What Causes Acne? Hormones, Diet, Stress & Medications Explained
Updated: 10 minutes ago
Written by Dr. Charles Drew, Lead Pharmaceutical Content Specialist & Clinical Drug Information Reviewer
Reviewed for medical accuracy under the Ivermectinkart Editorial Policy
Introduction
Acne is a common skin condition that develops when tiny openings in your skin, called pores, become blocked by excess oil and dead skin cells. But what causes acne in the first place, and why do some people continue experiencing breakouts well into adulthood? The answer involves several connected factors, including hormones, skin bacteria, inflammation, genetics, diet, stress, and certain medications.
Hormonal changes can increase oil production, while everyday habits and health conditions may make existing breakouts worse. Understanding these triggers can help explain why acne appears at different ages and why the same treatment does not work for everyone. This guide explores the main causes of acne, the difference between common triggers and proven causes, and practical steps that may help you manage your skin.
What Actually Happens Inside Your Skin When Acne Develops?
Acne develops when a hair follicle becomes blocked with oil and dead skin cells. Bacteria and inflammation can then contribute to red, swollen, or painful spots. It is a medical skin condition, not simply a consequence of poor hygiene.
Your skin contains thousands of tiny hair follicles connected to oil-producing glands. These glands release a natural oily substance called sebum, which helps protect your skin and prevent moisture loss.
Normally, sebum moves through the follicle and reaches the skin's surface. Acne can begin when excess oil combines with dead skin cells and forms a blockage.
The Four Main Processes Behind Acne
Most ordinary acne involves four overlapping processes:
Excess oil production: Oil glands produce more sebum than the skin needs.
Blocked follicles: Dead skin cells accumulate and prevent oil from flowing out normally.
Bacterial activity: A naturally occurring skin bacterium called Cutibacterium acnes can contribute to inflammation within blocked follicles.
Inflammation: The body's immune response can cause redness, swelling, tenderness, and deeper acne lesions.
These processes can produce different types of acne.
Whiteheads form when blocked pores remain closed. Blackheads develop when material inside a clogged pore is exposed to air and darkens through oxidation.
Inflamed follicles can produce red bumps, pus-filled pimples, or deeper painful nodules. Blackheads are not caused by trapped dirt.
The American Academy of Dermatology's explanation of acne causes (External Link) identifies blocked pores, hormonal activity, and inherited susceptibility as important parts of acne development.
American Academy of Dermatology
How Do Hormones Cause Acne in Teenagers and Adults?
Hormones are among the most important influences on acne because they regulate how much oil your skin produces. Hormonal changes during puberty, menstrual cycles, pregnancy, and menopause can increase oil production or make existing breakouts more noticeable.
You do not necessarily need to have abnormal hormone levels to experience hormonal acne. Sometimes, your skin's oil glands are simply more sensitive to normal hormonal changes.
What Role Do Androgens Play in Acne?
Androgens are hormones found in people of all sexes. Testosterone is one example.
These hormones stimulate the skin's oil glands. When androgen activity increases, the glands may become more active and produce additional sebum.
This is one reason acne commonly begins during puberty, when androgen levels increase.
However, androgen activity continues throughout adult life, which helps explain why acne is not limited to teenagers.
Why Do Some Women Experience Acne Around Their Periods?
Some women notice that pimples appear or worsen shortly before menstruation.
Hormone levels naturally change throughout the menstrual cycle, and these changes may influence oil production and skin inflammation.
Period-related breakouts often affect the chin, jawline, and lower face, although their location alone cannot confirm a hormonal cause.
The timing of breakouts may provide a more useful clue. If acne regularly becomes worse at a similar point in each menstrual cycle, hormonal changes may be contributing.
Can Pregnancy, Menopause, or PCOS Trigger Acne?
Yes. Several hormonal conditions and life stages can influence acne.
Pregnancy: Changing hormone levels may increase oil production, particularly during certain stages of pregnancy. However, not everyone develops acne, and some people notice improvement.
Perimenopause and menopause: Changes in the balance of reproductive hormones may contribute to new or persistent adult acne.
Polycystic ovary syndrome (PCOS): This hormonal condition can be associated with increased androgen activity, acne, irregular periods, and excess facial or body hair.
Having acne alone does not mean you have PCOS. However, persistent acne accompanied by irregular menstruation or increased facial hair may justify a medical assessment.
Adult acne can also occur without any identifiable hormonal disorder.
Can Your Diet Cause Acne or Make Breakouts Worse?
Diet may influence acne severity in some people, particularly when eating patterns involve frequent blood sugar spikes. Research also suggests an association between cow's milk consumption and acne, although neither finding means that particular foods cause acne in everyone.
Diet is best understood as a possible contributing factor rather than the only explanation for breakouts.
Do Sugar and Refined Carbohydrates Make Acne Worse?
Some studies suggest that diets high in rapidly digested carbohydrates may worsen acne.
These are commonly called high-glycemic foods because they can raise blood sugar relatively quickly.
Examples include:
Sugary drinks and sweetened beverages
White bread and refined breakfast cereals
Doughnuts, pastries, and other sugary baked foods
Certain highly processed snack foods
Large portions of refined carbohydrates
When blood sugar rises, the body releases insulin, a hormone that helps move glucose into cells.
Insulin-related signaling can influence other growth hormones involved in oil production and skin cell activity. Researchers believe these processes may help explain the relationship between diet and acne.
Some small clinical trials have found improvement in acne among people following a lower-glycemic eating pattern.
However, the results are not consistent enough to establish a specific diet as an acne treatment.
Does Drinking Milk Cause Pimples?
Several observational studies have found that people who consume more cow's milk, particularly skim milk, are more likely to report acne.
Scientists are investigating whether milk-related hormones and biological growth signals could influence acne development.
However, observational studies cannot establish that drinking milk directly causes pimples.
It is also important to distinguish milk from other dairy products. Evidence linking yogurt or cheese with acne is much weaker.
The American Academy of Dermatology's review of diet and acne research describes the evidence concerning high-glycemic foods and cow's milk while emphasizing that additional research is needed.
Does Chocolate or Oily Food Cause Acne?
Chocolate, fried foods, and oily meals are often blamed for acne, but the evidence is more complicated.
A food containing oil does not automatically increase the oil produced by your skin.
Some chocolate products contain substantial sugar or milk, which makes it difficult to determine which ingredients might influence breakouts.
Similarly, fried foods may be part of a broader dietary pattern, but eating something greasy does not directly transfer that grease into your skin's pores.
If you suspect a particular food affects your acne, look for a consistent pattern rather than judging a single breakout.
Diet and Acne — What the Evidence Suggests
Food or dietary pattern | Possible relationship with acne | Practical takeaway |
Sugary drinks and refined carbohydrates | Some studies suggest they may worsen acne | Consider reducing frequent blood sugar spikes |
Cow's milk, especially skim milk | Observational research suggests an association | Monitor personal patterns without assuming milk is the cause |
Yogurt and cheese | Evidence of an acne association is limited | Routine avoidance is not generally necessary |
Chocolate | Findings are mixed; ingredients may influence results | Avoid assuming all chocolate causes breakouts |
Fried or greasy foods | No established direct relationship between dietary grease and clogged pores | Focus on overall eating patterns |
Vegetables, legumes, and higher-fiber foods | Can support a balanced, lower-glycemic diet | Include them regularly for general health |
Can Stress Really Cause Acne?
Stress is not considered an independent cause of acne, but it can make existing acne worse. Psychological stress affects hormonal and inflammatory processes in the body, which may increase breakouts in people already susceptible to acne.
This explains why some people notice more pimples during difficult periods, even when their skincare routine has not changed.
What Happens to Your Skin When You Are Stressed?
When you experience stress, your body activates several biological responses designed to help you manage challenging situations.
Stress-related chemical signals can affect the activity of oil glands and the inflammatory response in your skin.
Androgens and other stress-responsive signaling pathways may contribute to this process.
For someone whose pores are already prone to blockage, these changes may increase the severity of breakouts.
The relationship can also work in the opposite direction. Acne itself may cause emotional distress, embarrassment, or social anxiety, which can create a difficult cycle.
Can Lack of Sleep Make Acne Worse?
Poor sleep may contribute to acne flare-ups, although the relationship is not as clearly established as the role of blocked follicles and hormones.
Insufficient sleep can influence stress responses and general inflammatory processes.
Sleep disruption may also make it harder to maintain regular skincare habits.
Getting adequate sleep will not necessarily eliminate acne, but consistent sleeping habits can support overall wellbeing and may help reduce some contributing stressors.
Does Reducing Stress Help Acne Clear?
Stress management may help reduce flare-ups for some people, but it is not a substitute for proven acne treatment.
Practical approaches include maintaining a consistent sleep schedule, engaging in enjoyable physical activity, practicing relaxation exercises, and addressing ongoing sources of stress.
The American Academy of Dermatology notes that worsening stress can be associated with more severe acne.
Which Medications Can Cause Acne or Acne-Like Breakouts?
Certain medicines can trigger acne, aggravate existing breakouts, or cause rashes that resemble acne. These reactions may occur because the medicine affects hormones, hair follicles, or the skin's inflammatory response.
Medication-related acne is sometimes called drug-induced acne. A similar-looking condition, known as an acneiform eruption, may have a different underlying mechanism.
Can Steroids and Hormonal Medicines Trigger Acne?
Yes. Corticosteroids, testosterone, and anabolic steroids are recognized triggers of acne or acne-like eruptions.
Corticosteroids are used to treat numerous inflammatory and immune-related medical conditions. Some people develop similar-looking bumps after taking systemic steroid medication.
Testosterone therapy and anabolic steroids can increase androgen activity and stimulate skin oil production.
Certain hormonal contraceptives may also worsen acne in susceptible individuals, while others are used to treat it.
The effect depends on the formulation and the person's response.
Can Lithium, Vitamin B12, or Epilepsy Medicines Cause Acne?
Some non-hormonal medications have also been associated with acne or acne-like skin reactions.
Examples include:
Lithium, used for certain psychiatric conditions
Some antiseizure medicines, including phenytoin
High-dose vitamin B12 supplementation in susceptible individuals
Certain cancer treatments, particularly epidermal growth factor receptor inhibitors
Some immunosuppressant medicines, such as ciclosporin
Not everyone taking these medicines experiences skin problems.
The relationship is also not identical across medications. For example, rashes associated with some targeted cancer therapies may resemble acne but do not develop through the same process as ordinary acne.
The DermNet clinical reference on acne caused by medicines identifies several drug groups associated with acne and acne-like eruptions.
How Can You Tell Whether Medication Is Triggering Acne?
Medication-related breakouts may begin after starting a new prescription, changing a dose, or adding a supplement.
Some eruptions develop relatively suddenly and consist of many bumps that look similar.
Ordinary acne more often includes a mixture of blackheads, whiteheads, and inflammatory pimples.
However, appearance alone cannot reliably identify the cause.
A clinician may review when the eruption began, which medications you use, whether the skin changes are itchy or painful, and whether other explanations are possible.
Medicines Associated With Acne or Acne-Like Skin Reactions
Medication group | Examples | Possible skin effect |
Systemic corticosteroids | Prednisone and related medicines | Acne-like bumps in susceptible individuals |
Androgenic hormones | Testosterone and anabolic steroids | Increased oil production and sometimes severe acne |
Hormonal contraceptives | Certain progestin-containing methods | May worsen acne in some users |
Mood-stabilizing medicines | Lithium | Acne or acne-like eruptions |
Antiseizure medicines | Phenytoin and some others | Possible acne-like skin reactions |
Vitamins and supplements | High-dose vitamin B12 | Uncommon acne-like eruptions |
Targeted cancer medicines | EGFR inhibitors | Acne-like rash that requires specific medical management |
Do not stop, reduce, or change a prescribed medicine because of acne without discussing it with the prescribing healthcare professional.
What Other Factors Can Trigger Acne Breakouts?
Besides hormones, diet, stress, and medicines, inherited susceptibility, skincare products, friction, and certain environmental conditions may contribute to acne.
These factors do not affect everyone equally, which is why two people can follow similar routines and still have very different skin.
Does Acne Run in Families?
Genetics plays an important role in acne susceptibility.
If your parents or close relatives experienced persistent or severe acne, you may be more likely to develop it yourself.
Inherited differences can influence oil production, how follicles respond to hormones, and inflammatory activity.
This does not mean severe acne is inevitable. It simply means that some people's skin is more prone to developing blocked and inflamed follicles.
Can Makeup and Skincare Products Block Your Pores?
Some cosmetics, moisturizers, sunscreens, and hair products may contribute to clogged pores.
Heavy or oily preparations can sometimes make acne worse, particularly around the hairline and forehead.
Products labeled non-comedogenic are designed to be less likely to clog pores, although no label guarantees that a product will suit everyone.
Excessive cleansing can also irritate the skin.
Scrubbing aggressively, using harsh products, or repeatedly washing your face may worsen irritation without addressing the main biological causes of acne.
Can Sweat, Friction, and Humidity Worsen Acne?
Repeated pressure and rubbing can contribute to a condition called acne mechanica.
This may occur beneath helmets, tight clothing, chin straps, or sports equipment.
Heat and humidity can make these effects more noticeable in some people, particularly when sweat remains trapped beneath occlusive materials.
Sweat itself is not the fundamental cause of acne.
Gentle cleansing after heavy sweating, changing damp clothing, and reducing unnecessary friction can help prevent irritation and follicle blockage.
Acne usually does not have one single cause. Hormones, inherited susceptibility, excess oil, blocked follicles, bacterial activity, and inflammation create the underlying conditions, while diet, stress, medications, and skincare habits may influence how frequently or severely breakouts occur. Identifying your personal triggers can help, but effective treatment often needs to address more than one process.
When Should You See a Dermatologist for Acne?
Medical advice is appropriate when acne is persistent, painful, leaving scars, or affecting your emotional wellbeing. It is also important when breakouts begin suddenly, appear after a new medicine, or occur alongside symptoms suggesting a hormonal condition.
Consider a professional assessment if you experience:
Deep, painful nodules or cysts
Acne that leaves pits, scars, or persistent dark marks
Breakouts that do not improve with consistent, appropriate treatment
Sudden adult-onset acne with unusual symptoms
Irregular menstrual periods accompanied by persistent acne or increased facial hair
A new rash after starting a prescription medicine
Significant embarrassment, anxiety, or distress related to your skin
A dermatologist may recommend treatments targeting different aspects of acne, such as benzoyl peroxide, topical retinoids, azelaic acid, or prescription medicines.
Depending on acne severity and individual circumstances, hormonal treatments or other therapies may also be considered.
Treatment choice matters because some medicines, particularly certain retinoids and hormonal treatments, are unsuitable during pregnancy or when planning pregnancy.
The NICE guideline on acne vulgaris management recommends appropriate skincare, evidence-based treatment, and specialist assessment when scarring risk or psychological distress is significant. It also explains that noticeable improvement from acne treatment often takes six to eight weeks.
Conclusion
Understanding what causes acne is the first step toward managing it more effectively. Hormones, excess oil, blocked pores, bacteria, and inflammation form the foundation of acne development, while diet, stress, certain medications, genetics, and skincare habits can influence breakouts. No single food, hormone, or daily habit explains every case, and persistent acne does not mean you are caring for your skin incorrectly. A gentle skincare routine and evidence-based treatment can make a meaningful difference. If your acne is painful, leaving scars, or not improving, consult a dermatologist to identify possible triggers and discuss safe, appropriate treatment options for your skin.
Frequently Asked Questions
1. What is the main cause of acne on the face?
Acne mainly develops when excess oil and dead skin cells block hair follicles. Skin bacteria and inflammation can then cause pimples. Hormones and genetics influence how likely this process is to happen, while other factors may worsen breakouts.
2. Why am I suddenly getting acne in my 30s or 40s?
Adult acne can develop because of hormonal changes, stress, medications, or unsuitable skincare products. Some people also have an inherited tendency toward acne. Sudden or persistent breakouts, especially with other hormonal symptoms, may warrant a medical assessment.
3. Does eating too much sugar cause pimples?
High-sugar and rapidly digested carbohydrate foods may worsen acne in some people by influencing insulin-related pathways and inflammation. However, sugar is not the sole cause of acne, and eliminating it does not guarantee clear skin. Overall dietary patterns matter more.
4. Can anxiety and stress make acne worse?
Yes, stress can aggravate existing acne through hormonal and inflammatory responses. Some people notice more breakouts during stressful periods or poor sleep. Managing stress may help reduce flare-ups, but persistent acne often requires dedicated skincare or medical treatment.
5. Which medications are most likely to trigger acne?
Corticosteroids, testosterone, anabolic steroids, and lithium are recognized potential triggers. Certain hormonal contraceptives, antiseizure medicines, and other drugs can also cause acne-like reactions. If breakouts begin after a medication change, speak with the prescriber rather than stopping treatment independently.
6. Can acne go away without treatment?
Mild acne sometimes improves on its own, especially as hormonal patterns change. However, persistent or inflammatory acne may continue and can leave scars or dark marks. Early, appropriate treatment can help reduce breakouts and lower the risk of lasting skin changes.
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