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PDF File Acne Lesions, Treatment and Cosmetics. Acne usually starts shortly after puberty and begins because of hormonal changes and increased oil s ecretion. However, it is common to see patients (particularly women) in their 30s, 40 s, and 5 0 s with adult onset acne. Internal hormonal changes a nd starting/stopping/switching birth control pills may play a role. Acne develops when hair follicles, the site of acne, get plugged with dead skin cells. T hen sebum (oil) a nd bacteria accumulate and lead to inflammation . Stress may aggravate acne.