The Science Behind Acne: Understanding the Causes and Treatments

  • June 9, 2023
  • 6 Minutes

Last updated on 10/02/2023 by Souhela Ferrah

Acne is a skin condition that affects millions of people worldwide. It is easily identifies by the presence of pimples, blackheads, and whiteheads. It is mainly present in aereas of the body with a high density of oil glands: the face, neck, chest, and back.

Understanding what are the acne causes is crucial to finding an effective treatment and learning how to prevent it. In this guide backed with research, we will delve into the science behind acne, understanding the diverse factors that contribute to its development.

What is Acne?

Acne occurs when our hair follicles become clogged with oil, dead skin cells, and/or pollution leading to the growth of bacteria and subsequent inflammation of the area. There are different types of lesions like comedones, papules, pustules, nodules, and cysts. Its severity can go from mild to severe, depending on the number and type of lesions present in the skin.

It’s a condition often linked to adolescence where hormonal changes can increase oil production in the skin leading to the formation of acne. It is important to mention that increased oil production is not only caused by hormonal changes nor it is the only factor causing acne.

study by the European Academy of Dermatology and Venereology conducted in 2011 found several links between acne and diet. Yet, the root causes of acne may also reside in genetic or environmental factors.

image of a woman concerned for her skin
decorative image representing the science behind acne
picture showing high carbohydrate food which is one of the triggers for acne

Types and Classification of Acne

Knowing the various types and classifications of acne can assist in identifying the appropriate treatment approaches, as acne can manifest in different forms, each with its own set of characteristics. Some of the common types of acne include:


Non-inflammatory acne characterized by clogged hair follicles, which can be open (blackheads) or closed (whiteheads). For comedones an exfoliating agent can help unclog the follicles.


Small, raised, inflamed lesions on the skin. For papules, an anti-inflammatory agent may reduce the visibility of the lesions.


Similar to papules but filled with pus. For pustules, an antibacterial component can help reduce the reproduction acne-causing bacteria.


Large, painful, solid lumps beneath the skin’s surface. For nodules, a balanced mixture of astringent and anti-inflammatory compounds can help shorten their presence on the skin


Deep, pus-filled, painful lesions that can cause scarring. For cysts, consider a product that controls bacterial growth, has an anti-inflammatory agent to reduce the pain and a skin-regenerative component to lessen the possible scarring.


While I’ve been working with acne-prone skins for years, it’s important to remind you: always consult your skin professional for the correct identification of the lesions and to address the best treatment available for you. Don’t just Google things on your own.

The Impact of Genetics on Acne-Prone Skin:

Acne susceptibility can be influenced by genetic factors. Although there is no specific “acne gene”, certain genetic variations and combinations can increase the likelihood of having acne-prone skin. People with a family history of acne may have a higher chance of experiencing acne breakouts. Genetic factors can affect sebum production, immune response, and inflammation, contributing to more severe cases of acne development.

The Role of Hormones in Acne Development

Acne development is significantly influenced by hormonal imbalances, particularly during puberty. Androgens, a group of hormones that includes testosterone, stimulate the production of excess oil (sebum) in the sebaceous glands. This excess production of sebum can lead to the clogging of pores and the formation of acne.

Understanding the Role of Sebum Production:

Sebum, a natural oil produced by the sebaceous glands, is crucial for maintaining skin hydration. However, excess sebum production can lead to clogged pores. Hormonal imbalances and genetic predispositions are among the factors that can influence sebum production, contributing to the development of acne. An increased sebum production creates an ideal environment for acne-causing bacteria to thrive which can lead to pimples deeply rooted in the skin.

The Influence of Bacteria and Inflammation:

Acne formation is influenced by bacterial infection and inflammation. Propionibacterium acnes, a normal skin bacterium, can rapidly multiply in blocked pores, triggering an immune response that leads to inflammation and the development of acne lesions. Redness, swelling, and tenderness are the distinctive and annoying features of inflammatory acne. The body’s immune system reacts to the bacteria and inflammation, which can worsen the severity of acne.

Common Triggers and Lifestyle Factors:

Acne can be affected by a range of triggers and lifestyle factors. Although the development of acne is multifactorial, there are certain triggers and lifestyle choices that can exacerbate existing acne or lead to new breakouts. Some of these factors include:

  • Diet
  • Stress
  • Skincare Practices and Routines
  • Environmental Factors
  • Hormonal Changes

For a more detailed list of triggers, check out our article: 10 Surprising Acne Triggers You Need to Know About

skin care as prevention to acne outbreaks picture showing a healing cream on skin
picture showing the pillows and bedsheets that need to often be changed not to trigger acne issues
picture showing a woman relaxing in her house on the sofa

Effective Treatments for Acne Causes:

Depending on the type of lessions and their severity, one or a combination of treatments are available to deal with every case of acne.

Topical Treatments: Topical medications are commonly used to treat acne. There are synthetic and natural treatments available. Within the synthetic, it is common to find benzoyl peroxide which helps unclog pores and has antimicrobial properties. Topical antibiotics can help control bacterial growth on the skin’s surface. Natural ingredients can be even more effective that it’s synthetic counterparts: two double-blinded investigations confirmed that a PTAC (Propoilis, Tea tree oil & Aloe Vera) formulation was better than erythromycin cream in reducing erythema scars, acne severity index, and total lesion count.

Oral Medications: In more severe cases of acne, oral medications may be prescribed. Antibiotics can greatly control bacterial growth and help reduce inflammation. Hormonal therapies, like contraceptives or anti-androgen medications, may regulate hormone levels controlling sebum production. Isotretinoin, a very strong medication derived from vitamin A, can be prescribed to someone with resistant acne.

Before taking any oral medications, consult your skin professional.
Do not self medicate. Also, in my years of research I’ve found that a natural skincare routine can help strongly in most cases, without the need of oral medication.

Dermatological Procedures: Dermatological procedures can complement other treatments when treating acne. Chemical peels help remove dead skin cells, promote cell regeneration, and reduce the visibility of scars. Microdermabrasion exfoliates the skin and unclogs pores while not damamging the skin. Laser therapies can be used to target bacteria and reduce sebum production.

Depending on the type and severity of acne, one or a combination of these treatments with a proper daily skincare routine can greatly help to reduce acne.

image of a shadow of a woman using a skin care oil serum for acne

Prevention Strategies for Acne

Taking preventive measures to deal with the triggers that cause acne can be like a night-and-day comparison. It plays a crucial role in managing it and preventing future breakouts. What are some skincare steps that you can add to your daily routine?

  • Maintaining a consistent skincare routine: Discipline and consistency are the two most important ingredients in any skincare routine. Clean your skin gently using a cleanser before going to bed and moisturize, it helps maintain a healthy skin barrier. In our years of experience we have found that a balanced skincare routine can really help mantain a healthier skin. We have created specific daily and weekly skincare routines that, for us, have become rituals. Check them out in our Rituals section.
  • Avoiding triggers: Identify and minimize the triggers that worsen your acne. Triggers may be different for person to person which is why it is recommended to keep a diary and identify which triggers apply more to you.
  • Managing stress levels: Stress can launch hormonal imbalances, which can increase the presence of acne. Look for some stress management techniques, such as exercise, meditation, or therapy that will not only help you have a clearer skin but also contribute to a better mental health.
  • Protect your skin: Sun exposure can worsen acne and cause long term problems in the skin. Use a non-comedogenic sunscreen daily to protect the skin from harmful UV rays.
  • Avoiding excessive touching of your face: Touching you face, with unwashed hands of even with the screen of your phone can transfer bacteria potentially causing acne breakouts. Avoid picking or squeezing pimples and remember to disinfect your phone.

With a mix of prevention and treatment, acne lesions and scars can be dealt with. Just as with the treatments, consistency is key for a skincare routine to work. Do not get disappointed if you don’t see results immediately, give the products a couple of weeks to work their magic.

Addressing Acne Scarring and Post-Inflammatory Hyperpigmentation:

Acne, specially severe cases with nodules and cysts, can leave behind scars and post-inflammatory hyperpigmentation (PIH), which stays on the skin affecting its appearance even after the acne has resolved. This impacts negatively in the way that a person lives their life since it can make them become extremely self-consciouss imparing how they interact with their peers. There are some dermatological procedures and topical treatments that can be taken to help reduce the visibility of scars such as:

  • Laser treatments: Laser therapy helps promote collagen production reducing the appearance of scars.
  • Non-chemical peels: skin peels done with natural ingredients efficiently exfoliate the uppermost layers of skin. They can help reduce the visibility of scars and PIH.
  • Microneedling: This procedure involves making several tiny punctures in the skin to stimulate collagen production and minimize the appearance of scars.
  • Natural Topical creams: Certain creams or ointments can help fade acne scars and hyperpigmentation. These products work by promoting skin cell turnover and reducing melanin production. A natural component often found in these topical treatments is vitamin C. Vitamin C is a powerful antioxidant that brightens the skin helping hyperpigmentation fade. Glabridin, another natural ingredients commonly found in licorice root, has been used for centuries in traditional medicine of its properties inhibiting melanin production which leads to a reduction in hyperpigmentation.
black and white picture showing a woman applying anti acne cream on her skin

When incorporated into skincare products , these plant-based ingredients can contribute to the fading of post-inflammatory hyperpigmentation, resulting in a more even and radiant complexion. It’s important to note that consistent and long-term use is required to see improvements and that the treatment should be followed-up by a professional.

Emerging Research and Future Directions:

Ongoing research aims to uncover new useful components and develop more effective treatments. Researchers are exploring innovative approaches never tried before, such as topical probiotics, which aim to restore a healthy skin microbiome. They are also going back to ingredients used for millennia to deal with skin conditions: natural, plant-based ingredients.

The evident anti-inflammatory, antimicrobial, and antioxidant properties of plant extracts and natural ingredients are gaining recognition for their effective role in managing acne. Several controlled studies have demonstrated encouraging outcomes in utilizing plant-based elements such as tea tree oil, green tea, and aloe vera for acne treatment. These natural compounds help reduce inflammation, inhibit bacterial growth, and promote healing of acne lesions.

A correct and well balanced skincare routine can do wonders to clear the skin but sometimes it is not enough. Acne, with its multifactorial causes, may required a mix of different type of treatments and procedures. A close follow-up with a dermatologist and a consistent skincare routine can work wonders, to the point that it might become a daily ritual. A time to take care of you, a moment that is private and just between you and you


Which foods are common acne triggers?

While the relationship between diet and acne is complex and varies from person to person, there is evidence to suggest that foods with a high glycemic index can potentially worsen acne. These foods, including sugary treats, processed snacks, and white bread, can cause a rapid spike in blood sugar levels. This, in turn, triggers a cascade of hormonal responses that can lead to increased sebum production, inflammation, and clogged pores. It's worth noting that not everyone will experience the same effects from these foods, but it may be beneficial for individuals prone to acne to monitor their diet and reduce consumption of high-glycemic foods.

How does stress affect acne?

When we're stressed, our bodies release stress hormones like cortisol, which can stimulate the sebaceous glands to produce more sebum. Excess sebum, along with the buildup of dead skin cells and bacteria, can clog pores and lead to acne formation. Moreover, stress can compromise our immune system, making it less effective at fighting off bacteria and inflammation associated with acne. Therefore, managing stress through relaxation techniques, exercise, and self-care can be beneficial for maintaining clear skin

How do hormonal changes act as acne triggers?

Hormonal changes can have a profound effect on the development of acne, particularly during puberty, menstrual cycles, or in individuals with hormonal disorders. Fluctuations in hormone levels, such as an increase in androgens (male hormones), can stimulate the sebaceous glands to produce more sebum. This excess sebum, combined with dead skin cells and bacteria, can clog pores and create an environment ideal for acne formation. Hormonal acne often presents as deep, painful cysts on the lower face, jawline, and neck. It's important to note that hormonal changes can affect both males and females, although they are typically more pronounced in females due to the menstrual cycle. Managing hormonal acne often requires a holistic approach that may include topical treatments, oral medications, and lifestyle modifications

Can wearing a tight hat or clothing trigger an acne outbreak?

Yes, wearing tight clothing or hats can potentially trigger acne breakouts, especially in areas where there is friction or heat buildup. Tight clothing, such as tight-fitting shirts or sports gear, can create friction against the skin, leading to irritation and inflammation. This friction can disrupt the skin's natural barrier and contribute to the formation of acne. Similarly, wearing hats or caps that are tight or made from non-breathable materials can trap sweat and bacteria against the skin, promoting the growth of acne-causing bacteria and clogged pores. To minimize the risk of acne in these areas, it's advisable to wear loose-fitting, breathable clothing and choose hats made from breathable fabrics like cotton.

Can birth control pills and other medications be considered acne triggers?

Yes, certain medications can potentially cause or worsen acne as a side effect. For example, corticosteroids, which are commonly used to treat inflammatory conditions like asthma or allergies, can disrupt the hormonal balance in the body and lead to acne breakouts. Anticonvulsant medications used to treat epilepsy or mood disorders have also been associated with acne as a side effect. Furthermore, some hormonal medications, including certain types of birth control pills or hormone replacement therapies, may cause hormonal fluctuations that can contribute to acne development. If you suspect that a medication you are taking is affecting your skin, it's important to consult with your healthcare provider to explore alternative options or adjust the dosage if possible

Does smoking trigger acne?

Yes, smoking has been associated with an increased risk of acne development. Smoking affects the skin in multiple ways that can contribute to the formation of acne. Firstly, smoking reduces blood flow to the skin, depriving it of oxygen and vital nutrients. This can impair the skin's ability to heal and regenerate, making it more susceptible to inflammation and acne breakouts. Secondly, smoking increases the production of free radicals in the body, leading to oxidative stress and inflammation. Inflammation plays a key role in the development of acne lesions. Lastly, smoking weakens the immune system, making it less efficient at fighting off acne-causing bacteria and reducing inflammation. Quitting smoking or avoiding exposure to secondhand smoke can significantly improve overall skin health and reduce the risk of acne.

Can lack of sleep affect acne

Yes, insufficient sleep can have a negative impact on the skin and contribute to acne breakouts. During sleep, the body undergoes various restorative processes, including skin cell turnover and repair. When we don't get enough sleep, these processes can be disrupted, leading to an accumulation of dead skin cells and a compromised skin barrier. This can make the skin more prone to inflammation, clogged pores, and acne breakouts. Lack of sleep can also elevate stress hormone levels, further exacerbating acne. It's important to prioritize quality sleep and establish a consistent sleep routine to support healthy skin and overall well-being.

About the Author

Souhela Ferrah
Souhela Ferrah

Researcher, mom and founder of Fields of Yarrow

Growing up in the south of France, Souhela Ferrah was surrounded by flower fields. As the daughter of a pharmacist, and with her educational background as chemist, she grew up with a strong affinity with nature and understood its power very well. Thanks to her family, her hometown and her travels around the world, she found inspiration in natural healers, herbalists and nature itself. And this was enough to motivate her to start the awarded honest skincare brand, Fields of Yarrow.
Tags: acne / acne treatment / causes of acne / understanding acne

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