Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 9/20/2020
Dealing with an acne breakout can be a stressful experience. Beyond the annoyance of trying to disguise a breakout with makeup (something that, long term, usually always a good idea), acne can seriously affect your self confidence.
Although most people think of acne as something you’ll only ever face as a teenager, the reality of acne is that it can affect anyone at any time.
In fact, clinical studies show that adult acne is incredibly common. According to the Journal of the American Academy of Dermatology, more than half of women aged 25 and up have some amount of adult facial acne.
In short, acne is more common than most people think, especially in women, and it isn’t limited to your teen years.
The first step in preventing something is understanding how it works. Unlike other common skin conditions, acne doesn’t have a singular cause. Instead, a variety of factors all contribute to the development of acne, from your body’s hormone production to your genetics.
Below, we’ve covered the key factors that cause acne breakouts. We’ve also listed some of the most effective treatments for each factor to help you fight back against acne breakouts and keep your skin smooth, healthy and pimple-free.
The number one factor that contributes to acne is your body’s production of sebum — a natural oil-like substance that’s produced in your sebaceous glands.
Sebum acts like your body’s own natural skin oil, helping to lubricate and moisturize your skin throughout the day. You can think of it as a natural, highly effective moisturizer that helps your skin maintain a protective barrier from the outside world.
Normal sebum levels are important for healthy skin. However, when your body produces too much sebum, the excess can get stuck inside your hair follicles, leading to blocked pores and the development of pimples.
When these clogged follicles are left partially open to the outside, they form into blackheads. A completely blocked hair follicle becomes a whitehead. Blackheads and whiteheads are types of “comedones,” or small, skin-colored acne lesions.
Hair follicles clogged with sebum can also produce different types of acne. Acne can form into a pustule, which is a pimple that contains yellowish pus. Acne can also form beneath the skin and result in the development of solid, irritated and uncomfortable nodules.
If bacteria gets trapped inside a sebum-filled pore, it can even contribute to the development of severe cystic acne.
Everyone produces a slightly different amount of sebum, making certain people more prone to acne breakouts than others. Excess sebum production is often visually noticeable, giving your skin an oiler look and feel than it would normally have.
There are several ways to deal with excess sebum production. The easiest is to wash your face using a therapeutic acne prevention wash. You can also manage sebum production with topical acne prevention products, such as our acne cream.
However, one of the most effective way to reduce your sebum production is to target it at the source by using medication to manage your body’s production of sebum-producing hormones.
If sebum is the main cause of acne, what’s the cause of sebum? Your body produces sebum in order to keep your skin fresh, soft and safe by forming a protective barrier. Production of sebum is regulated by your body’s level of testosterone — a powerful androgenic hormone.
Although most people think of testosterone as a male hormone, both men and women produce testosterone. Women generally have a large amount of estrogen and a small amount of male hormones such as testosterone; in men, the ratio is reversed.
In women, testosterone is essential for healthy muscles and bones. It’s also a key hormone for your sex drive.
Unfortunately, testosterone is also the hormone that regulates your production of sebum. When your testosterone levels drift upwards, your body starts to produce more sebum, increasing your risk of experiencing an acne outbreak.
This is one reason why acne often occurs right before and during your period. As you approach your period, your body’s testosterone production surges, contributing to a stronger sex drive and outbreaks of hormonal acne.
Most of the time, the most effective way to treat androgen-induced acne is through the use of a combined oral contraceptive, or birth control pill.
All three of these pills work through a combination of estrogen and a progestin, helping to keep androgen levels in your body low and steady.
Each type of pill uses a different progestin, meaning there can be slight differences in the acne prevention effects of different combined oral contraceptives. It’s very common to have to work with your healthcare provider to find the best pill for you for acne prevention and general wellbeing.
As with anything contraceptive-related, the best way to start using birth control to combat acne is to talk to your healthcare provider. They’ll be able to recommend the best birth control option for you based on your needs and medical history.
Our guide to birth control and acne also covers the basics of using birth control as a treatment for hormonal acne.
As well as birth control, some healthcare providers use spironolactone to control the androgenic hormones that cause acne. Spironolactone is an anti-androgen and, like with any medication that affects your hormones, should only be taken with a prescription from your healthcare provider.
Your skin has a life cycle, with skin cells taking around six weeks to make their way up to the surface before dying, flaking off and being replaced.
When dead skin cells collect on the surface of your skin, they can mix with sebum and cause your hair follicles to become blocked. The end result is an increase in comedones and other forms of acne.
Because of this, an easy way to reduce your risk of experiencing acne outbreaks is to make sure your dead skin cells are quickly washed away from your skin, without the chance to get caught inside your hair follicles.
There are several ways to do this. One of the most effective is to use a topical retinoid like tretinoin.
Tretinoin works by speeding up your body’s skin cell turnover cycle, helping to get rid of dead skin cells at a faster rate. As your skin cell turnover cycle accelerates, there’s less of a chance for dead skin cells to collect inside your hair follicles and cause blockages.
Another option is to exfoliate your skin regularly. Although this isn’t as effective as tretinoin, it’s often enough to deal with mild to moderate hormonal acne outbreaks. Just make sure you don’t overdo it, as exfoliating too frequently can damage your skin and cause irritation.
Although makeup can help to disguise acne and make your skin look smooth and clear when it isn’t, it can also damage your skin. Long term, many makeup products can cause skin irritation that makes your acne breakouts more severe and difficult to treat.
The worst makeup products for acne tend to be oily ones. Primer oil and other makeup products that make your skin wet and oily are best avoided if you suffer from acne, as the oils used in the makeup can potentially worsen hair follicle blockages.
Powders can also do serious damage to your skin. While setting and mattifying powders don’t directly introduce any oil onto your skin, they can make your hair follicles secrete more sebum than normal, increasing your risk of dealing with blocked pores and pimples.
The solution? The first is to avoid makeup except when absolutely necessary. If you’re prone to acne, try switching to light or no makeup for your everyday appearance and reserving most of your makeup for special occasions.
Sound impossible? If a light makeup look isn’t your style, look for skin-friendly alternatives to your regular makeup products. Acne-friendly foundation, makeup that’s formulated for oily skin and salicylic-acid free makeup products will usually be your best options.
Other ingredients to avoid include silicones and combination products, both of which can clog pores and worsen your acne symptoms.
Certain medications can change your body’s hormone levels, sebum production and skin cell turnover cycle, all of which can potentially make your acne breakouts worse.
The medications most commonly linked to acne include lithium, steroids, and medications used to prevent seizures.
Although hormonal birth control is often prescribed to treat acne, some forms of birth control have the potential to worsen acne outbreaks in some people. These include birth control implants, injections such as Depo-Provera® and progestin-only oral contraceptives.
Finally, oral corticosteroids can temporarily cause acne outbreaks by triggering an increase in yeast, which can irritate hair follicles.
If you’re concerned that your acne outbreaks could be the result of a medication you use, the best approach is to talk to your healthcare provider r about other options to mitigate your current medication’s effects on your skin.
To a certain extent, your environment can have an impact on your acne outbreaks. If you live in a warm, humid region, excessive sweating could worsen your acne.
Sweat-induced acne is called pityrosporum folliculitis. Although it’s less common than hormonal acne, it has similar symptoms, ranging from the usual whiteheads and blackheads to painful and irritating cystic acne.
Pityrosporum folliculitis is more common on the body than the face, but it can affect any part of your skin that’s exposed to sweat.
In addition to temperature, sweat-induced acne is also affected by your lifestyle. If you exercise often, the sweat you excrete during your workout can clog your hair follicles, increasing your risk of experiencing acne breakouts.
While it’s difficult to completely avoid pityrosporum folliculitis from sweating, the best ways to cut down your breakouts are to shower immediately after exercise and opt to wear light, breathable clothes in hot weather to wick sweat again from your skin.
Did one or both of your parents have severe, recurring acne? If so, there’s a possibility that you have inherited a genetic susceptibility to acne.
Although there’s no “acne gene,” factors like your immune system and androgen levels — both of which are partially determined by genetics — can contribute to worse acne breakouts and a higher chance of dealing with issues like cystic acne.
Luckily, there’s no need to blame Mom and Dad just yet. A genetic predisposition to acne isn’t untreatable. Although your acne might be harder to control than it is for others, you can still use the usual treatments to manage your acne, from birth control to topical retinoids.
Contrary to popular belief, things like your diet and exposure to dirt are rarely the cause of acne breakouts:
Dirty air, water and other dirty environments aren’t causes of acne breakouts. Contrary to popular belief, the darkened surface of a blackhead is just sebum after it’s been exposed to air — not a buildup or dirt, mud or pollutants.
Although poor sleep habits can affect your immune system, sleeping too little generally isn’t linked to acne. Despite this, it’s still good to make sure you sleep well for wellbeing and optimal health.
Whether you break out every now and then or have serious, persistent acne, the key to getting rid of your acne for good is understanding how and why it develops.
Our guide to hormonal acne goes into more detail on why acne breakouts occur, from the key hormones that trigger outbreaks to how your androgen production, menstrual cycle and other factors can worsen your acne symptoms.