Objective To explore the risk factors of acne in adult. Methods From February 2022 to October 2023, 420 adult acne patients in the dermatology clinic of our hospital were selected as the observation group, and 420 healthy people in the same period were selected as the control group. The general data, psychological status and sex hormone levels of the two groups were compared, and the factors affecting acne were analyzed by multivariate analysis. Results There was no significant difference in different genders, ages and the proportion of whether cosmetics were used for external use between the two groups (P >0.05). The proportion of family history, anxiety, depression, stress score, LH and T levels in the observation group were higher than those in the control group (P <0.05). Multivariate logistic analysis showed that family history, psychological status, and testosterone in sex hormones were independent risk factors for adult acne (P <0.05). Conclusion The occurrence of adult acne is related to genetic, endocrine, psychological status and other factors. Clinical prevention and treatment of related risk factors should be strengthened to reduce the harm of acne.