What Causes Acne

Common causes of acne and their treatment options |


Trying to figure out why you get acne is one of the best things you can do for successful acne treatment. It's not easy and once your skin clears, you still may not know the reason behind all the pimples, but understanding the common triggers of acne will help narrow the search for a solution.

If you can kind of guess what's causing your skin problems, then you stand a better chance of fixing them. For example, let's say you thought bacteria was causing your breakouts so you started using an antibiotic. But that didn't work, so then you tried not drinking milk, thinking your acne may be related to a food allergy, etc. Knowing what causes acne will provide a checklist of things to go through as you experiment with different treatment products and hopefully make the process of clearing your skin somewhat less confusing.

Since there are so many things that can cause or aggravate acne, I thought it'd be helpful to consolidate the information right here. I put together the below chart, which lists 13 of the most common causes or aggravators of acne, their descriptions and/or symptoms, along with potential acne treatment options.


13 Common Causes of Acne

Acne Culprits Description Treatment Options
Genetics Genes play a big role in the make up of your skin. Take a look at your parents' skin or ask them about their skin history and that should give you an idea of your own skin issues.

Some people are just blessed with beautiful skin genes and can sleep in a tub of lard everyday without getting a single pimple. Others, like me, are not as blessed.

My dad has bad breakouts and huge pores, but my mom has porcelain skin. The only thing she uses is Vaseline, believe it or not. And who do I take after? My dad, of course. Life's just not fair sometimes. 		There's nothing you can do about your genetic makeup. However, if your parents have decent skin now, then you likely won't be cursed with acne for life. In fact, if your parents had skin issues, whatever they did to treat them might work for you. Of course, do your own follow-up research because acne products and treatments have evolved as information and technology have improved.

While you can't change the genes you inherited, having a good skin care routine and looking into different acne treatments will definitely help. More nurture than nature in this case.
Hormones The most obvious examples of hormonal acne is the acne you get during puberty, menstrual cycles, pregnancy, and menopause.

Hormonal acne, especially adult acne, tends to occur around the chin and jaw line. Women typically experience more adult hormonal acne than men because of their periods.

In my experience, hormonal acne is also the kind of acne that hurts. So, if you get lots of deep pimples and/or cysts, there's a good chance those are related to your hormones. 		Keep a diary of your pimples and see if they pop up around the same time every month. Tracking your acne and taking detailed notes will help you get a better understanding of how your skin works.

You can also get your hormone levels checked to see if they're all normal. Though if you do have hormonal imbalances, they would probably manifest themselves in other aspects of your health.

Topical treatments can only do so much for hormonal acne, but they can help mitigate the situation. Supplements and oral contraceptives are other alternatives.
Bacteria P. acnes, the acne bacteria, gets a pretty bad rep. People assume that you kill the bacteria and you kill the acne. However, p. acnes exists on everyone's skin, whether it's clear or riddled with pimples.

P. acnes feeds off sebum. With acne-prone skin, there is usually an overproduction of sebum or sebum doesn't get sloughed off properly and gets trapped in hair follicles, either way creating fertile grounds for p. acnes growth.

You can kill off p. acnes, but it will keep coming back as long as it can make a home in your skin. Destroy the home and destroy the bacteria.

 Topical or oral antibiotics kill bacteria. I don't like taking oral ones because they obliterate all the bacteria in your system, both good and bad. However, people respond differently to different treatments.

Antibiotics may work initially, but I don't think they're a long-term solution for clear skin. Most dermatologists prescribe them with a retinoid to reduce purging and jump start the clearing process. Antibiotics are, in my opinion, a sidekick product. You can kill off bacteria, but you still have to keep your skin healthy so p. acnes can't settle down in its home.

Other topicals, such as benzoyl peroxide, also help to kill surface bacteria.
Cosmetically Related Acne This is the kind of acne you get when you use a new product and start to break out.

It could be from makeup, sunscreen, products with ingredients that clog your pores, irritating fragrance from fabric softeners, or even irritation from toothpaste.

It could also be hygiene related, such as improperly removing makeup and/or sunscreen, not cleaning cell phones, not changing pillow cases often, or using dirty makeup brushes.		 These breakouts usually subside once you stop using the product.

Practice proper hygiene: thoroughly (but gently) cleaning your skin, removing makeup and sunscreen before bed, using allergen-free detergents/softeners, cleaning cell phones, and changing pillow cases.

Introduce new products to your routine one at a time so you can tell which products are breaking you out.

Look at product ingredient lists to see which ingredients can be irritating and steer clear of pore clogging ones.
Food Allergies Food allergies are very subtle but they could pack a big punch in the acne department.

These include a sensitivity to milk, dairy, iodine, gluten, etc.

If you have acne from food sensitivities, the pimples might take 4-5 days to show up after eating a particular food. For example, if you eat shrimp one day and break out the next, that's too short a span to tell if the shrimp was the actual culprit, unless you had an allergic reaction. 		Keep a daily food journal and track when you get breakouts.

You can isolate milk, iodine-rich foods (seafood, iodized salt), or whatever food sensitivity of your choice from your diet one at a time to see if your skin gets better. Some people also see their skin get better after switching to organic milk (fewer hormones in the milk).

Otherwise, you can get an allergy test to see if you are allergic to anything.
Poor Cell Turnover Rate This is when dead skin cells are not being shed at the proper rate and contribute to pore blockage. Manual and/or chemical exfoliants (AHAs, BHAs, retinoids) can help your skin shed properly.

However, there is a fine line between exfoliating your skin and overdoing it.
Disturbed Skin Barrier Function When your skin is irritated (red, flaky, itchy, stingy) or overly dry, it can make you more vulnerable to p.acnes.

Poor skin barrier function doesn't do a good job protecting skin and keeping it healthy.

This is one of the reasons why people with dry skin can get acne, when acne is usually associated with oily skin.		 Use gentle products instead of harsh ones so you don't wash away your skin's natural moisture.

Don't use harsh scrubs either, because you could be giving your skin microscopic tears!

I think this is part of the reason why some people see their skin clear up after using "nothing" or "water only".
Underlying Health Problems Underlying health problems can cause acne.

There include thyroid problems, PCOS, diabetes, digestive imbalances, and metabolism issues.		 While the presence of acne isn't enough to make a diagnosis for any illness, acne can be a symptom of underlying health problems.

Consult your doctor if you are experiencing other health related symptoms.
Stress, Lack of Sleep Stress can wreak havoc on skin and worsen acne symptoms. But it isn't so direct a cause of acne that every time you feel stressed, you instantly get a new pimple. The alternative, being stress-free, also doesn't guarantee clear skin.

Sleep is also very important, not only for your skin, but also so your body can repair itself as you rest.		 While it's close to impossible to be stress-free, try not to stress out too much. Breathe deeply, meditate, exercise, think happy thoughts, take regular breaks, or simply count to ten!

Also, try to keep a normal sleeping schedule so your circadian rhythms don't get out of whack. My Chinese medicine doctor always says to sleep early (10pm) and wake early (6am).
Overly Active Sebaceous Glands This is usually what happens during puberty, when hormonal changes cause oil glands to change, producing more oil, and creating a fertile environment for p. acnes. Topical acne treatments can help. Using oil blotters throughout the day so excess oil won’t be sitting on the surface of your skin is another option. However, your skin does need some oils to function properly!

As a last resort, Accutane can help eliminate oil production, but it is a very serious drug.
Diet While Western dermatologists don't think there is a connection between diet and acne, most Asian dermatologists are more willing to make this link.

Too much sugar, alcohol, caffeine, etc. can aggravate acne.

Meat, dairy, and soy also contain hormones that you may be sensitive to. This goes back to having food allergies.

My dermatologist in Taiwan actually advises his patients to eat less sugar, drink less coffee, and avoid alcohol, peanuts, and eggplants. 		You could try switching to an organic diet to see if your skin improves.

Or you can try eliminating certain foods from your diet, but eliminating them doesn't necessarily mean you will clear your skin.

I find that when I eat less processed foods, my skin looks calmer. I don't break out if I eat french fries or chocolate, but when I eat a lot of junk food, I feel like my skin looks a bit more haggard.

I think diet helps your overall skin condition, but unless your acne is from a food allergy, you would probably need another treatment boost.
Toxin Build-Up Toxins can build up in your body through constipation or poor liver/kidney/intestinal function.

When this happens, the build up gets released through your skin, resulting in acne.

Some people think sweat can cause acne, but in my experience (and I sweat a lot), sweat is a good thing for your skin. 		Many people believe that when your body isn't getting rid of toxins properly, the toxins will show up as acne on your skin. I tend to think that your body cleanses itself (internally) just fine, but to each his own.

Possible treatment options for toxin-induced acne include internal cleanses (Not to be taken lightly; these can be very dangerous without professional medical guidance) or dietary changes.
Mixed Signals A lot of the times, acne lesions can be mistaken for Rosacea flares, different types of dermatitis, and/or keratosis pilaris. A qualified dermatologist will be able to give you an accurate diagnosis. Though I would probably get at least 2 opinions because a lot of these skin conditions look alike.


When isolating the potential causes of your acne, you have to treat the process like a science experiment. Keep track of everything: what you put on your skin, what you eat, how you're feeling, where you get your acne, when you break out, whether pimples hurt, how big they are, etc. And keep track of everything for a good 2-3 months so you can get a better understanding of how your skin works, how it reacts, and what it likes or doesn't like.

Knowledge is the first step to learning how to clear your skin and without understanding what causes acne for you individually, you will forever be treating the symptoms of acne and not the cause. Treating the symptoms is pointless if acne is always going to come back. Aside from gathering useful information, a healthy dose of patience and perseverance will help tremendously on the journey to clear skin.

Check out this interactive acne face map for more information about potential acne culprits. It illustrates what it means when you break out on your forehead, temples, nose, cheeks, around the mouth, or chin and what you can do about it.



Last updated: January 18, 2012


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