If you’re over 35 and still breaking out, you’re not doing anything “wrong”- but you may be using an approach that no longer matches your skin’s needs.
After two decades in clinic, helping thousands of patients get bright, clear skin, I’ve seen firsthand that adult acne is a different beast. And if you’re still treating your skin like you did as a teenager? That’s probably why you’re not seeing results.
In this post, I’ll walk you through the biggest mistakes I see in clinic every day - and how to fix them. Plus, I’ll share the exact adult acne framework I give to my 35+ patients that gets results, without wrecking your skin barrier.
Why Adult Acne Is Different to Teen Acne
Let’s start with the basics: how does acne form? Acne begins when a hair follicle becomes blocked with a mix of dead skin cells and oil. This creates a plug, known as a comedone. Once oxygen can't get in, acne-causing bacteria (called C. acnes) thrive, triggering inflammation. The result? That red, painful spot that seems to appear overnight.
Yes, the biological process behind acne - the clogged pore, the bacteria, the inflammation - is the same. But your skin has changed:
● Your skin is drier and more sensitive
● You may be juggling hormonal changes
● The impact of stress takes its toll
● You’re trying to address the signs of ageing too
And while the teen aisle at the pharmacy is stacked with blemish solutions, they often backfire in adult skin, stripping the barrier and fuelling inflammation as they’re often harsh and drying.
Adult acne disproportionately affects women and, unsurprisingly, hormones often play a role: around 80% experience pre-menstrual blemishes and at least 40% will be affected at some point in their adult life. This is why breakouts can worsen with stopping or starting the contraceptive pill, IVF cycles, or even the Mirena coil. In conditions such as PCOS, where testosterone is often higher, acne can be more persistent and jawline-focused, and needs a barrier-respecting, hormone-aware approach.
We also see a distinct U-pattern of acne in adult women (jawline, chin, cheeks), which is drier and more prone to pigmentation than the typical teen T-zone.
The Four Adult Acne Mistakes Sabotaging Your Skin
1. Over-cleansing and stripping the skin
Somewhere along the line, we were told to "dry out" spots. Big mistake. This often leads to:
● An unhappy skin barrier
● Disrupted microbiome
● Lingering breakouts and pigmentation
The fix: Use a simple, effective, alcohol-free gel cleanser, once. If your cleanser isn’t removing everything, it might be time to look at your makeup practices, rather than changing your skincare.
2. Inconsistent (and chaotic) use of actives
Salicylic acid one night, vitamin C the next, then a retinoid... this kind of skincare roulette doesn’t work.
The fix: Choose 2–3 clinically effective actives (more on those below) and use them consistently, not randomly. Acne-prone skin loves routine.
3. Cocktailing too many products
Layering acids over retinoids over vitamin C might look tempting on TikTok, but it leaves your skin barrier in tatters. Less is more.
The fix: Simplify your routine. Make space for your actives by choosing gentle basics that support their use.
4. Spot-treating instead of zone-treating
This is the big one. If you’re still applying Actives only when a spot appears, you're in crisis mode. That’s not how you get clear skin.
The fix: Treat the whole zone - jawline, chin, T-zone, even your back or chest. Think about prevention, not panic.
These are the four pillars you need to know
Here's the structure I use in clinic, and it's brilliantly simple. Four pillars:
1. Cleanse
Gentle, non-foaming, fragrance-free. No double cleansing needed. Just one smart step to reset your skin.
2. Treat with Targeted Actives
Here’s the powerful combination I recommend:
● Morning: Azelaic Acid
Calms inflammation, unclogs pores, tackles pigmentation, and supports the skin barrier. If your skin’s too sensitive for retinoids right now, press pause - you can use azelaic acid twice a day instead.
● Night: Retinoid
Speeds cell turnover, clears pores, and improves texture and tone over time. Choose the right strength for your skin and build tolerance slowly.
“Let me repeat - with retinoids, go low and slow.”
- Dr Sam
For new inflamed blemishes, use salicylic acid or benzoyl peroxide directly on the blemish in the morning and treat with your daily active everywhere else until redness subsides.
3. Hydrate
Yes, even if you’re oily. Find your perfect fragrance-free moisturiser - it’s an essential tool, for a supporting Actives use and ensuring barrier health.
4. ProtectDaily sunscreen is non-negotiable, even in winter. Choose a formula that won’t clog pores - many now include niacinamide, helping with both breakouts and post-blemish pigmentation.
Routine Recap: Your Adult Acne Cheat Sheet
● Morning:
Cleanser → Azelaic Acid → Moisturiser → Sunscreen
● Night:
Cleanser → (buffer with moisturiser if needed) → Retinoid → Moisturiser
Final Thoughts: Bright, Clear Skin Is Achieved Through Balance, Not A Battle
Adult acne isn’t a sign that you’re doing something wrong. It’s a reflection of how your skin biology evolves with age. When you move away from “spot warfare” and towards calm, consistent barrier support with the right targeted actives, breakouts become far easier to control, and your skin gets healthier in the process.
Remember: structure, simplicity, and consistency win every time.
