost cell turnover. Start slowly with lower concentrations, she advises, as stronger formulas can be too drying or irritating for some skin types. Salicylic acid (BHA): “This ingredient gets deep into pores to clear blockages and reduce blackheads and whiteheads,” said Dr Yong. Using it in a cleanser or toner is a great first step. Benzoyl peroxide: Both cite this as an effective option for killing acne-causing bacteria. Dr Yong recommends starting with lower strengths (2.5 per cent to 5 per cent) to minimise dryness. Niacinamide: A soothing multitasker, niacinamide helps regulate oil production and reduce redness. “It’s a gentle addition to almost any routine,” says Dr Yong. HOW TO BALANCE ACNE AND ANTI-AGEING CARE “The key is not to throw every active on at once, but to use them in a thoughtful, layered way in rotation,” said Dr Yong. Alternate actives – for instance, use acids in the morning, and retinol at night – and pair with niacinamide to soothe the skin. “Sunscreen is non-negotiable,” she added. “UV exposure worsens both acne marks and ageing.” THE NEW ERA OF ACNE TREATMENTS Acne care is now gentler, smarter and more targeted. “For adult skin, we now have treatments that treat acne while respecting sensitivity and barrier health,” said Dr Yong. She cites radiofrequency microneedling, fractional lasers, and the new 1726nm wavelength lasers that specifically target sebaceous glands. “Light and photodynamic therapies like blue and red light, or gold photothermal therapy, are effective for overactive oil glands with minimal downtime.” Dr Too often combines oral and topical medications with energy-based treatments: “Carbon laser peel helps to cleanse the skin and reduce sebum production, while Pico laser targets acne-causing bacteria and lightens post-acne marks, making it effective for both active breakouts and residual pigmentation.” IT’S A MARATHON, NOT A SPRINT For Dr Too, achieving clear skin is as much an emotional journey as a physical one. “Adult acne can be really frustrating, and I completely understand because I’ve experienced it myself,” she shared. “I started developing cystic flare-ups during university and still get the occasional breakout. Over time, I’ve learned to be patient and focus on keeping my skin balanced and calm instead of trying to eliminate every imperfection.” She often reminds patients: “Breakouts don’t define your confidence or self-worth. How you treat and care for yourself matters so much more.” Dr Yong’s approach begins with reassurance. “Adult acne is extremely common, and it’s not a sign of poor hygiene or personal failure – it’s biology, hormones, environment, and stress all interacting,” she explained. “Acne management is a journey, not a quick fix. We set realistic goals together, whether that’s reducing breakouts, fading scars, or restoring confidence in how their skin feels.” The message is clear: Be kind to your skin and yourself, and remember that the goal isn’t perfection – it’s resilient, healthy skin and the confidence to show up as you are.