What are the main causes of acne?

Acne is one of the most common skin conditions. Although it is often associated with adolescence, many adults also experience persistent or recurring acne. Understanding what causes acne is an important first step in choosing the right approach and avoiding treatments that may be ineffective or even make the skin worse.

Key takeaways

• Acne develops when hair follicles become clogged with sebum and dead skin cells.

• Hormones, excess sebum production, bacteria and inflammation are among the main factors involved.

• Stress, diet, certain skincare products and environmental factors may also influence acne.

• Acne is not simply caused by poor hygiene. Excessive cleansing can irritate the skin and compromise the skin barrier.

• Persistent, painful acne or acne that leaves marks or scars should be professionally assessed.

How does acne develop?

Acne begins inside the hair follicles, commonly referred to as pores. Each follicle is connected to a sebaceous gland, which produces sebum, an oily substance that helps protect the skin.

When excess sebum combines with a build-up of dead skin cells, the follicle can become clogged. This environment can encourage the proliferation of Cutibacterium acnes, a bacterium naturally present on the skin and involved in the development of acne.

The combination of clogged follicles, sebum, bacterial activity and inflammation can lead to blackheads, whiteheads, pimples, pustules, nodules or cysts.

What are the main causes of acne?

Acne rarely results from a single factor. In most cases, several mechanisms contribute to its development.

• Hormonal activity

Hormones, particularly androgens, can stimulate the sebaceous glands and increase sebum production. This is one reason acne may appear or worsen:

• During puberty

• At certain stages of the menstrual cycle

• During periods of hormonal change

• At different stages of adulthood

• Excess sebum production

Higher sebum production increases the likelihood of clogged follicles. However, having dry skin does not mean that you cannot develop acne. It is possible to have acne while also having dry, sensitive or dehydrated skin.

• Dead skin cell build-up

Skin-cell renewal is a natural process. When dead skin cells are not shed effectively, they can accumulate inside the follicles and, together with sebum, contribute to blockages.

• Bacterial proliferation

Cutibacterium acnes is part of the skin's normal microbiome. Within a clogged follicle, certain conditions can encourage its proliferation and contribute to the inflammatory response associated with acne.

• Inflammation

Inflammation plays a central role in acne and contributes to redness, swelling and the development of inflammatory lesions. In more severe cases, deep and painful nodules or cysts can develop, which also carry a greater risk of leaving marks or scars.

Other factors that can aggravate acne

In addition to the main mechanisms involved in acne development, several factors may contribute to its appearance or make existing acne worse. These can include:

• Stress

• Diet

• Certain cosmetics or skincare products

• Some medications

• Pollution and other environmental factors

• Heat and humidity

• Friction or occlusion of the skin

The importance of these factors varies considerably from person to person. Identifying individual triggers can therefore be an important part of an acne assessment.

Acne is not caused by poor hygiene

There is still a common misconception that acne is the result of skin not being sufficiently clean. In reality, over-cleansing does not resolve acne and may actually make it worse.

Cleansing too frequently or aggressively can irritate the skin and compromise the skin barrier.

The goal should be to maintain a consistent skincare routine appropriate for your skin type while avoiding unnecessarily harsh products.

Depending on your skin and the type of acne, active ingredients such as salicylic acid or benzoyl peroxide may form part of an appropriate skincare routine. However, product choice and concentration should take into account skin sensitivity and acne severity.

Why is identifying the cause of acne important?

Two people may have similar-looking acne lesions but very different factors contributing to the condition.

Hormones, sebum production, skincare routines, diet, medications and other individual factors can all play different roles.

When acne persists, a more comprehensive assessment can therefore help identify the factors that may be contributing to your acne and guide a more individualized treatment strategy.

When should you seek professional help?

It may be appropriate to seek professional assessment if your acne:

• Persists despite using appropriate skincare products

• Is recurring or becoming worse

• Causes deep, painful lesions or cysts

• Leaves pigmentation, marks or scars

• Is significantly affecting your quality of life

• Does not respond to your usual skincare routine

Early assessment can be particularly important when there is a risk of scarring.

Assess first, treat second

There is no single acne treatment that is right for everyone. Understanding the type of acne and the factors that may be contributing to it allows for a more targeted strategy - from changes to your daily skincare routine to medical treatments or specific procedures when appropriate.

At Skin Reset Studios, the Acne Root Cause Analysis is designed to assess the potential factors associated with acne and help define a personalized treatment plan.

Book an Acne Root Cause Analysis in Lisbon to identify the factors that may be contributing to your acne and receive a personalized treatment plan.

This article provides general educational information and is not a substitute for individual medical diagnosis or advice.