Acne Part I: Why Do Some People Get Acne?

What exactly is acne and what causes it?

Sanaz Majd, MD
3-minute read

Acne can do a big number on our self-esteem.  I myself suffered from acne when I was younger, and I remember always wanting to cover up my face.  I was so embarrassed to go outside and socialize.  And I would occasionally encounter another socially unskilled person who would come up to me and say, “what’s that on your face?!” not realizing that what they were pointing to, was my sad attempt to hide a big zit with makeup! 

Why do some people get acne so badly, while others are blessed with beautifully clear skin?  This will be the topic of the next two episodes.  Today, I’ll discuss acne’s causes, and next time I’ll tell you the various ways to treat it.

What Is Acne?

The medical term for acne is “acne vulgaris” (and it has nothing to do with acne being “vulgar”).  Up to 90% of teenagers suffer from acne, but many adults and even post-menopausal women get it as well, although its rates tend to decline with age. 

Acne is really a disorder of the sebaceous follicles underneath the skin.  It is found on the parts of the body containing high number of sebaceous (or oil-producing) glands – like on the face, chest, upper arms, and back.  There are several ways these follicles can go wrong:

  • they can overproduce debris and oils

  • they can house a special type of bacteria called, not coincidentally, P. Acnes

  • they can overreact on the skin of people whose bodies are generally more prone towards inflammation

What Causes Acne?

There are various potential causes of acne.  Here are the most common culprits:

  • Genetics -- Those who suffer from acne often have a family member afflicted with it, like a parent.  Unfortunately, there’s not much you can do about it if your parents passed on the zitty genes to you. 

  • Hormones -- Testosterone and other hormones, like DHEAS which spikes during puberty, cause sebaceous follicles to produce more gland material, and hence more acne.

  • Medications -- There is a list of medications that can cause or exacerbate acne.  These include:  certain anti-seizure medications, lithium that is often used to treat bipolar disorder, and steroids. Even vitamin B2, B6, and B12 have been found to cause acne.

  • Cosmetics and moisturizers -- Although makeup alone is not the cause of acne, certain makeup that is oil-based, rather than water-based, can actually worsen the situation.  I suggest looking for the words “non-comedogenic” on all skin products, which means it won’t clog pores, otherwise known as comedones.

Acne Myths

Here are two mythical causes of acne that I often get asked about:

  • Diet -- Believe it or not, it’s really a myth that chocolate, milk, French fries, or any other types of food can cause acne.  There is no good evidence behind these claims, and most doctors don’t generally think diet has anything to do with acne.

  • Stress -- There are mixed studies suggesting that stress may play a role in acne.  Even though I do think learning to handle stress and minimizing it is important, there’s just not enough evidence to link the two at this time.

When Should You Worry About Acne?

It’s time to see your doctor if you suffer from acne and any of the below apply to you:

  • If it is interfering with your self-esteem

  • If you are unable to control it with over-the-counter acne medications

  • If you suffer excess body or facial hair or if your menstrual periods are irregular

Stay tuned next week for some Quick and Dirty Tips to treat your acne!

Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.

About the Author

Sanaz Majd, MD

Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women's health and patient education.