Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 3/11/2021
Have you ever dealt with acne that only ever seems to get worse? While some acne breakouts are easy to deal with, others can seem immune to treatment, bouncing back in days after even the most aggressive and extensive cleansing and skin care efforts.
If you’re prone to bad acne breakouts, it’s easy to become frustrated and overwhelmed by the seemingly endless number of products available claiming to clear your skin.
The reality of acne is that it’s largely caused by a few factors, namely your skin’s production of oils, the accumulation of dead skin cells and the growth of bacteria on your skin.
Behind these factors are a few root causes, which may include your hormone levels, skin care habits, use of cosmetics and general hygiene.
If you have bad acne, don’t panic. Once you’re able to identify the cause of your acne, treating your breakouts becomes far easier.
Below, we’ve explained how acne develops, as well as the root causes of acne breakouts that can affect your skin. We’ve also explained exactly how you can treat severe or persistent acne to get rid of acne breakouts and keep them away for good.
To understand why your acne is so bad (as well as how to treat it), it’s important to be aware of how acne develops in the first place.
Acne develops when your hair follicles, or pores — the tiny, microscopic holes in the surface of your skin — become clogged.
Several factors can cause your pores to become clogged. The two most common are a natural, oil-like substance called sebum and dead skin cells that can accumulate on your skin’s surface as a result of your skin’s natural rejuvenation and repair process.
Sebum is an oil that’s produced by your sebaceous glands. It plays a major role in keeping your skin lubricated and healthy. Sebum allows your skin to retain moisture and forms a part of your skin’s protective barrier, keeping bacteria, fungi and other germs out of your body.
In addition to producing sebum, your skin constantly repairs itself through a process referred to as epidermal turnover.
As part of the epidermal turnover process, new skin cells are created in the basal layers of your skin. Over 40 to 56 days, these cells travel upwards to your skin’s surface to replace older skin cells that have been exposed to the environment.
The outermost layer of your skin, which is known as the stratum corneum, is mostly made up of old, dead skin cells left behind by this process.
These old, dead cells shed naturally over the course of each day, such as when you rinse your skin or touch your face.
Over time, debris from dead skin cells can build up on the surface layer of your skin. When this debris mixes with sebum on your skin, it can form into plugs that clog your pores, causing acne lesions to develop.
There are several different types of acne. The smallest, mildest acne lesions, which form when sebum and dead skin cells clog pores, are known as comedones. Whiteheads and blackheads are both forms of comedonal acne.
While sebum and dead skin cells cause acne, the presence of bacteria can make acne lesions become far worse.
When bacteria such as P. acnes become trapped inside a clogged pore, they can multiply at a rapid pace, causing the acne to become red, inflamed and painful.
Acne lesions that contain bacteria are usually known as papules or pustules. When inflamed, infected acne becomes severe or develops deeper within your skin, it’s referred to as nodular acne, or cystic acne.
Technically, all acne is caused by sebum, dead skin cells and/or bacteria. However, a variety of different factors all have an effect on things like your body’s sebum production or the amount of bacteria that grows on your skin.
These include your genetics, your production of certain hormones, your use of certain products that may irritate your skin and even simple things like how often you touch your face.
If you have bad or persistent acne, identifying these root causes and taking action to treat them can reduce the severity of your acne and have a real positive impact on your skin.
One of the biggest factors related to acne is your production of certain hormones. Your body is constantly producing hormones such as estrogen, progesterone and even male sex hormones such as testosterone.
These hormones are extremely important for your health. For example, estrogen plays a major role in maintaining your reproductive health. It also helps to maintain your brain, cardiovascular system, bones and other tissue.
Similarly, despite being a “male” hormone, testosterone is vital for your health and wellbeing as a woman. In fact, your body relies on testosterone as a building block for many other hormones, including estrogen.
Some hormones can affect your skin. For example, testosterone plays a part in regulating your production of sebum — the oil-like substance that can cause acne.
As we’ve explained our guide to hormonal acne, your production of hormones fluctuates during your menstrual cycle. Before and during your period, your production of hormones like estrogen and testosterone increases.
This sudden increase in testosterone production stimulates the production of sebum, which can clog your pores and cause those annoying breakouts that occur before or during your period, or when you first start using a new form of hormonal birth control.
Research shows that your family’s history of acne is closely associated with your risk of dealing with acne breakouts, suggesting that acne has a genetic component.
If your parents were prone to acne during their youth or as adults, you may have a higher risk of experiencing acne breakouts. A study of twins found that as much as 81 percent of the variance of acne may be attributable to genetic effects.
Unfortunately, experts aren’t yet aware of what you can do to treat the genetic factors that may contribute to acne.
Your skin care and personal hygiene habits can have a huge impact on the appearance of your skin, including your risk of dealing with acne breakouts.
While acne isn’t always caused by poor hygiene, some habits can increase bacterial growth on your skin and worsen your acne. Others can increase your risk of developing the clogged pores that turn into comedonal or inflamed acne lesions.
Skin care and hygiene factors that may cause or worsen acne breakouts include:
Rarely washing your face. Washing your face is an important part of cleaning away excess sebum, cornified skin cells and other substances that can clog your pores and cause acne breakouts.
If you rarely wash your face, or just briefly rinse it without using any cleanser, you may be more likely to develop acne.
Washing your face too often. On the other hand, washing your face too frequently, especially with cleansers or other products that dry out your skin, can cause irritation and may lead to more acne breakouts.
Try to wash your face a maximum of two times per day. It’s also okay to wash your face after you exercise or do anything else that causes you to sweat.
Scrubbing your skin aggressively. Just like washing your face too often, scrubbing too aggressively or overusing cleansers and other acne treatments can irritate your skin and lead to breakouts and flare-ups.
Popping your pimples. Although popping pimples can be satisfying, it’s an easy way to accidentally push their contents deeper into your skin, worsening your acne and making it harder to properly treat your breakouts.
Popping your pimples can also lead to infections, more painful acne and a higher risk of developing acne scarring. If you have severe or painful acne that you’d like to remove, talk to a dermatologist about having it extracted professionally.
Using oil-heavy makeup. Some of the oils and other ingredients used in cosmetics and other personal care products can build up on the surface layer of your skin and clog your pores, causing comedones and other types of acne.
We’ve talked more about this in the section below and explained how you can stop your makeup from contributing to acne breakouts.
Sharing makeup brushes and other items. Although these items don’t cause acne on their own, they can transfer sebum, dead skin cells and bacteria from other people’s skin to yours, potentially causing breakouts or worsening your existing acne.
As we briefly mentioned above, some types of makeup and certain hair care products may have the potential to make your acne worse.
Although makeup as a whole doesn’t cause acne, the oils in some cosmetics can build up on the outer layer of your skin and clog your pores just like sebum. This type of acne is usually referred to as acne cosmetica.
If you’re prone to acne, you can lower your risk of developing acne cosmetica by using makeup that’s labeled “oil-free” or “non-comedogenic.” These products are formulated to be less likely to cause comedones (small acne lesions) to develop on your skin.
It’s also important to practice good makeup habits. Make sure that you completely remove your makeup before you go to bed. Every week, carefully clean your makeup brushes to stop dead skin cells, bacteria and other substances from making their way back onto your skin.
Clothing and other items that frequently come into direct contact with your face, such as hats, sports helmets, visors, masks and even pillowcases and other forms of bedding, can all contribute to acne breakouts.
This is because oils, dead skin cells and bacteria can grow on these items and aggravate your acne when you wear them. Skin and hair care products containing oils can also make their way onto these items, then eventually back onto your skin.
You can reduce your risk of developing acne from these items by washing them regularly. It’s particularly important to wash items that come into contact with your head for long periods of time, such as pillowcases and sheets.
Some medications can cause acne, including severe or persistent acne. If you use medication, there’s a possibility that it could trigger or worsen your breakouts. Medications that may cause acne include:
Medications used to treat epilepsy
Immunosuppressant medications, such as ciclosporin
Some forms of hormonal birth control, including the injection (Depo-Provera®), implant and hormonal intrauterine device, or IUD
Other medications may also cause or worsen acne. If you’re prescribed medication and notice that your acne has gotten worse since you started to take it, you should talk to your healthcare provider to learn more about your options.
Dealing with acne can be a frustrating experience, especially when your breakouts are severe, painful and seemingly impossible to get rid of.
The reality of acne is that while it can be immensely stressful to deal with, it’s almost always a treatable issue. Once you’ve identified the cause of your acne, simple things such as changes to your habits and use of medication can almost always clear up your skin.
Below, we’ve explained how you can treat your acne using a combination of over-the-counter products, prescription medications and effective skin care habits.
If you have acne, one of the best things you can do to stop your breakouts and improve your skin is to talk to a licensed healthcare provider.
Based on the type and severity of your acne, they may recommend using one or more of the following medications:
Tretinoin. Tretinoin is a topical retinoid that’s used to treat acne. It works by promoting the peeling of old skin cells, reducing your risk of developing clogged pores that cause acne breakouts.
Tretinoin is a prescription medication. It’s available in our Customized Rx Acne Cream, which is available following an online consultation with a healthcare provider who will determine if a prescription is appropriate.
Other retinoids. Several other retinoids, including retinol and adapalene, may help to treat your acne. These are often available over-the-counter in topical acne creams and other products.
Clindamycin. Clindamycin is a topical antibiotic. It works by preventing bacteria from growing on your skin, including the bacteria that can cause breakouts of inflamed and infected acne.
Like tretinoin, clindamycin is a prescription medication that’s one of several ingredients in our Customized Rx Acne Cream.
Benzoyl peroxide. Benzoyl peroxide is an acne medication that works by stopping the bacteria that cause inflamed acne from growing. It’s used as an active ingredient in a variety of over-the-counter acne creams, cleansers, gels and other products.
Our guide to using benzoyl peroxide to treat acne provides more information about how this medication works, its side effects and more.
Birth control. If your acne is hormonal, your healthcare provider may suggest that you start using the combination birth control pill.
As we’ve explained in our guide to birth control and acne, several birth control pills have been approved by the FDA as acne treatments. These work by regulating your hormone levels, reducing your risk of developing acne before and during your period.
Isotretinoin. This prescription medication comes in tablet form. It’s used to treat severe acne that doesn’t respond to other medications. Your healthcare provider may suggest this medication if your acne never seems to go away, no matter what you do.
Although isotretinoin is effective, it can cause certain side effects and isn’t safe for use if you’re pregnant or may become pregnant in the near future. To keep yourself safe, you will need to keep in contact with your healthcare provider while using this medication.
If you’re prescribed medication to treat acne, make sure that you closely follow your healthcare provider’s instructions. You may need to continue taking your medication to prevent acne, even after your breakouts clear up.
Certain habits, such as those listed above, can aggravate your acne and make your breakouts worse. If you have habits that are linked to acne breakouts, it’s important to change them while you treat your acne using medication.
You can change your habits and improve your skin care routine using the tips and tactics we’ve listed above under each cause of acne.
Acne becomes significantly easier to treat once you identify the factors that are causing you to experience breakouts.
If you’re prone to acne breakouts and can’t seem to stop them, the best thing you can do is talk to a healthcare provider to find out what’s causing your acne breakouts and what you can do to stop them for good.
Depending on the severity of your acne, you may need to use one or more medications to stop pimples from developing and keep your skin acne-free in the future.