You know what acne is. You likely had it as a teenager — most of us did, to some extent. But when you struggle with adult acne, it can be particularly difficult. 

It’s embarrassing, painful, and can feel just plain gross. It forces you to spend more money and effort than you’d like to treat it, to wear maybe more makeup than you otherwise would, and maybe even to cancel plans in the midst of a particularly bad breakout. There’s really nothing to like about this skin condition. 

Figuring out how to clear up your skin begins with understanding what’s causing your breakouts. Rather than throwing everything labeled “anti-acne” at your face, really knowing how acne works can lead you toward more effective acne treatments and long-lasting solutions. 

How Acne Develops 

Acne vulgaris is caused by the interaction of skin oil (sebum), dead skin cells and bacteria. How it all works:

Your skin produces oil to stay supple and moisturized. That oil is released after traveling from your oil glands through your hair follicles and out your pores. Your skin also sheds dead skin cells on a regular basis. 

But when those dead skin cells build up and block a pore, they prevent the oil from leaving. That trapped oil mixes with bacteria, and boom! A pimple develops. 

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Repeat across your face, back, chest, or any number of locations on your body, and you have acne. 

Not all acne is the same — it can be “graded” by how severe it is: mild, moderate, or severe. 

This grading is based not only on the number of lesions you deal with at any given time, but the type of acne lesions you encounter. 

Closed comedones (whiteheads) and open comedones (blackheads) are the most basic forms of acne lesions. Papules are small, pink bumps. Pustules are filled with pus and red at the base. Nodules are hard, large, and deep pimples. And cysts are pus-filled, painful pimples that scar. 

Even though they’re different, they’re all types of inflammatory acne lesions. 

So what makes one person more likely to develop acne? Or what makes you more likely to develop it at certain times of your life? Let’s move on to causes and risk factors. 

Acne Causes and Risk Factors 

Acne is common in adolescence primarily because your body is going through a hormonal upheaval. The production of androgens (male sex hormones) in both girls and boys causes the body to produce more oil, which can lead to oily skin and the development of acne. 

But long after your teenage years, hormones can play a role in acne development. Here are some of the primary acne risk factors and causes: 

Menstrual cycle and related hormonal events: Your sebaceous glands — that produce oil — are heavily dependent on the balance of male (androgenic) and female (estrogenic) hormones. 

So, even as your body goes through completely normal hormonal changes, both monthly and throughout your life, these changes can trigger acne. 

Your menstrual cycle, pregnancy, perimenopause (the period before menopause), and menopause can all lead to acne.

Hormonal birth control: Stopping or starting birth control pills can cause hormonal fluctuations that lead to acne.

Genetics: If someone in your immediate family struggles with similar acne, you could have a genetic predisposition for acne.

Certain medications: Some medications can cause acne as a side effect. In addition to oral contraceptives, some of these drugs include lithium, benzodiazepines, cyclosporin, ramipril, vitamin B complexes, serotonin uptake inhibitors, and more.

Stress: There is a known association between stress and acne. Related: a lack of sleep, which can certainly be caused by and cause stress, can result in acne.

Smoking: There is a significant difference in the risk of acne among nonsmoking and smoking women. Chemicals in cigarettes can irritate the sebaceous gland, influencing oil production, according to researchers.

Endocrine diseases: Your endocrine system regulates your hormones, so diseases of the endocrine system can lead to acne. Such conditions include polycystic ovarian syndrome, menstrual disorders, infertility, metabolic syndrome, hirsutism (abnormal hair growth), and more.

Acne Treatment and Prevention

Knowing what’s causing your acne can help you determine the best course of treating and preventing it. Working with a healthcare professional or certified dermatologist can get you headed in the right direction sooner rather than later. But your treatment may involve: 

• Topical retinoids, such as tretinoin or adapalene 

• Over-the-counter topical drying agents, such as benzoyl peroxide

• Topical antibiotics 

• Oral antibiotics, such as tetracyclines 

• Oral contraceptives to control hormonal fluctuations

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In addition to medications, you can take steps to further prevent acne breakouts. According to the American Academy of Dermatology, here are a few of the many things you can do to help control your acne: 

• Use non comedogenic cosmetics and skin care products

• Clean your makeup brushes and applicators regularly, and don’t share them with other people

• Remove makeup before going to bed

• Wash your face twice each day, and not more frequently

• Be gentle when washing your face

• Use a clean towel when wiping sweat from your face 

• Resist the temptation to pop or pick at your pimples

• Follow your healthcare provider’s recommendations and instructions when it comes to applying or taking your acne medication(s)

*A note on benzoyl peroxide. In March 2024, Valisure shared results of a study that showcased that benzene can form in benzoyl peroxide (BPO) products. We currently recommend avoiding benzoyl peroxide products until the FDA provides more guidance on the safety of BPO.

References:

• https://www.aafp.org/afp/2000/0115/p357.html

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088940/

• https://www.aad.org/public/diseases/acne/really-acne/overview

• https://www.hopkinsmedicine.org/health/conditions-and-diseases/acne

• https://www.ncbi.nlm.nih.gov/books/NBK279211/

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360964/

• https://www.aad.org/public/diseases/acne/really-acne/adult-acne

• https://www.aad.org/public/diseases/acne/skin-care/habits-stop