Acne occurs when pores in our skin become clogged with dead skin cells. This typically happens due to an overproduction of oil, which causes the dead skin cells to stick together inside the pore instead of rising to the surface to be shed.

Bacteria that live on our skin can also cause or exacerbate acne. If it gets inside clogged pores, the bacteria can cause inflammation. If the inflammation goes deep into the skin, an acne cyst or nodule appears.

Acne may also be caused by certain medications, genetic factors, or hormonal changes.

Mild non-inflamed acne consists mostly of open comedones (blackheads) and closed comedones (whiteheads), also called comedonal acne. Moderate acne typically consists of inflammatory bumps (papules and pustules), also called papulopustular acne, while severe acne consists of deep painful cysts and nodules, often resulting in scars (nodulocystic acne).

Any type of acne can affect the face, neck, chest, shoulders, and back. Adult-onset acne (specifically adult female acne) often develops on the lower face, jawline, and neck, and consists of deep, often painful, nodules.

Adult acne seems to be more common among women, but can affect men as well. Most commonly, persistent acne from teenage years is typically due to a genetic predisposition, having one or more family members with acne.

A new onset of acne in adulthood (> 25 years old) is often due to genetics and a hormone imbalance. For women, fluctuating hormones can occur around their menstrual cycle, when starting or discontinuing birth control pills, or during pregnancy, perimenopause, and menopause. Other possible causes of acne include emotional stress, cosmetics, medication side effects, and underlying medical conditions.

What you eat is not likely the cause but can be a contributing factor to acne breakouts, particularly carbohydrates and dairy products. A high-glycemic index diet (i.e. chips, white bread, potatoes, and white rice) may worsen or trigger acne. Dairy products, particularly skim milk, may be associated with acne, although this association is unclear.

It is possible that hormones and growth factors in milk might play a role. If food is a concern, your dermatology provider may suggest keeping a food diary and avoiding foods that seem to make your acne flare.

No, not typically. Environmental factors, such as sweat, dirt, and makeup (cosmetics) contribute to acne breakouts, but are not typically the only cause. We recommend gently cleaning your skin at the end of every day and exfoliating two to three times a week or as tolerated.

Try to avoid touching your face as much as possible. Avoid rubbing, picking, squeezing, or draining pimples, as it can cause scarring and contribute to more acne breakouts. We often suggest gentle cleansers such as CeraVe, Cetaphil, or Neutrogena.

If you have oily skin that is not too sensitive, we suggest a cleanser with the ingredient benzoyl peroxide such as Panoxyl, Clearasil, or Clean & Clear.

We recommend you use makeup, cleanser, moisturizer, and sunscreen that says it is non-comedogenic, won’t clog pores, or is oil-free.

Avoid touching or squeezing it. We often suggest applying an over-the-counter cream/gel that contains benzoyl peroxide (Neutrogena On-the-Spot Acne Treatment 2.5%, Panoxyl 3% Spot Treatment, or Clearasil 10% Benzoyl Peroxide Acne Cream).

If over-the-counter remedies don’t improve or clear up your acne, you should see a dermatologist. Also, if acne affects your daily life in any way such as avoiding certain activities because of how your skin looks, or if acne is painful or causes permanent pitted scars, you should make an appointment with a dermatology provider.

Yes, if your acne is moderate to severe and resistant to oral antibiotics, your dermatologist may recommend Accutane. It is a very effective medication and is often considered if your acne is painful, affects multiple areas of your body, and/or causes permanent, pitted scars.

It is likely, although it is difficult to predict when. It can take two to three months before seeing improvement with topical treatment alone. There is no cure for acne, so most treatment regimens are continual and prolonged to control breakouts.