Understanding acne: what causes it, and skincare tips that can help

Medically reviewed by Rosanna Sutherby, PharmD on February 18, 2020. Written by Libby Pellegrini. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


If you suffer from acne, you aren’t alone: according to the American Academy of Dermatology, acne is the most common skin condition in America, and it affects up to 50 million people each year. Read on to learn more about what causes acne, plus 10 tips to help manage it.

Causes of acne

What causes acne? It’s important to first understand the anatomy of the skin’s surface. Each skin pore is made up of a “pilosebaceous unit,” which comprises a hair follicle and a sebaceous oil gland. Typically, this unit works to keep the skin protected and properly moisturized. However, when certain hormones are present in abnormal levels, or when the gland becomes blocked by dead skin cells or infected with bacteria, inflammation erupts. Inflammation and hyperactivity of the pilosebaceous unit can cause comedones (known as “blackheads” or “whiteheads”) and deeper cysts, known as cystic acne.

Acne is also influenced by increased androgen levels in both men and women. Androgens are typically thought of as the family of hormones related to male characteristics (testosterone is an example of an androgen hormone); however, they are present in both men and women. Androgens increase the production of sebum—or oil—in the pilosebaceous unit, which can lead to skin pore blockages. This oil itself is also a growth medium for the type of bacteria that can cause acne, Propionibacterium acnes.


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Health conditions related to acne include polycystic ovarian syndrome (PCOS), in which women have high circulating levels of androgen hormones (such as testosterone). Similarly, congenital adrenal hyperplasia and tumors of the adrenal glands or ovaries can cause acne via the same mechanism of increased androgen levels.

Some women find that their acne also fluctuates with their menstrual period, as the rise of progesterone mid-cycle may also increase sebum production and lead to breakouts before the onset of a period. Progesterone levels also change during pregnancy, which is why some women will see increased acne while pregnant.

As hormone levels fluctuate around the menopausal transition, many women will notice changes in their skin’s health, and potentially a resurgence of acne.


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Seeking medical care for acne

If you are suffering from acne, particularly if you are noticing other changes such as weight fluctuations or thinning hair, you may want to consult your healthcare provider. A thorough history, physical examination, and—potentially—laboratory tests to check hormone levels may help clarify the cause of your acne.

Depending on the severity of your acne, your healthcare provider may recommend certain prescription medications for acne treatment. Some medications are topical, meaning they are applied directly to the skin and target the inflammation at the site. Others—such as oral contraceptive pills—help regulate the hormones that may be at the root of the acne flare.

Other remedies for acne

In many cases, acne can be managed at home with a targeted skincare routine. Here are 10 tips that could help:

  1. Clean your skin with cool to lukewarm water. Using hot water can dry out the skin, triggering increased sebum production and further inflammation.
  2. Clean your skin twice a day with a mild, hypoallergenic cleanser. By using this skincare routine, you can prevent the build-up of dead skin cells, which can lead to acne flares.
  3. Do not squeeze or manipulate pimples. Squeezing a zit can trigger further inflammation, making the acne flare-up even more troublesome. "Picking" can also lead to the formation of acne scars.
  4. Use a salicylic acid body wash. Salicylic acid can help clear away dead skin cells, effectively breaking up comedones, and it also has an anti-inflammatory effect on the pores. You can find over-the-counter face washes and body washes with up to 2% salicylic acid content. They are safe for daily use.
  5. Use a benzoyl peroxide topical cream or ointment. Benzoyl peroxide is a powerful topical acne medication that is available over the counter in cream or ointment form. Not only does benzoyl peroxide help break up comedones, but it also has antibacterial properties that may help reduce the growth of acne-forming bacteria.
  6. Use a moisturizer. Look for these characteristics in a facial moisturizer: fragrance-free, hypoallergenic, and non-comedogenic. Apply a thin layer after your cleansing routine to prevent excessive dryness of the skin (which can trigger excess oil production and the development of more acne).
  7. Clean your face after exercising. After any activities in which you are producing excess sweat or oil, quickly clean your face to remove any buildup that could block the glands.
  8. Avoid harsh exfoliators. Though it may be tempting to use an exfoliator to rid your pores of the dead skin cells, this method will actually cause more inflammation and can increase acne. Lightly scrubbing with your fingertips is usually sufficient for cleaning.
  9. Remove inflammatory foods. Any food that causes inflammation in the body, especially sugar, may trigger more acne. Keep a food diary to see if your personal food intake is connected to your acne flares.
  10. Drink more water. The more you can hydrate your skin from the inside out, the less oil the sebaceous glands need to produce to keep your skin moisturized. This decreases the chance of blockages occurring in these glands.

Common questions about acne

What kind of acne do I have?

There are several different types of acne, and many people will experience a combination of these.

  • Closed comedones. Otherwise known as whiteheads, these occur when a sebaceous gland gets blocked beneath the surface of the skin. They are typically less than half a centimeter in diameter.
  • Open comedones. Otherwise known as blackheads, these occur when a gland is blocked at the surface of the skin, at the follicle. They appear as small circular dots with gray, brown, or black material.
  • Papulopustular acne. These are inflamed, red papules and pustules, also known as "zits" or "pimples."
  • Nodular acne or cystic acne. These are deep-seated facial bumps, frequently larger than half a centimeter, which are often tender and inflamed.

Why do I have acne?

Acne is often related to hormonal changes. However, it can also be related to your lifestyle (excessive exercising and sweating), diet (eating inflammatory foods, such as sugar), or occupation—especially if you are exposed to a hot area where you may have excessive sweat gland activity. There may also be a genetic component when it comes to acne: if your parents had acne, you are more likely to experience it yourself.


References

1. Skin conditions by the numbers. American Academy of Dermatology. URL. Accessed February 18, 2020.

2. Ayer J, Burrows N. Acne: more than skin deep. Postgrad Med J. 2006;82(970):500-506. doi:10.1136/pgmj.2006.045377

3. Chen WC, Zouboulis CC. Hormones and the pilosebaceous unit. Dermatoendocrinol. 2009;1(2):81-86. doi:10.4161/derm.1.2.8354

4. Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P T. 2013;38(6):336-355.

5. Dessinioti C, Katsambas A. Congenital adrenal hyperplasia. Dermatoendocrinol. 2009;1(2):87-91. doi:10.4161/derm.1.2.7818

6. Geller L, Rosen J, Frankel A, Goldenberg G. Perimenstrual flare of adult acne. J Clin Aesthet Dermatol. 2014;7(8):30-34.

7. Chien AL, Qi J, Rainer B, Sachs DL, Helfrich YR. Treatment of Acne in Pregnancy. J Am Board Fam Med. 2016;29(2):254-262. doi:10.3122/jabfm.2016.02.150165

8. CARING FOR YOUR SKIN IN MENOPAUSE. American Academy of Dermatology. URL. Accessed February 18, 2020.

9. Acne. Mayo Clinic. URL. Accessed February 18, 2020.

10. Acne. National institute of Arthritis and Musculosceletal and Skin Diseases. URL. Accessed February 18, 2020.

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