The attack of adult acne: I’m already in my 30’s and 40’s, why do I still have troubling active acne on my face?

The attack of adult acne: I’m already in my 30’s and 40’s, why do I still have troubling active acne on my face?


The period of teenage/adolescence to early adulthood is the period where one is most prone to acne. As acne is a chronic recurring skin condition, even adults in their 30s or 40s, especially women, may also suffer from adult acne.

Causes of adult acne

Acne is a chronic inflammatory skin disease of the pilo-sebaceous (oil gland and hair follicle) unit in the skin, usually occurring on the face, chest and back. Acne has a spectrum of manifestations ranging from excessive oiliness, clogged pores, inflamed pimples to acne marks and pitted scarring.


Image credit to: Marcia Hartstock

Adult acne and teenager acne are similarly caused by the complex interaction of genetic factors and hormonal imbalance. Hormonal imbalance can cause the excessive production of sebum or oil by the sebaceous glands, enlarging the pores, and subsequently the remaining sebum and dead skin cells on the skin will form blackheads and white heads (medically termed “comedones” or “clogged pores” in laymen’s term).

Gradually, comedones or clogged pores become inflamed, and infected by acne bacteria (p. acne), resulting in painful inflammation and red swellings (layman termed as "pimples" or “zits”) with or without pus, and more serious large fluid-filled cystic acne. These inflamed acne problems can eventually leave reddish-brown acne marks, and permanent pitted depressed scars on the skin.


Circumstances that can exacerbate acne in adults

  • Emotional stress
  • Squeezing acne inappropriately.
  • Women are more prone to acne during the pre-menstrual period.
  • Some cosmetics contain certain comedogenic ingredients that can cause the formation of even more clogged pores.
  • Certain medications, such as long-term intake of oral steroids or the excessive use of steroidal applications on the skin, the intake of anti-epileptic medications, or medications or injections with androgens (male-hormones).
  • Certain illnesses such as polycystic ovarian syndrome and Cushing syndrome.
  • For those working in oil or petroleum refinery industries, physical exposure to chemicals and oils may cause acne.


Q&A Session on Acne

Is acne more prevalent in men or women?
Is it more prevalent in adults or teenagers/adolescents?

More than 80% of teenagers and adolescents may suffer from acne problems.(1) In about 20% of male and female teenager and adolescent acne patients, their acne problems can continue into adulthood. (1)

Generally speaking, most adult acne patients suffered from acne during their teenage years, but for most of them, their condition will often gradually stabilize in their 20’s. Conversely, there are some patients who may not have acne in their teenage years, but only develop severe acne in their 30’s.

Adult acne is more likely to appear on the lower half of the face (U-zone), especially on the side of the cheeks, jawlines and chin, around the mouth, and neck, while teenage and adolescent acne is more likely to appear on the forehead, nose, and centre of the face (T- zone). (1)

When men have acne, their conditions tend to be more serious than in women. In addition, people with oily skin are also more likely to suffer from adult acne, because oily skin is more prone to comedones formation, and as such the probability of suffering from inflammatory acne is also higher.

Teenager and adolescent acne area: T-zone

Adult acne area: U-zone



What are the most effective treatments for adult acne?

Although acne is a chronic recurring skin disease, there are still several effective ways to treat and control it. A good daily skincare routine can be used to control acne through the use of medical skincare products that aim to reduce excessive oil secretion and comedones on the face.

Comedones extraction by professionally trained aestheticians via facial treatments are also to a certain degree, effective in removing stubborn clogged pores and cleansing the pores to remove accumulated debris on the skin.



Patients should be reminded that they should avoid squeezing or extracting the inflamed acne or pimples by themselves, because inappropriate squeezing can cause the skin and the acne to be prone to infection and inflammation, which can further aggravate the acne or even cause acne marks or permanent scars to form.



For more severe cases of acne, especially for patients with a lot of inflamed or cystic acne and scars, it is best to be treated by experienced skin and aesthetic doctors. In such cases, oral medications such as antibiotics or isotretinoin (high dose vit-A medication) may be needed. Female patients can also consider to take anti-androgen (anti-male hormones) medications as part of the treatment. Experienced doctors should be consulted, so that the patient can best understand the use of these oral medications and their associated side effects.


If I do not wish to take oral medications, are there any other options to treat my acne?

Other than oral medications, treatments such as chemical peels, intense pulsed light (IPL), lasers, and steroidal injections into the inflamed acne, etc. are also possible treatments.

Speak to your doctor to find out if these treatments are suitable for your case, if you prefer not to take oral medications.



What are some undesirable aftereffects of acne?

If left untreated, acne may leave unsightly reddish-brown marks on the skin. This is medically known as post-inflammatory hyperpigmentation (PIH) or post-inflammatory erythema (PIE). Acne inflammation can also lead to skin damage, causing the skin to fail to regenerate properly, which can form the appearance of unsightly permanent pitted depressed scars.

The best way to prevent acne marks and scars is to treat and control inflamed acne as soon as possible.

Acne scars
Reddish-brown acne marks


What kind of psycho-social effects or impacts on one’s quality of life are there caused by acne?

Adult or teenage acne is a common skin problem, and if inappropriately treated, it can cause a series of serious and unsightly inflammation or permanent scars on the face or body.

This may cause a certain degree of emotional and psycho-social distress to some adults or teenagers. These impacts may affect their self-confidence, acceptance from peers, or even unwillingness to engage in social activities etc, thus hurting their overall quality of life. (1)


Conclusion: Know where to seek help, keep your acne far away!

Adult acne is a very prevalent skin problem for those in the 30’s or 40’s (especially so for the ladies), and many may suffer in silence not knowing where to seek real help. Do not despair or lose hope, as there are effective and proper treatments available for you, with the right and experienced doctors.

It is in your best interest not to delay seeking proper treatment, as early treatment can provide you the golden opportunity to achieve the most optimal results, and to significantly reduce the impact of permanent acne scarring, thus improving your quality of life.

As the saying goes, prevention is better than cure.


If you have any inquiries about acne issues, feel free to WhatsApp me at +65 9822 2989 or call in at +65 6222 2262, I’ll be happy to address all of them.

You can also e-mail me at:



Dr. David Ng C H


  1. A/Prof Chua S. H. and Dr Hazel Oon H. B.

    A to Z about Acne & Zits: The Complete Guide to Clear Skin. (Published by Straits Times Press)