Four main factors cause acne:
- Oil production
- Dead skin cells
- Clogged pores
Acne typically appears on your face, neck, chest, back and shoulders. These areas of skin have the most oil (sebaceous) glands. Acne occurs when hair follicles become plugged with oil and dead skin cells.
Hair follicles are connected to oil glands. These glands secrete an oily substance (sebum) to lubricate your hair and skin. Sebum normally travels along the hair shafts and through the openings of the hair follicles onto the surface of your skin.
When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicles. They form a soft plug, creating an environment where bacteria can thrive. If the clogged pore becomes infected with bacteria, inflammation results.
The plugged pore may cause the follicle wall to bulge and produce a whitehead. Or the plug may be open to the surface and may darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it's exposed to the air.
Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce cyst-like lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren't usually involved in acne.
Factors that may worsen acne
These factors can trigger or aggravate an existing case of acne:
- Hormones. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
- Certain medications. Drugs containing corticosteroids, androgens or lithium can worsen acne.
- Diet. Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread, bagels and chips — may trigger acne. Chocolate has long been suspected of making acne worse. A recent study of 14 men with acne showed that eating chocolate was related to an increase in acne. Further study is needed to examine why this happens or whether acne patients need to follow specific dietary restrictions.
- Stress. Stress can make acne worse.
These factors have little effect on acne:
Nov. 08, 2014
- Greasy foods. Eating greasy food has little to no effect on acne. Though working in a greasy area, such as a kitchen with fry vats, does because the oil can stick to the skin and block the hair follicles. This further irritates the skin or promotes acne.
- Dirty skin. Acne isn't caused by dirt. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse. Though it does help to gently remove oil, dead skin and other substances.
- Cosmetics. Cosmetics don't necessarily worsen acne, especially if you use oil-free makeup that doesn't clog pores (noncomedogenics) and remove makeup regularly. Nonoily cosmetics don't interfere with the effectiveness of acne drugs.
- AskMayoExpert. Acne (adult and pediatric). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Tea tree oil. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 24, 2014.
- Alpha hydroxy acids. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 24, 2014.
- Zinc. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 24, 2014.
- Bovine cartilage. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 24, 2014.
- Saccharomyces boulardii. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 24, 2014.
- Pizzorno JE, ed. Textbook of Natural Medicine. 4th ed. St. Louis, Mo.: Elsevier; 2013.
- Sawni A, et al. Complementary, holistic and integrative medicine: Acne. Pediatrics in Review. 2013;34:91.
- Lebwohl MG, et al. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2014.
- Hajheydari Z, et al. Effect of aloe vera topical gel combined with tretinoin in treatment of mild and moderate acne vulgaris. Journal of Dermatologic Treatment. 2014;25:123.
- Eichenfield LF, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131:s163.
- Questions and answers about acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Acne/default.asp. Accessed June 24, 2014.
- Thiboutot D, et al. Pathogenesis, clinical manifestations and diagnosis of acne vulgaris. http://www.uptodate.com/home. Accessed June 24, 2014.
- Emmy Graber. Treatment of acne vulgaris. http://www.uptodate.com/home. Accessed June 24, 2014.
- Dover JS, et al. Light-based, adjunctive and other therapies for acne vulgaris. http://www.uptodate.com/home. Accessed June 24, 2014.
- Pride HB, et al. What's new in pediatric dermatology?: Part II. Treatment. Journal of the American Academy of Dermatology. 2013;68:899.
- Garner SE, et al. Minocycline for acne vulgaris: Efficacy and safety. Cochrane Database of Systematic Reviews. http://ovidsp.tx.ovid.com/sp-3.12.0b/ovidweb.cgi. Accessed June 24, 2014.
- Titus S, et al. Diagnosis and treatment of acne. American Family Physician. 2012;86:734.
- Goldsmith LA, et al., eds. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.mhmedical.com/book.aspx?bookId=392. Accessed June 24, 2014.
- Zouboulis CC. Acne as a chronic systemic disease. Clinics in Dermatology. 2014;32:389.
- Caperton C, et al. Double-blind, placebo-controlled study assessing the effect of chocolate consumption in subjects with a history of acne vulgaris. The Journal of Clinical and Aesthetic Dermatology. 2014;7:19
- Han Song B, et al. Photodynamic therapy using chlorophyll-a in the treatment of acne vulgaris: A randomized, single-blind, split-face study. Journal of the American Academy of Dermatology. In press. Accessed June 24, 2014.
- Wheeland R, et al. Safety and effectiveness of a handheld blue light device for self-treatment of mild to moderate acne. Journal of the American Academy of Dermatology. 2012;66(suppl):AB18.
- England Owen C. Treating acne with high-dose isotretinoin. JAMA. 2014;311:2121.
- Murase JE, et al. Safety of dermatologic medications in pregnancy and lactation. Journal of the American Academy of Dermatology. 2014;70:401.e1
- Lam C, et al. Contraceptive use in acne. Clinics in Dermatology. In press. Accessed June 24, 2014.
- Brown MM, et al. Quality of life in pediatric dermatology. Dermatologic Clinics. 2013;31:211.
- Williams HC, et al. Acne vulgaris. Lancet. 2012;379:361.
- FDA drug safety communication: FDA warns of rare but serious hypersensitivity reactions with certain over-the-counter topical acne products. U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/ucm400923.htm. Accessed June 26, 2014.
- Brent A. Bauer, M.D. (expert opinion). Mayo Clinic, Rochester, Minn. July 2, 2014.
- Tetracycline. Micromedex 2.0 Healthcare Series. http://www.micromedexsolutions.com. Accessed Sept. 30, 2014.
- Filling in wrinkles safely. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049349.htm. Accessed Sept. 9, 2014.
You Are ... The Campaign for Mayo Clinic
Mayo Clinic is a not-for-profit organization. Make a difference today.