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Why Do I Have Acne?

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Why Do I Have Acne?

Your teenage years may be behind you, but lo and behold — you now have acne! Why is this happening? Does it have anything to do with diabetes? And most importantly, how do you get rid of it?

What is acne?

Think of acne, and you probably think “pimples,” “whiteheads,” or “blackheads.” Acne is a common skin condition that occurs when hair follicles under the skin become clogged with oil and dead skin cells. Skin pores become plugged, and this can lead to pimples (aka, “zits”). You can have acne on your face, as well as your back, chest, and shoulders, which is where you have the most oil glands.

People of any race, age, and gender can get acne, but it tends to occur mostly in teens and young adults. Acne in teenagers is more common in males, whereas acne in adulthood is more common in women.

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What causes acne?

There are a number of factors that contribute to the development of acne:

  • Too much oil in the skin pores
  • A buildup of dead skin cells in the pores
  • Bacterial growth in the pores

But what causes all of this to happen? In teens and young adults, androgen hormones (including testosterone) are peaking, making it more likely for acne to develop.

Acne can run in the family, so you can thank your parents if they had it and you do, as well.

Other factors that can trigger acne include:

  • Some medications, such as corticosteroids (e.g., prednisone), testosterone, and lithium
  • Some hair or skin care products
  • Stress
  • Constant friction on the skin from cell phones, helmets, or tight collars

Why do adults get acne?

If you’re older than age 25 and have acne, this is called “adult acne” or “post-adolescent acne,” writes Harvard Health Publishing. The same things that cause teen acne can also cause acne in adults: too much oil, clogged pores, bacteria, and inflammation, as well as medications, hair and skin care products, and cosmetics.

Women’s menstrual cycles can contribute to acne. Women may notice that acne appears or flares up right before their period starts. This acne differs from adolescent acne in that it usually appears as papules, mostly on the lower third of the face, jawline, and neck. It’s thought that progesterone levels, which are higher during the second half of the menstrual cycle, lower estrogen levels, and a constant level of testosterone are responsible for activating sebaceous glands to make more sebum. Sebum contributes to oil production, and the bacterium P. acnes feeds off this oil, leading to breakouts and inflammation.

Acne can appear in women who are pregnant or who are in menopause, and who start or stop taking birth control pills, again, due to changes in levels of hormones.

Acne that occurs along with other symptoms, such as hair loss or excessive hair growth, irregular menstrual cycles, and rapid changes in weight, can be linked to endocrine disorders, including polycystic ovary syndrome (PCOS).

Men get acne too, thanks to testosterone, which increases oil production. Oil production leads to clogged pores and breakouts. Also, men who have facial hair may have acne because the hair can trap oil, leading to pimples.

Is there a link between diabetes and acne?

People who have diabetes are prone to having various skin conditions, such bacterial infections that cause boils and styes; fungal infections that cause rashes; acanthosis nigricans, which causes brown areas on the neck, armpits, and groin; and diabetic dermopathy which causes light brown, scaly patches, usually on the legs.

There is some evidence that excess insulin levels, a hallmark of prediabetes and type 2 diabetes, increase levels of androgen hormones which, in turn, cause increased sebum production, leading to acne.

How is acne treated?

Over-the-counter acne remedies products, such as benzoyl peroxide and salicylic acid, can be helpful for mild cases of acne. However, if these products aren’t doing the job, ask your health care provider for more potent, prescription medications, such as:

  • Retinoids
  • Dapzone
  • Antibiotics (used topically or taken orally)
  • Oral contraceptives
  • Spironolactone (to help control testosterone levels)

Other treatments include photodynamic (light) therapy, chemical peels, and steroid injections. These may be used in combination with medications.

Can acne be prevented?

Not all cases of acne can be prevented, thanks to fluctuations in hormones. But the following steps can help:

  • Wash your face every day with warm water and a mild cleanser. A cleanser with salicylic acid may help.
  • Choose skin care products, sunscreens, and makeup that are either non-comedogenic or oil-free, or that state that they won’t clog pores.
  • A low-glycemic diet may reduce acne; sticking to fresh fruits, vegetables, beans, and whole grains and laying off white bread, white rice, potato chips, and sugary foods have been shown to lessen outbreaks.
  • Don’t smoke. Smoking has been linked with causing adult acne.
  • Since stress can exacerbate acne, find ways to help better manage your stress, such as exercise, listening to music, and setting realistic goals and expectations.
  • Avoid picking at or squeezing pimples. Doing so can increase inflammation and worsen acne; plus, it can cause scarring.
  • Always use clean towels (dry your skin gently!) and never share makeup or makeup brushes or applicators.

Want to learn more about diabetes and skin care? Read “Diabetes and Your Skin: Protecting Your Outermost Layer,” “Summertime Skin Care,” and “Diabetic Dry Skin.”

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter, DiabeticConnect.com, and CDiabetes.com

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