activity. Androgens (male hormones) increase in both boys and girls at the onset of puberty, causing the body’s sebaceous (oil) glands to enlarge and produce more oil. Oil production can also increase during pregnancy, or with starting or stopping oral contraceptives. In women, it decreases during menopause. [55]
Medications. Medicines that contain or stimulate androgens, corticosteroids, and/or lithium can play a role in the development of acne.
Heredity. Researchers believe that good old genetics could have a hand in whether or not a person gets acne. [56] Thus, if your parents suffered from breakouts, you’re at greater risk of suffering from them, too.
In addition to the actual causes of acne, there are other factors that can make acne worse if you’re already prone to breakouts, such as those below. [27]
Hormonal changes that occur in girls or women two to seven days before the beginning of their menstrual cycle. It’s no surprise to women around the world that breakouts are quite typical during your period.
Breakouts and oily skin can also plague women going through perimenopause (the beginning phase of menopause that normally begins after a woman turns 40) and during menopause. What happens is that estrogen levels (estrogen is the “female” hormone) drop, but the androgen levels (the male hormone that women also have) remain constant. [55] Androgens are a primary trigger of acne and when you have more of them in your body without the estrogen to balance it, your skin can start acting like you have a teenager’s skin, and not in a good way. The extra androgens cause the oil glands to produce more oil, and a stickier oil to boot, that can clog pores. There’s also the issue of older women having excess skin cells due to accumulated sun damage which can also lead to clogged pores.
Sensitizing reactions to makeup, irritating skincare ingredients, specific foods (rarely), allergies, or medicines. Sometimes such reactions aren’t true acne, but rather what’s known as “irritant contact dermatitis.” The red bumps seen with this type of reaction can resemble acne and tend to happen quickly, while true acne develops over a longer period of time. [27,57]
Inflammation caused by conditions inside the pore or by outside influences, such as using products that contain irritating ingredients, trying to “dry” up a pimple, or over-scrubbing. Squeezing pimples doesn’t increase the incidence of acne, but when done incorrectly, it can further inflame the breakout, potentially push the contents deeper into the pore lining, and generally keep it around longer. [27]
Allergic reactions to foods such as milk and milk products, gluten, nuts, or fish can cause acne in some people, but there’s research showing that this may not be true. Nonetheless, if you want to see if certain foods are acne triggers for you, it’s easy enough to experiment to see how your skin reacts if you eliminate one or more of these from your diet for several weeks. [27]
We touched on this above but to elaborate a bit before moving on to the next section: Acne and its typical partners-in-crime whiteheads and blackheads aren’t the result of dirty skin. The black dots that comprise the tip of blackheads aren’t dirt; dead skin cells and oxidized oil make these plugs appear dark. You cannot wash or scrub acne, whiteheads, or blackheads away, so please ignore all products making such claims. In truth, finally getting your acne under control is far more involved than that.
Getting Acne Under Control Is the Same for Everyone
Although there really isn’t a cure for acne, there’s a lot you can do to greatly reduce the problem and get it under control. No matter what else you do, the most important thing to remember about acne is that it’s an inflammatory disorder, which means anything you can do to reduce or avoid inflammation is going to help keep breakouts, the swelling, and the telltale redness at bay.
We describe below key steps you can take to make sure acne doesn’t stick around for long.
Keep skin clean, but don’t overdo it. Clean skin is a good thing because washing removes the excess oil and dead skin cells that contribute to clogged pores and create conditions ripe for acne to occur. However, washing too often, especially if you use harsh cleansers or scrubs, will lead to irritation and chronic inflammation. (Remember, anything that causes inflammation will increase acne conditions in your skin.) The best way to go is to wash your skin twice a day (once in the morning, once at night) with a gentle, water-soluble cleanser. We can’t stress the “gentle” part enough!
Also stay away from bar soaps and bar cleansers—they can leave a film or residue on your skin, which in turn can clog pores and reduce the effectiveness of any anti-acne products you apply after cleansing. [58]
Avoid skincare and makeup products that can cause irritation. Irritation = inflammation, and that’s bad news! Unfortunately, many skincare and makeup products, including many claiming to treat acne, contain irritating, drying ingredients. Don’t use products that contain SD or denatured alcohol because it dries out skin and actually can lead to increased oil production. [3,4,53]
Also on the “do not use” list are mint (including menthol and peppermint), witch hazel, eucalyptus, or citrus ingredients, as they will wreak havoc on your skin—yet these ingredients show up in a shocking number of products claiming to help acne.
Be sure to remove all your makeup before going to bed. Sleeping with makeup on will prevent skin from exfoliating and also block pores, which increases the conditions that promote acne. If you wear heavy makeup or just want to feel extra clean (without causing inflammation), it can help to use a Clarisonic brush or a washcloth with your gentle water-soluble cleanser. After you’ve rinsed your face, follow with a gentle toner that contains anti-inflammatory ingredients or a gentle makeup remover to be sure every last trace of makeup is gone before your head hits the pillow.
Avoid overly emollient or thick moisturizers. These types of products not only make oily skin feel more oily and greasy, but also can block pores and even absorb into pores, adding to the clog that’s already there or creating a new one. No matter how you look at it, these types of products are usually a problem for someone struggling with breakouts and oily skin.
Exceptions to this are the small percentage of the population who have acne, clog-prone skin and dry skin with little to just-visible pores. This confusing skin type is not easy to treat. More emollient moisturizers may be necessary to deal with the dryness, but they can also clog pores. The best way to deal with this is to follow our skincare routine suggestions and then experiment to find the lightest lotion moisturizer that will take care of your dry skin and not trigger more breakouts. Layering two or three thin-textured hydrating products (for example, a water-based serum layered with a lotion moisturizer) may be necessary.
Does wearing makeup cause acne? Not for most people. Foundations are designed to stay on the top of skin; they don’t absorb into the pore and cause problems like thick, emollient moisturizers can. But what can cause acne is not getting all of your makeup off at night. So don’t blame your breakouts on the makeup you’re wearing, blame it on being a bit too tired at night to follow your skincare routine.
Use lighter hair-care products. If your hairstyle is such that your hair touches your forehead or the sides of your face, traces of the products you use to style your hair will also end up on your skin. Therefore, if you have acne-prone skin, you should avoid thick, waxy hairstyling products along the hairline because they can clog pores and lead to breakouts. Conditioners can also trigger acne breakouts, so avoid getting these on your face. If you have neck or back acne, try rinsing the conditioner in a way that prevents those areas from coming into contact with it.
Protect yourself from the sun. You might have heard that a good dose of sunlight can “clear up” acne breakouts, but there’s no research indicating that sun exposure
