Why Do I Have Acne?

Many people experience bouts of acne during adolescence. However, adults can have acne that is just as frustrating!

What’s worse – it can be hard to treat. Over-the-counter creams and face wash products are effective for some people, but not everyone. Prescription treatments have better results but often come with serious side effects.

So, what causes acne, and how can you prevent outbreaks?

 

Common Causes of Acne

During adolescence, acne is usually triggered by hormones.¹ As teens enter puberty, their bodies begin producing large amounts of sex hormones (testosterone in boys, estrogen in girls). This drastic chemical change can lead to outbreaks of acne.

As adults, however, our hormone levels have mostly normalized. Women are prone to normal hormone levels throughout their menstrual cycle, during pregnancy, or in menopause. However, this is not the rush of estrogen or testosterone all teenagers experience during puberty. Regardless, hormones are a chief cause of acne, and upsetting the regulation of your body’s hormones can lead to outbreaks.

In addition, adults primarily have acne for three additional reasons: diet, stress, and environmental factors.²

 

Hormonal

Although hormones are most active in teenagers, adults can experience acne as a result of hormonal fluctuations.¹ Natural shifts in hormone levels are more common in women throughout the phases of the menstrual cycle. However, men can also experience some fluctuations.

Both sexes can experience sudden declines in sex hormones later in life. For women, this manifests as menopause. For men, it is Low-T. This abrupt change can shock the body, causing acne.

In addition to these natural shifts, hormone levels can vary due to chemical changes caused by diet, stress, or other environmental factors. Let’s talk about each of these and how they can influence the course of acne.

 

Dietary

Food allergies are a common cause of acne. When you have a food allergy, your body reacts to proteins in foods. One of the most common foods people are allergic to is gluten. Some people with gluten allergies experience digestive discomfort, but other symptoms are possible. Mild food allergies may not provoke pronounced symptoms. Yet, they can contribute to acne and worsen outbreaks.³

In addition, some foods (as mentioned previously) can cause hormonal changes, exacerbating outbreaks. Likewise, some foods can increase the body’s inflammatory response. Inflammation can contribute to acne.¹

There is conflicting evidence regarding which (if any) foods are most likely to contribute to acne. ⁴ If you have bad acne as an adult, it may be worth removing some of the following foods from your diet, at least temporarily:

• Milk
• Large amounts of sugar
• Gluten
• Large amounts of carbohydrates
• Processed foods

 

Stress

The stress response in humans increases a hormone called cortisol. Cortisol has many effects on the body, including increased inflammation and altering levels of other hormones in the body. This can indirectly contribute to acne but is unlikely to be the primary cause of acne.⁵

 

Additional Environmental Factors

There are additional environmental factors that contribute to breakouts. Some of these may be hard to control (e.g., pollution and genetics), but you may easily avoid others.

We all know that acne can be caused by clogged pores and excess oils in the skin. There are a few things you might be doing to keep the pores closed off. For example, wearing sweatbands can trap oil and prevent your pores from breathing naturally, thus worsening breakouts. Likewise, some beauty products can contain high amounts of oil. Again, these are not likely the primary cause of acne but can exacerbate the problem.⁶

Beauty products deserve increased attention because they can contribute to acne even if they aren’t oil-based. Many beauty products contain harmful chemicals that can disrupt hormone balance or cause many other negative effects. ⁷ These products can include lotions, makeup, soaps, sunscreens, etc. Always check the label! (For more information about dangerous ingredients in cosmetics, visit Campaign for Safe Cosmetics.)

Finally, certain medications can cause or worsen acne.² This is especially true of hormone therapies (including steroids). Men receiving testosterone replacement for Low-T may be more prone to acne. Women receiving estrogen therapy for menopause are also more prone to breakouts. These medications adjust your body’s natural hormone balance, thus potentiating the risks of acne.

 

Acne Tips

As you’ve seen, some causes of acne are easily avoidable. You can’t control your body’s natural hormone balance, but you can adjust your diet. If you have terrible acne, try eating a simple and healthful diet full of whole foods. See if you can find ways to reduce your stress levels. Look at all your beauty products, including soaps and body washes, and see if you can replace them with safer alternatives. If you take any steroid or hormone medications, discuss your concerns with your doctor to see if there are alternative or supplemental medications that can alleviate your acne symptoms.

References

1. Bagtin E, de Freitas THP, Rivitti-Machado MC, et al. Adult female acne: A guide to clinical practice. An Bras Dermatol. 2019;94(1):62-75. DOI: 10.1590/abd1806-4841.20198203.
2. Acne: Symptoms & Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047. Accessed 9/30/2020.
3. Penso L, Touvier M, Deschasaux M, et al. Association between adult acne and dietary behaviors: Findings from the NutriNet-Santé prospective cohort study. JAMA Dermatol. 2020;156(8):854-862. DOI: 10.1001/jamadermatol.2020.1602.
4. Claudel JP, Auffret N, Leccia MT, Poli F, Dréno B. Acne and nutrition: Hypotheses, myths and facts. J Eur Acad Dermatol Venereol. 2018;32(10):1631-1637. DOI: 10.1111/jdv.14998.
5. Adult acne: Understanding underlying causes and banishing breakouts. Harvard Health Publishing. https://www.health.harvard.edu/blog/adult-acne-understanding-underlying-causes-and-banishing-breakouts-2019092117816. Accessed 9/30/20.
6. Harvard Health Publishing. https://www.health.harvard.edu/a_to_z/acne-a-to-z. Accessed 9/30/20.
7. Krause M, Klit A, Blomberg Jensen M, et al. Sunscreens: are they beneficial for health? An overview of endocrine disrupting properties of UV-filters. Int J Androl. 2012;35(3):424-436. DOI: 10.1111/j.1365-2605.2012.01280.x.