Adult Acne: When Should I See a Dermatologist?
How to recognise when persistent, painful or sudden adult acne needs professional assessment.
You don’t need to wait until adult acne becomes severe before asking for help. If breakouts are persistent, painful, beginning to scar or affecting how you feel, it’s reasonable to see a GP or dermatologist, even if you’ve only previously tried pharmacy or high-street products.
As a consultant dermatologist, I see adults whose acne has continued since adolescence and others who develop it for the first time in their twenties, thirties or forties. Many have spent months changing products or blaming themselves. Acne isn’t caused by poor hygiene or insufficient cleansing, and effective adult acne treatment begins with understanding what is driving it.
Why have I suddenly developed acne as an adult?
Acne develops when the sebaceous glands, which produce the skin’s natural oil (sebum), become overactive. Dead skin cells can also build up and block the hair follicles, commonly known as pores, through which sebum reaches the skin’s surface. When oil and dead skin cells block these follicles, inflammation can follow.
Hormones influence oil production, but sudden adult acne can also be associated with a change in contraception, pregnancy, certain medicines, oily skincare or hair products, stress, significant dietary changes, or an underlying hormonal condition.
Adult acne in women that flares around periods or is concentrated around the jawline may have a hormonal pattern. However, the position of spots alone can’t confirm this. Irregular periods, excess facial or body hair, scalp hair thinning, difficulty conceiving or difficulty losing weight may justify assessment for Polyendocrine Metabolic Ovarian Syndrome (previously called Polycystic Ovary Syndrome) or another hormonal cause.
Could my spots be something other than acne?
Yes. Rosacea, perioral dermatitis and folliculitis can all produce acne-like bumps but require different management. Blackheads and whiteheads, known as comedones, support a diagnosis of acne. Prominent flushing, visible facial vessels, a rash around the mouth or very uniform itchy spots may point elsewhere. An assessment by a dermatologist is often more useful than trying another skincare ingredient at random.
What can I try before seeing a dermatologist?
- Cleanse gently with products that remove excess oil, but no more than twice daily. Scrubbing and repeated washing can increase irritation.
- Remove make-up at the end of the day.
- Choose non-comedogenic skincare, sunscreen and make-up (products that don’t block pores), and avoid layering several rich or oily products. Consider mineral make-up.
- Avoid getting hot and sweaty, for example during heavy exercise, while wearing heavy make-up.
- For mild acne, over-the-counter products such as benzoyl peroxide, azelaic acid and nicotinic acid can be helpful. Introduce them gradually, rather than at the same time, as they can cause irritation. Apply acne treatments to the acne-prone area as directed, rather than only to individual spots.
- Don’t pick or squeeze spots, as this increases inflammation and the risk of scarring.
- If you have a darker skin tone, wear non-comedogenic sunscreen that protects against UVA, UVB and visible light to reduce the risk of post-inflammatory pigmentation.
Improvement with adult acne treatments is rarely immediate. Many prescription creams and lotions need around 8-12 weeks of correct, consistent use before their effectiveness can be assessed. If a product is causing significant irritation, seek advice rather than repeatedly adding or switching treatments.
When should I see a dermatologist for acne?
An assessment by a dermatologist may be particularly valuable if any of the following apply:
- You have painful acne beneath the skin, including nodules or cysts
- Your acne is beginning to scar or leave persistent pigmentation
- Simple skincare measures or appropriately used pharmacy or prescribed treatments haven’t helped after a suitable trial
- Acne affects your chest or back extensively, repeatedly returns or is difficult to control
- You suspect you may have hormonal acne or need advice that takes account of contraception, pregnancy or plans to conceive
- You’re uncertain whether the condition is acne
- Your acne is having a significant effect on your confidence or emotional wellbeing
What happens during an acne dermatologist consultation?
One of our consultant dermatologists will begin by confirming the diagnosis and assessing the types of spots present, their distribution, severity and duration, and whether scarring or changes in pigmentation have started. They will also ask about previous treatments, skincare, medicines, menstrual patterns where relevant, medical history, pregnancy plans and the effect acne is having on daily life.
This matters because an acne treatment plan should fit both the biology of the condition and the person living with it. What is suitable for occasional comedones may not be appropriate for persistent inflammatory or cystic acne.
How can a dermatologist treat persistent adult acne?
Depending on the assessment, treatment may include prescription creams or lotions containing ingredients such as retinoids, benzoyl peroxide, anti-androgens, or azelaic acid; oral antibiotics used for controlled periods alongside treatments applied to the skin; hormonal treatments where appropriate, such as the contraceptive pill or spironolactone; or isotretinoin for severe, scarring or treatment-resistant acne.
Some options are unsuitable during pregnancy or while trying to conceive, and isotretinoin requires specialist supervision and strict pregnancy-prevention measures where relevant, as well as counselling about possible effects on mental health.
Some patients may also benefit from in-clinic treatments as part of their wider acne treatment plan. These include HydraFacial or microdermabrasion for deep cleaning of pores, red and blue LED light treatments to reduce bacteria and inflammation, and pulsed dye laser or Laser Genesis treatments to reduce redness and the risk of scarring.
Dermatology Consulting now offers AviClear®, a laser developed specifically for mild, moderate and severe inflammatory acne, which specifically targets the sebaceous glands to reduce their activity. It may provide an additional non-drug option to patients.
Learn more about AviClear® acne treatment
Can early treatment help prevent acne scarring?
Yes. Deep, inflamed lesions, particularly nodules and cysts, carry a greater risk of permanent scarring. Picking also increases that risk. Controlling active acne early is therefore more effective than waiting to treat established scars. Retinoid creams and isotretinoin also have separate benefits in improving scars. In addition, pulsed dye laser treatment for red spots can speed up healing and reduce the risk of scars developing.
Red or brown marks after acne are not always permanent scars, but they can take time to fade and may be more noticeable in some skin tones. The earlier they’re treated, the quicker they’ll fade.
Getting the right help for adult acne
Persistent or painful adult acne can be frustrating, particularly when you’ve tried different products without seeing an improvement. A dermatologist can help identify the cause, assess the risk of scarring and recommend a treatment plan suited to your skin.
If you’re concerned about adult acne, arrange a consultation with one of Dermatology Consulting’s consultant dermatologists.
About Dr Anne Farrell
Dr Anne Farrell is an Oxford-trained Consultant Dermatologist and founder of Dermatology Consulting in Tunbridge Wells, with more than 30 years’ experience across medical, surgical, laser and aesthetic dermatology.
Find out more about Dr Anne Farrell