What Causes Acne and How to Manage It

Acne is a very common concern but it can often be managed with an effective skincare routine. Let’s look at what causes acne as well as the different types of acne. We’ll also provide some tips to help you manage breakouts.

What is acne?

Acne is a condition where pimples or hard bumps appear on your skin, which typically develop on the face, chest, and upper back.[1] It’s the second most common skin disorder after eczema, around 85% of teenagers and young adults are affected by it. However, people of any age can experience acne.[2]

Different types of acne

There are six main types of acne: blackheads, whiteheads, pustules, cysts, nodules, and papules. You can have some or all of the different types, which are characterized as follows:3

Blackheads appear as black dots. They appear black as a result of the pimple being open and the skin oils oxidizing in the air.
Whiteheads are closed pimples that are filled with pus.
Pustules are similar to whiteheads, but are inflamed and therefore red at their base.
Cysts contain pus, are painful and deeper in the skin, meaning they often scar when they heal.
Nodules are hard, large, and painful bumps that appear deeper in the skin.
Papules are small hard bumps that often arise in groups on your skin.

Common acne triggers

Everyone's experience of acne is different, but there are some common triggers that can cause follicles to become blocked, which can result in acne. We take a look at these below.

Hormones

Acne is very common in teenagers because puberty involves changes in hormones. During puberty, sex hormones called androgens are stimulated, and this can lead to an overproduction of sebum oil, causing follicles to become blocked.[3]

The same is true for women during their menstrual cycle and pregnancy when many hormonal changes take place, including an increase in androgens.[3]

Additionally, as women get older, their estrogen levels naturally decline whilst testosterone (an androgen) levels increase. This can result in larger pores and more skin oils that can lead to acne flare-ups.[4]

Diet

Your diet might also impact your skin. While there are still debates around the relationship between diet and acne, some studies suggest that certain foods can worsen acne. These include foods with a high glycemic index, such as white bread, fries, cakes, sugary foods, dairy, processed meat, and refined grains. If you have acne-prone skin, you may want to reduce these foods in your diet.

Similarly, some studies indicate that eating more foods with omega-3 fatty acids, like oily fish, could benefit your skin as can probiotics - such as those found in yogurt.[5]

Genetics

There may be a link between family history of acne and your likelihood to develop this skin condition. Research suggests that having a parent who had acne increases your risk of developing acne at a younger age, especially if both parents had acne.[8]

A history of acne on your mother’s side appears to be a more important indicator of your risk of getting acne earlier, compared with acne on your father’s side.[6]

Medications

Some medications can cause acne as a side effect. These include some birth control pills, corticosteroids, lithium, and barbiturates. If you think your acne may be caused by your medication you should speak to your doctor.3

Smoking

It’s well understood that smoking is bad for your health, but did you realize that it could also harm your skin? Some studies have found a link between smoking and adults with acne.[7,8]

Acne myth-busting

Let’s take a look at some of the myths surrounding acne:

Myth 1: Acne is caused by dirty skin

Acne is not triggered by dirty skin. If you have acne, you may be tempted to wash your face a lot, but you should only wash your face twice a day – morning and evening – and after sweaty activities like physical exercise. Repeated washing can actually irritate the skin, leading to more breakouts.[9,10]

Myth 2: Acne is only a teenage problem

While young adults and teenagers are more likely to get acne because of hormonal changes, it can affect people of any age. As much as one-half of women in their twenties, one-third of women in their thirties, and one-quarter of women in their forties experience acne. It’s far more common for women than men to have acne beyond their teenage years.[5]

Myth 3: You should let acne run its course

Waiting out acne can take years. With a proactive approach using the right skincare products, you may be able to manage your acne-prone skin, .You may also need the help of a dermatologist and medication, depending on the severity of your acne.[11]

Myth 4: Eating greasy food causes acne

While some studies suggest that diet might play a part in the severity of your acne, there isn’t enough evidence indicating that greasy food alone causes acne.

Research suggests that sugar and not grease has more of an impact on acne. Scientists believe that this is linked to the fact that eating high-sugar foods spikes your blood sugar, which in turn can cause inflammation throughout your body. Sugar spikes can also push your body to produce more sebum. The combination of inflammation and sebum production is thought to lead to acne.[12]

Myth 5: Pimples will disappear sooner if you pop them

While you may want to pop your pimples, this can actually push pus and bacteria deeper into your skin, often making acne worse.10 So try not to squeeze any pimples!

Skincare for acne-prone skin

If you have acne-prone skin you should develop a good skincare regime with the right products to help manage and improve the appearance of your skin. You want to use products that are non-comedogenic, which means that they won’t clog your pores10 – such as Cetaphil’s Acne Relief Body Wash and Cetaphil Gentle Mattifying Acne Moisturizer.

There are also some ingredients you can look out for in your skincare products that help manage acne breakouts. These include:

Salicylic acid

Salicylic acid can help clear acne and prevent future breakouts – including mild breakouts, whiteheads, and blackheads – by helping to remove dead skin cells and clear clogged pores. Try Cetaphil Gentle Clear Clarifying Acne Cream Cleanser, which contains salicylic acid, soothing aloe, and white tea extract to nourish your skin.[13]

Niacinamide

Niacinamide, an active ingredient in Cetaphil Gentle Clear Triple-Action Acne Serum, is great at tackling inflammation and pigmentation. It also helps with skin pore appearance and oil regulation.[13]

Licorice Root

Cetaphil Gentle Clear Complexion Clearing BPO Acne Cleanser contains licorice root that can help to soothe irritated skin and to reduce acne-related redness. It also contains micronized benzoyl peroxide (BPO) that kills acne-causing bacteria while being less irritating than traditional BPO formulations.[14]

Tips to help manage your acne

Besides using products specifically for acne-prone skin, there are a couple of lifestyle changes that could also help.

Don't touch your face

Touching your face with unwashed hands can introduce bacteria to your skin, which can worsen acne. So remember to wash your hands before doing anything to your face, such as putting in contact lenses or rubbing your eyes.15 Also, try to keep your cell phone away from your skin and clean it regularly.

Avoid trigger foods

Pay attention to whether specific foods trigger an outbreak. Everyone is different but if you take notice of how your acne reacts after eating certain foods, you might find a trigger that makes your acne worse.

Acne, mental health, and stress

Acne doesn't always just affect your skin; it can influence your mental health as well. If your acne is causing you to feel anxious or depressed then don’t be afraid to ask for help. Stress can make acne worse, so taking care of your mental health is important.[16,17]

The bottom line

If you have acne it’s important to find a skincare routine that works for you. Make sure you use products that don’t clog your pores and try ingredients that specifically target acne-prone skin. Using the right products and making a few lifestyle changes can help you manage breakouts, but if your acne is a concern you should speak to your doctor or dermatologist.

References

Ogé LK, Broussard A, Marshall MD. Acne Vulgaris: Diagnosis and Treatment. Am Fam Physician. 2019;100(8):475-484.
Xu H, Li H. Acne, the Skin Microbiome, and Antibiotic Treatment. Am J Clin Dermatol. 2019;20(3):335-344. doi:10.1007/s40257-018-00417-3.
Acne. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/acne. Accessed November 18, 2022.
Got Adult Acne? Get Answers from an Expert. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/got-adult-acne-get-answers-from-an-expert. Accessed November 18, 2022.
Baldwin H, Tan J. Effects of Diet on Acne and Its Response to Treatment. Am J Clin Dermatol. 2021;22(1):55-65. doi:10.1007/s40257-020-00542-y.
Ballanger F, Baudry P, N'Guyen JM, et al. Heredity: a prognostic factor for acne. Dermatology. 2006;212(2):145-149. doi:10.1159/000090655.
Yang YS, Lim HK, Hong KK, et al. Cigarette smoke-induced interleukin-1 alpha may be involved in the pathogenesis of adult acne. Ann Dermatol. 2014;26(1):11-16. doi:10.5021/ad.2014.26.1.11.
Capitanio B, Sinagra JL, Ottaviani M, et al. Acne and Smoking. Dermatoendicrino. 2009;1(3):129-135 doi:10.4161/derm.1.3.9638.
Acne. National Library of Medicine. https://medlineplus.gov/acne.html. Accessed November 18, 2022.
10 Skin care habits that can worsen acne. American Academy of Dermatology Association. https://www.aad.org/public/diseases/acne/skin-care/habits-stop. Accessed November 18, 2022.
What can clear severe acne? American Academy of Dermatology Association. https://www.aad.org/public/diseases/acne/derm-treat/severe-acne. Accessed November 18, 2022.
Can the right diet get rid of acne? American Academy of Dermatology Association. https://www.aad.org/public/diseases/acne/causes/diet. Accessed November 18, 2022.
Fox L, Csongradi C, Aucamp M, et al. Treatment Modalities for Acne. Molecules. 2016;21(8):1063. doi:10.3390/molecules21081063.
Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. JClin Aesthet Dermatol. 2010;3(7):20-31.
Facial Cleanliness. Centers for Disease Control and Prevention. https://www.cdc.gov/hygiene/personal-hygiene/face.html. Accessed November 18, 2022
Barankin B, DeKoven J. Psychosocial effect of common skin diseases. Can Fam Physician. 2002;48:712-716.
Yosipovitch G, Tang M, Dawn AG, et al. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta Derm Venereol. 2007;87(2):135-139. doi:10.2340/00015555-0231.