Last updated: 2 November 2026
Nobody warns you that you can leave your teens, build a career, perhaps have children, and still be hiding a chin full of spots behind your hand on a Zoom call. Adult acne is common, it is under treated, and it is surrounded by two unhelpful ideas: that it is caused by poor hygiene, and that the right cleanser will fix it. As an NHS GP I see women every week who have spent hundreds of pounds on skincare for acne that needed a prescription, and as an aesthetic doctor in Hale I see the marks and scars that months of delay leave behind.
This article is the conversation I would like to have with each of them. It covers why adults get acne, how to tell when skincare is not enough, exactly what your GP can prescribe (according to the national guideline), when you should be referred to a dermatologist, and where a skin clinic fits, which is afterwards, for the marks and scars, not instead. The order matters more than almost anything else in acne, because scars are permanent and spots are not.
In this article:
- How common is adult acne?
- Why do adults get acne?
- When is skincare not enough?
- What can your GP actually prescribe?
- Hormonal options for women
- When should you be referred to a dermatologist?
- How to get the most from a GP appointment about acne
- What should your skincare look like during treatment?
- Where does a skin clinic fit? Marks, scars and the order of things
- Frequently asked questions
How common is adult acne?
Far more common than the teenage stereotype suggests, and far more common in women. A study of 1,013 adults aged 20 and over, published in the Journal of the American Academy of Dermatology, asked people simply whether they had acne.
"Our findings demonstrate that acne is a persistent problem for people of all ages." Dr Julie Harper, lead author, Journal of the American Academy of Dermatology, 2008.
So if you are 38 and still breaking out, you are one of roughly a third of women your age. That matters because adult acne is a medical condition with effective, evidence based treatment on the NHS, not a personal failing to be managed quietly with concealer.
Why do adults get acne?
The mechanics are the same at any age: oil glands over produce, the pore lining sheds abnormally and blocks, bacteria multiply in the trapped oil, and the follicle inflames. What differs in adults is what drives it, and the driver decides the treatment.
How to get the most from a GP appointment about acne
Ten minutes goes quickly, and acne appointments often end with the first cream on the list. This is how to make yours count.
What should your skincare look like during treatment?
Prescription treatment works best on calm, uninflamed skin, and the main job of skincare during acne treatment is to make the prescription tolerable rather than to treat the acne itself.
Medical grade skincare has a role here, chosen for the stage you are at: barrier support and SPF during treatment, then pigment control and a maintenance retinoid afterwards. What it is not is a replacement for the prescription ladder above. I will say that to anyone who asks me to "fix" active inflammatory acne with a product.
Where does a skin clinic fit? Marks, scars and the order of things
I run a skin clinic, so you might expect me to put it higher up this article. It belongs here, after the medical treatment, for a simple reason: treating marks and scars while new spots are still forming is painting a wall that is still being knocked down. Once acne has been quiet for a few months, this is what I can do.
The whole of this article comes down to a sequence. GP first, for the diagnosis and the guideline treatment. Gentle skincare alongside, to make the treatment tolerable and protect against marks. Dermatology if you scar or do not respond. A skin clinic last, for what the acne left behind. Done in that order, most adult acne can be controlled and most of its marks improved. Done in reverse, with peels on active acne and prescriptions never requested, it costs more and scars more. At my clinic in Hale I would rather tell you to see your GP first and treat your scars properly in six months than take your money now.
Takeaway: scars are permanent and spots are not. Get the prescription early, protect the skin while it works, and bring me the marks afterwards.
Frequently asked questions about adult acne
Why do I have acne at 35 when I never had it as a teenager?
Adult onset acne is common in women and is usually hormonal: cyclical fluctuations, PCOS, stopping the pill, a progestogen only contraceptive or early perimenopause. A GP can help work out which, and treat accordingly.
Is adult acne caused by poor hygiene?
No. Acne is driven by oil production, pore blockage, bacteria and inflammation, all influenced by hormones and genetics. Over washing makes it worse by stripping the barrier and increasing oil.
What is the best over the counter treatment for adult acne?
Adapalene 0.1% gel, a retinoid now available from pharmacies, and benzoyl peroxide are the two with real evidence. Give them twelve weeks with a gentle cleanser, moisturiser and SPF. If that has not worked, or you are scarring, see your GP rather than buying more products.
Can my GP prescribe tretinoin for acne?
Yes, usually as a fixed combination gel with clindamycin, or adapalene combined with benzoyl peroxide, as part of a 12 week course under the NICE guideline. These are prescribed for acne by your GP; at my clinic prescription retinoids are used for skin quality and pigmentation following consultation, not as acne treatment.
Why has my GP only given me antibiotics?
Oral antibiotics alone are not recommended by NICE; they should always be combined with a topical treatment, reviewed at three months and rarely continued beyond six. It is reasonable to go back and ask for the guideline combination.
Does the pill help adult acne?
Often, yes, particularly for jawline acne that flares before a period. Some combined pills are licensed for acne. Suitability depends on your medical history, which is why it is a GP decision; allow three to six months to judge.
When should I be referred to a dermatologist?
If your acne is scarring, leaving persistent pigmentation, causing persistent distress, if the diagnosis is uncertain, or if two 12 week courses have failed. Severe nodular acne should be referred early. Use the word "scarring" and ask directly about referral criteria.
Is isotretinoin dangerous?
It is a powerful medicine with real side effects, including dryness, mood effects that need monitoring and absolute pregnancy prevention, which is why only a consultant dermatologist led team can prescribe it. It is also the most effective treatment for severe or scarring acne, and under proper supervision most people complete it safely.
Does diet cause adult acne?
Diet does not cause acne on its own, but high glycaemic eating and, for some people, whey protein and skimmed milk make it worse. Lower glycaemic eating helps the insulin pathway that drives oil production, especially in PCOS.
Can I have a chemical peel or microneedling while I have active acne?
Superficial peels can help mild congestion, but inflamed acne should be treated medically first, and microneedling should never be done through active spots because it spreads inflammation. I treat marks and scars once the acne has been quiet for a few months.
How long after isotretinoin can I have microneedling or peels?
Most guidance is to wait at least six months after finishing, as the skin heals differently in that time. Your dermatologist's advice takes precedence, and I check before treating anyone who has had it.
Next steps
If your acne is active, start with your GP; take this article with you if it helps. If it has settled and you are left with marks, scars or skin that feels tired after years of breakouts, I would be glad to see you for a consultation at the clinic in Hale and plan the next stage properly.
Learn more about Dr Caroline Warden Clinic
Learn more about other treatments offered
Further reading
- The Best Treatments for Acne Scars
- PCOS (Now PMOS) and Your Skin: A GP's Guide
- Post Inflammatory Pigmentation: The Marks Left After Spots
- The Gut Skin Axis: How Your Diet Could Be Causing Breakouts
- Retinol vs Prescription Retinoids: What Works
- Medical Microneedling in Hale and Altrincham (for acne scarring)
- Medical Grade Skincare in Hale and Altrincham
Dr Caroline Warden (GMC 6157708) is an NHS GP with over 19 years of clinical experience, an independent prescriber, and holds a Level 7 postgraduate diploma in cosmetic injectables. She has practised aesthetic medicine since 2017 and runs Dr Caroline Warden Skin & Aesthetic Clinic with her sister Louise at 2 Crown Passages, Hale, Cheshire, WA15 9GN, serving patients from Hale, Altrincham, Bowdon, Hale Barns, Timperley, Sale, Alderley Edge, Wilmslow, Knutsford, Didsbury and across Cheshire and South Manchester. You will only ever be seen and treated by Dr Warden. The clinic does not diagnose or treat acne or other medical conditions; medical care should be sought from your own GP. Prescription only medicines are prescribed following a face to face consultation and are not promoted in this article. The clinic is an authorised Obagi stockist and ambassador clinic. This article provides general educational information and does not replace an individual assessment. Information correct as of November 2026.
References
- National Institute for Health and Care Excellence. Acne vulgaris: management. NICE guideline NG198, 2021, updated 2023. Read the guideline
- Collier CN, Harper JC, Cantrell WC, et al. The prevalence of acne in adults 20 years and older. Journal of the American Academy of Dermatology 2008;58(1): pages 56 to 59. Read the abstract
- NHS. Acne: overview, causes, treatment and complications. Read the NHS page
- British Association of Dermatologists. Patient information leaflet: acne. Read the leaflet
- British Association of Dermatologists. Patient information leaflet: isotretinoin. Read the leaflet
