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.
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.
Wondering if you might be transitioning towards menopause? Conveniently check key hormones that may indicate you’re approaching menopause with the at-home Perimenopause Test.
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.
In many cases, acne can be managed at home with a targeted skincare routine. Here are 10 tips that could help:
There are several different types of acne, and many people will experience a combination of these.
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.
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