Although acne is most common during the teenage years, a number of patients in their 20’s – 40’s suffering from acne that either persists from their teens or that actually begins after the age of 20. Whatever the age, the first step in the formation of an acne lesion is a clogged “pore” (hair follicle), and we can use a number of prescription medications for treatment. If bacteria and inflammation also become involved as the acne lesion evolves, either oral or topical antibiotics are used to treat this. For a woman with late-appearing or particularly treatment-resistant acne, it is often important to check her hormonal status and make sure that her androgen (male hormone) levels are not increased.