Adult Acne Explained: A Functional Medicine Approach to Clear Skin Naturally
Why breakouts persist beyond your teens—and how hormones, gut health, inflammation, and lifestyle drive acne from the inside out
Why Adult Acne Is Different
For many adults, acne isn’t just a skin issue—it’s a daily reminder that something deeper in the body feels off. While acne is often dismissed as a teenage rite of passage, for many adults it becomes a persistent, frustrating condition that lingers well beyond adolescence. Adult acne is not simply a surface-level problem; it is a visible signal of internal imbalance involving hormones, inflammation, metabolism, gut health, and stress physiology (1).
Adult Acne Reflects Systemic Drivers
Unlike adolescent acne, which is largely driven by pubertal hormone surges and rapid sebaceous gland activity, adult acne reflects chronic, systemic drivers that evolve over time. These drivers often reinforce one another, which is why topical treatments, antibiotics, and short-term medications frequently provide only temporary relief rather than lasting resolution (2).
From a functional medicine perspective, acne is best understood as an inflammatory condition with upstream causes. Excess sebum production, clogged pores, and bacterial overgrowth are downstream expressions—not the origin of the problem (3). When internal regulatory systems remain dysregulated, the skin continues to express that imbalance regardless of how aggressively symptoms are treated at the surface.
Why Acne Often Appears Alongside Other Health Issues
This framework helps explain why adult acne frequently coexists with other health concerns, including:
Hormonal irregularities or cycle-related flares
Digestive symptoms or food sensitivities
Chronic stress, poor sleep, or nervous system dysregulation
Inflammation, insulin resistance, or metabolic instability
These patterns point toward shared regulatory dysfunction rather than isolated skin pathology.
Evaluating Acne Beyond the Skin
A functional medicine approach evaluates acne through this broader lens, identifying why breakouts persist and which internal systems are driving them, rather than focusing exclusively on suppressing visible lesions.
At Denver Sports and Holistic Medicine, acne care is approached as part of whole-body regulation. Evaluation and treatment are guided through Functional & Integrative Medicine, where skin health is understood as a reflection of hormonal balance, gut integrity, detoxification capacity, immune signaling, and nervous system regulation.
Understanding adult acne therefore requires looking beyond the skin and examining how hormones, gut health, inflammation, stress physiology, and lifestyle factors interact to drive persistent breakouts.
What Acne Really Is — Beyond Clogged Pores
Acne is commonly described as a condition caused by clogged pores, excess oil, and bacteria. While this description is not incorrect, it is incomplete. From a physiological standpoint, acne is best understood as a chronic inflammatory skin condition influenced by systemic regulation, not merely a surface-level blockage problem (4).
The Local Skin Cascade
At the skin level, acne develops when excess sebum combines with dead skin cells, leading to follicular obstruction. This environment allows Cutibacterium acnes (formerly Propionibacterium acnes) to proliferate, triggering an immune response that results in redness, swelling, and lesion formation (5). However, this cascade does not occur in isolation.
Internal Drivers of Persistent Acne
What determines whether pores overproduce oil, whether inflammation escalates, and whether breakouts become persistent is largely governed by internal signaling systems—particularly hormonal regulation, immune activity, metabolic health, and stress physiology (6).
As a result, adult acne is rarely driven by local skin factors alone. Instead, it commonly reflects:
Altered hormonal signaling affecting sebaceous gland activity
Immune system activation that amplifies inflammatory responses
Changes in insulin sensitivity and metabolic signaling
Disruptions in gut integrity that influence systemic inflammation
In this framework, clogged pores are the visible outcome, not the initiating cause.
Why Adult Acne Looks Different Than Teenage Acne
This systems-based view also explains why adult acne often presents differently than teenage acne. Rather than widespread oiliness across the face, adult acne more commonly appears along the jawline, chin, neck, or lower face—areas that are particularly sensitive to hormonal and inflammatory signals (7).
Why Surface-Only Treatment Falls Short
When acne is approached solely as a skin-deep issue, treatment tends to focus on suppressing oil, killing bacteria, or accelerating skin turnover. While these strategies may reduce lesions temporarily, they do not address the underlying drivers that determine whether acne resolves—or keeps returning (8).
Understanding acne as an inflammatory condition rooted in internal regulation sets the foundation for identifying why breakouts persist and which systems require support for long-term improvement.
Hormonal Drivers of Adult Acne
Hormones play a central role in regulating sebum production, inflammation, and skin cell turnover, which is why adult acne so often follows predictable patterns related to the menstrual cycle, stress exposure, or underlying endocrine conditions. In functional medicine, hormonal acne is not viewed as a single diagnosis, but as the skin’s response to disrupted hormonal signaling across multiple pathways (9).
Androgens and Sebum Production
One of the most common contributors to adult acne is androgen activity, particularly testosterone and its more potent derivative, dihydrotestosterone (DHT). Androgens stimulate sebaceous glands to produce oil. When androgen signaling is elevated—or when skin receptors are overly sensitive—even hormone levels within conventional reference ranges can drive excessive sebum production and increase the likelihood of inflammatory breakouts (10).
Common Patterns of Hormonal Acne
Hormonal acne in adults often presents with recognizable patterns, including:
Breakouts concentrated along the jawline, chin, or lower face
Cyclical flares before or during menstruation
Deep, tender, or cystic lesions
Acne that persists despite topical treatment
These patterns reflect hormone–skin interactions rather than isolated surface issues.
Estrogen–Progesterone Balance
Another key factor is estrogen–progesterone balance. Estrogen generally has anti-inflammatory and skin-supportive effects, while progesterone helps counterbalance estrogen and regulate sebaceous activity. When progesterone is low relative to estrogen—a pattern commonly referred to as estrogen dominance—acne flares may occur premenstrually due to increased inflammatory signaling and impaired estrogen clearance (11).
Stress, Cortisol, and Hormonal Signaling
Stress further complicates hormonal acne through activation of the hypothalamic–pituitary–adrenal (HPA) axis. Chronic HPA activation increases cortisol output, which can indirectly elevate androgen activity and worsen insulin resistance. Cortisol also interacts directly with sebaceous glands and immune cells in the skin, amplifying inflammation and oil production during periods of prolonged stress (12).
PCOS and Hormonal Acne
Certain endocrine conditions, such as polycystic ovary syndrome (PCOS), represent a more pronounced example of hormonally driven acne. In PCOS, elevated androgens, insulin resistance, and disrupted ovulatory signaling converge to create a hormonal environment that strongly favors persistent acne (13).
Why Hormone Labs Can Look “Normal”
Importantly, hormonal acne does not require clearly abnormal laboratory values to exist. Many individuals with persistent adult acne have hormone levels that fall within conventional reference ranges, yet still experience dysregulated signaling at the tissue level. This disconnect is one reason symptom-based suppression—rather than physiologic evaluation—often fails to produce lasting results (14).
Evaluating Acne Through a Hormonal Lens
Evaluating acne hormonally means assessing patterns, timing, and system interactions, not just isolated hormone values. This approach aligns acne treatment with broader endocrine and metabolic health, rather than addressing the skin in isolation.
For patients whose acne appears hormonally driven, deeper evaluation is often guided through Hormone & Metabolic Optimization, where hormone signaling, insulin dynamics, stress physiology, and detoxification capacity can be assessed together within a broader clinical context.
Gut Health, Inflammation, and the Gut–Skin Axis
The connection between gut health and skin health is no longer theoretical. An expanding body of research describes a bidirectional communication network—often referred to as the gut–skin axis—through which intestinal integrity, microbial balance, immune signaling, and systemic inflammation influence skin function and disease expression (15).
When the gut microbiome is balanced and the intestinal barrier is intact, immune signaling remains regulated and inflammatory responses are appropriately controlled. However, disruptions such as dysbiosis, increased intestinal permeability, or chronic digestive inflammation can promote systemic immune activation. The skin, as a highly immune-responsive organ, often reflects this internal inflammatory burden through conditions such as acne, eczema, or rosacea (16).
Key Gut-Related Mechanisms in Adult Acne
Several gut-driven mechanisms are particularly relevant in persistent adult acne:
Microbiome imbalance (dysbiosis):
Alterations in gut bacterial populations can increase inflammatory cytokine production and oxidative stress, which may exacerbate acne severity (17).Increased intestinal permeability:
Commonly referred to as “leaky gut,” impaired barrier function allows inflammatory compounds to enter systemic circulation, amplifying immune activation and skin inflammation (18).Food sensitivities and immune reactivity:
Certain foods may trigger delayed immune responses that do not present with immediate digestive symptoms, yet still contribute to chronic inflammation that manifests through the skin (19).
Inflammation, Hormones, and the Skin
Inflammation originating in the gut can also influence hormonal regulation. Inflammatory signaling affects insulin sensitivity, cortisol output, and estrogen metabolism—all of which are known contributors to adult acne. This interconnected physiology helps explain why acne often coexists with bloating, irregular bowel habits, food intolerance, or fatigue, even when those symptoms are mild or intermittent (20).
Why Digestive Symptoms Are Not Required
Importantly, gut-driven acne does not require overt gastrointestinal disease. Many individuals with persistent breakouts report “normal” digestion, yet still experience low-grade inflammation or microbial imbalance sufficient to influence skin expression (21). This disconnect is one reason gut involvement in acne is frequently overlooked in conventional evaluations.
Restoring Balance Along the Gut–Skin Axis
Viewing acne through the gut–skin axis shifts the clinical focus away from surface suppression and toward restoring internal balance. When gut integrity, immune tolerance, and microbial diversity improve, inflammatory signaling to the skin often decreases—creating a more favorable environment for long-term acne resolution.
For individuals with acne accompanied by digestive symptoms, food sensitivities, or inflammatory conditions, further evaluation may be supported through Gut Health & Digestive Restoration, where gut function is assessed as part of a broader, systems-based approach.
For a deeper explanation of how gut microbiome imbalances contribute to systemic inflammation and chronic symptoms beyond digestion—including skin conditions like acne—this is explored further in:
→ Gut Health & Dysbiosis: How Imbalances Like SIBO, Candida, and IBS Drive Chronic Symptoms
Stress, Lifestyle, and the Nervous System–Skin Connection
Stress is often discussed as a vague contributor to acne, yet its physiological impact on the skin is both measurable and significant. Chronic psychological or physiological stress alters nervous system signaling, hormone output, immune activity, and inflammatory balance—each of which directly influences acne expression (22).
How Stress Signals Affect the Skin
When the body perceives stress, the hypothalamic–pituitary–adrenal (HPA) axis is activated, increasing the release of cortisol and corticotropin-releasing hormone (CRH). CRH receptors are present in sebaceous glands and immune cells within the skin. When overstimulated, this pathway promotes increased sebum production and amplifies local inflammatory responses, creating conditions that favor acne development and persistence (23).
Lifestyle Factors That Reinforce the Stress–Acne Loop
Lifestyle patterns can further compound nervous system strain and inflammatory signaling. Common contributors include:
Inadequate or irregular sleep
Disrupted circadian rhythms
Excessive caffeine or stimulant use
Restrictive dieting or under-fueling
Chronic overtraining or inadequate recovery
Over time, these factors reduce the body’s capacity to buffer inflammatory signals and maintain hormonal balance, allowing acne to become more reactive and less responsive to topical interventions (24).
Stress, Cortisol, and Metabolic Signaling
Stress also interacts closely with metabolic health. Elevated cortisol contributes to insulin resistance and blood sugar instability, both of which are associated with increased androgen activity and inflammatory signaling. This interaction helps explain why acne may worsen during periods of emotional strain, work overload, poor sleep, or illness—even when skincare routines remain unchanged (25).
Why “High-Functioning Stress” Still Matters
Importantly, stress does not need to feel overwhelming to affect the skin. Many individuals with persistent adult acne describe themselves as “high-functioning” or “used to stress,” yet exhibit physiological signs of nervous system dysregulation. In these cases, acne reflects the cumulative load placed on regulatory systems rather than an acute stressor alone (26).
Supporting Nervous System Regulation
Addressing acne through a functional lens therefore requires attention not only to hormones and gut health, but also to how the nervous system processes and adapts to stress over time. Supporting nervous system regulation can reduce inflammatory signaling, stabilize hormonal communication, and create a more resilient internal environment for skin healing.
For individuals whose acne flares are closely tied to stress, sleep disruption, or burnout patterns, this aspect of care may be supported through Acupuncture & Nervous System Regulation, where interventions are aimed at restoring physiologic balance rather than suppressing symptoms.
Liver Detoxification, Estrogen Clearance, and Acne
The liver plays a central role in hormone metabolism, detoxification, and inflammatory regulation—making it a critical, and often overlooked, factor in adult acne. When hepatic detoxification pathways are impaired or overloaded, hormones and inflammatory byproducts may recirculate in the body, increasing the likelihood of hormone-driven skin flares (27).
Estrogen Metabolism and Acne Flares
Estrogen metabolism occurs in two primary phases within the liver.
Phase I reactions modify estrogen into intermediate metabolites.
Phase II reactions conjugate these metabolites so they can be safely eliminated through bile and urine.
When these processes are inefficient—due to nutrient deficiencies, chronic inflammation, or excessive toxic exposure—estrogen metabolites may accumulate. This pattern, often described as estrogen dominance, is frequently associated with cyclical acne and premenstrual flares (28).
The Gut–Liver Connection (Enterohepatic Recirculation)
The gut and liver function as an integrated detoxification system. Impaired bile flow, dysbiosis, or increased intestinal permeability can interfere with estrogen elimination by allowing deconjugated hormones to be reabsorbed rather than excreted. This process, known as enterohepatic recirculation, places additional strain on hormonal balance and inflammatory control, reinforcing acne patterns over time (29).
Environmental Toxins and Detoxification Load
Modern environmental exposures further burden hepatic detoxification capacity. Endocrine-disrupting chemicals commonly found in:
Plastics and food packaging
Pesticides and herbicides
Personal care products
Household cleaning agents
can interfere with hormone signaling and increase the detoxification workload placed on the liver. Over time, this toxic burden may contribute to both systemic inflammation and hormonal imbalance that manifest through the skin (30).
Why Standard Liver Labs Often Miss the Problem
Importantly, liver-related acne does not require abnormal liver enzyme values on standard blood work. Many individuals with acne-related estrogen imbalance have liver function tests within conventional reference ranges, yet still experience impaired hormone clearance at the functional level (31).
This disconnect explains why acne driven by detoxification inefficiency is frequently overlooked in conventional evaluations.
Supporting Liver Function Without “Cleansing”
Supporting liver detoxification is not about aggressive cleanses or restrictive protocols. Instead, it involves restoring efficient biochemical processing, reducing toxic load, and ensuring adequate nutrient availability for conjugation pathways. When hepatic clearance improves, hormonal signaling becomes more balanced, inflammatory tone decreases, and acne-driving stimuli are reduced.
The biochemical phases of liver detoxification and how they influence hormone clearance are examined in greater detail in:
→ Detox Done Right: A Comprehensive Guide to Safe and Effective Detoxification
For individuals whose acne is accompanied by estrogen-related symptoms, chemical sensitivity, or chronic inflammatory burden, this aspect of care may be evaluated through → Detoxification & Environmental Medicine.
Why Conventional Acne Treatments Often Fail Long-Term
Conventional acne treatment typically focuses on suppressing visible symptoms—reducing oil production, killing bacteria, or accelerating skin turnover. While these approaches may improve acne in the short term, they often fail to produce durable results because they do not address the internal drivers that determine whether acne resolves or recurs (32).
Topical Therapies: Local Control Without Systemic Impact
Topical agents such as benzoyl peroxide, topical antibiotics (e.g., clindamycin), retinoids (adapalene, tretinoin), salicylic acid, and chemical exfoliants are commonly used to reduce bacterial load, unclog pores, and calm inflammation. While these therapies can temporarily improve lesion count and skin texture, they act only at the surface and do not influence hormonal signaling, gut integrity, immune regulation, or stress physiology—the systems most often responsible for persistent adult acne (33).
Oral Antibiotics: Short-Term Improvement, Long-Term Consequences
Oral antibiotics are frequently prescribed for moderate to severe acne to suppress Cutibacterium acnes and reduce inflammation. However, prolonged use disrupts the gut microbiome, increases antibiotic resistance, and may worsen systemic inflammation—contributing to acne relapse once treatment stops (34).
Hormonal Suppression: Masking the Signal, Not Correcting the Cause
Hormonal interventions, including oral contraceptives, are often used to regulate cycles and reduce androgen activity. While these medications may suppress acne symptoms, they do not resolve the underlying drivers of hormonal imbalance and frequently lead to recurrence after discontinuation (35).
Spironolactone is another commonly prescribed option for adult and hormonal acne. By blocking androgen receptors and reducing androgen-driven sebum production, it can decrease breakouts while the medication is taken (36). However, spironolactone does not address upstream contributors such as insulin resistance, chronic stress, impaired estrogen clearance, gut-driven inflammation, or disrupted ovulatory signaling. Acne commonly returns when the medication is tapered or discontinued (37).
Because spironolactone alters aldosterone and electrolyte balance, some individuals experience side effects such as:
Fatigue or lightheadedness
Menstrual irregularities
Breast tenderness
Reduced exercise tolerance
These effects may be particularly relevant for physically active individuals or those already under significant physiologic stress (38).
Isotretinoin (Accutane): Potent but Not Universally Corrective
Isotretinoin dramatically reduces sebaceous gland activity and inflammation and may be appropriate in select cases of severe, refractory acne. However, it exerts broad systemic effects and does not guarantee lasting resolution if hormonal, inflammatory, metabolic, or detoxification drivers remain unaddressed (39).
Procedural and Cosmetic Interventions
Procedures such as chemical peels, laser therapies, and facials may improve skin texture and reduce surface inflammation, but they do not correct internal drivers of acne. These approaches may be useful adjuncts but are rarely sufficient as standalone solutions for persistent adult acne (40).
The Core Limitation of the Conventional Model
Ultimately, the limitation of the conventional approach is that acne is treated as an isolated dermatologic condition rather than a systemic inflammatory signal. This framing leads to repeated cycles of suppression and recurrence, often accompanied by cumulative side effects and frustration (41).
From a functional perspective, lasting improvement requires shifting the clinical question from “How do we eliminate acne lesions?” to “Why is the body producing inflammatory signals that manifest through the skin?” Without addressing hormonal balance, gut health, detoxification capacity, stress physiology, and nutrient status, most conventional strategies remain incomplete solutions.
How Acne Is Addressed in Functional Medicine Care
Once the limitations of symptom-based acne treatment are clear, the focus shifts from suppressing breakouts to understanding what is driving inflammation and dysregulation internally. Functional medicine approaches acne as a reflection of whole-body physiology rather than an isolated skin condition.
Care is guided by identifying the systems under the greatest strain—such as hormonal signaling, gut integrity, metabolic balance, detoxification capacity, or stress physiology—and supporting regulation where it matters most. The goal is not to follow rigid stages or universal protocols, but to reduce competing demands on the body so the skin no longer needs to express imbalance.
Support may involve a coordinated combination of nutrition and lifestyle guidance, targeted supplementation or herbal support, nervous system regulation, and skin-directed therapies. The specific mix is individualized and adjusted over time, rather than applied as a fixed formula.
At Denver Sports and Holistic Medicine, acne care is approached within the broader context of whole-body regulation, with strategies selected to support stability and resilience rather than short-term suppression.
→ Functional & Integrative Medicine
Integrative Therapies That Support Skin Healing
While internal regulation is foundational, integrative therapies play an important supportive role in acne care—particularly when inflammation, scarring, tissue resilience, or nervous system dysregulation are contributing factors. In a holistic model, these therapies are not used in isolation, but coordinated to support the body’s ability to heal and adapt more effectively.
Integrative Care as a Coordinated Model
In an integrative framework, skin healing is supported through multiple entry points, each addressing a different aspect of regulation. Internal drivers such as hormones, gut health, detoxification capacity, and metabolic balance shape the inflammatory environment, while external and procedural therapies support tissue repair, circulation, and nervous system stability.
The goal is not to “treat acne from every angle,” but to reduce overall physiologic strain so healing signals can take precedence over inflammatory ones.
Acupuncture and Nervous System Regulation
Acupuncture supports skin health indirectly by influencing nervous system balance, circulation, immune modulation, and stress physiology. Because chronic stress and autonomic dysregulation amplify inflammation and hormonal reactivity, supporting nervous system regulation can improve how the body responds to other aspects of care.
When stress physiology contributes to acne flares, acupuncture may help reduce inflammatory signaling, improve resilience, and enhance overall treatment responsiveness.
→ Acupuncture & Nervous System Regulation
Microneedling and Skin Repair
Microneedling is used to support collagen remodeling, post-inflammatory scarring, and skin barrier integrity. While it does not address the internal drivers of acne, it can be a valuable adjunct when internal inflammation is being addressed concurrently.
Within an integrative model, microneedling supports the local tissue environment—helping the skin repair more effectively once systemic contributors are better regulated.
→ Microneedling & Skin Rejuvenation
Integrating Internal and External Support
Effective integrative acne care recognizes that internal regulation and tissue-level support are complementary, not competing, priorities. Nutrition, lifestyle support, targeted supplementation or herbal care (when appropriate), nervous system regulation, and skin-directed therapies each contribute differently depending on the individual and stage of care.
When these elements are coordinated rather than applied piecemeal, the skin is better supported in moving out of chronic inflammation and toward long-term stability.
Bringing It All Together
Adult acne is rarely just a skin problem. As this article has outlined, persistent breakouts often reflect how the body is responding to hormonal signaling, inflammation, metabolic stress, gut integrity, detoxification capacity, and nervous system load—often in combination rather than isolation.
This complexity explains why one-size-fits-all solutions so often fall short. When acne is treated only at the surface, underlying drivers continue to shape the internal environment that determines whether inflammation resolves or persists. A systems-based approach shifts the focus from suppression to regulation, allowing skin health to improve as overall physiologic balance is restored.
Importantly, meaningful improvement does not require addressing everything at once. It comes from identifying the most influential drivers, reducing unnecessary strain on the body, and supporting regulation in a way that is responsive and adaptable over time.
When You’re Ready to Address Acne at the Root
If you’ve been dealing with persistent, cyclical, or treatment-resistant acne—and suspect there may be more going on beneath the surface—a functional medicine evaluation can help clarify what’s driving your individual pattern.
Care at Denver Sports and Holistic Medicine focuses on understanding acne within the broader context of whole-body regulation, rather than treating it as an isolated cosmetic concern.
Request a complimentary 15-minute consultation with Dr. Martina Sturm to discuss next steps in healing your acne.
To explore whether a systems-based approach is appropriate for you, you can begin with a personalized evaluation through
→ Functional & Integrative Medicine
Frequently Asked Questions About Adult Acne
What causes adult acne even if I wash my face consistently?
Adult acne is often driven by internal factors—such as hormone signaling, inflammation, insulin dynamics, gut–immune interactions, and stress physiology—rather than hygiene alone. Cleansing helps reduce surface buildup, but it does not address systemic drivers that influence oil production and inflammatory signaling.
How can I tell if my acne is hormonal?
Hormonal acne commonly presents as cyclical flares around the menstrual cycle, deeper or tender lesions, and distribution along the jawline, chin, neck, or lower face. Patterns can overlap, so timing, triggers, and associated symptoms are often more informative than appearance alone.
Why does acne often worsen during stress or poor sleep?
Stress activates neuroendocrine signaling (including the HPA axis), which can increase inflammatory tone and influence sebaceous activity. Poor sleep and circadian disruption can further impair metabolic regulation and recovery, making the skin more reactive and breakouts more persistent.
Can gut health really affect acne?
Yes. The gut–skin axis describes how microbiome balance, intestinal barrier integrity, and immune signaling can influence systemic inflammation. Even without obvious digestive symptoms, low-grade dysbiosis or immune activation may contribute to inflammatory skin patterns in some individuals.
Why do antibiotics or topical treatments help temporarily but acne returns?
Many conventional therapies reduce bacterial load, oil production, or surface inflammation, which can improve lesions short-term. If underlying drivers—such as hormonal imbalance, insulin resistance, chronic inflammation, impaired clearance pathways, or stress physiology—remain unchanged, acne may recur once treatment stops.
Does adult acne require abnormal lab results to be real?
No. Many people fall within standard reference ranges but still have functional dysregulation—such as tissue-level hormone sensitivity, subclinical inflammation, impaired clearance, or metabolic instability—that meaningfully affects the skin. Symptoms and patterns often provide important context beyond labs alone.
Is diet always the main cause of acne?
Diet is not always the primary driver, but it can influence inflammation and blood sugar stability in susceptible individuals. The impact varies widely; some people respond strongly to dietary shifts while others need a primary focus on hormones, gut function, stress regulation, or other upstream factors.
How long does it typically take to see improvement with a root-cause approach?
Timelines vary depending on acne severity, baseline inflammation, hormonal patterns, and consistency of care. Some people notice early changes within several weeks, while more entrenched patterns—especially with scarring or endocrine and metabolic drivers—often require a longer, staged approach.
Resources
PubMed – Adult acne: prevalence, impact, and management
National Library of Medicine – Pathogenesis and treatment of acne vulgaris
National Library of Medicine – Acne as an inflammatory disease
PubMed – Acne pathogenesis: the role of inflammation
PubMed – Cutibacterium acnes and the inflammatory response in acne
PubMed – Systemic factors influencing acne severity
PubMed – Clinical patterns of adult female acne
PubMed – Limitations of topical acne therapies
PubMed – Hormonal influences in acne development
PubMed – Androgens and sebaceous gland activity
PubMed – Estrogen–progesterone balance and skin health
PubMed – Stress, cortisol, and acne pathophysiology
Food and Drug Administration – Spironolactone and isotretinoin safety information
Springer Link – Hormonal signaling and acne persistence
PubMed – The gut–skin axis and inflammatory skin disease
Biomed Central – Gut microbiota, systemic inflammation, and skin conditions
PubMed – Dysbiosis, intestinal permeability, and immune-mediated acne