Why Am I Breaking Out?

Are you breaking out and not sure why? Acne and other skin problems can strike anyone at any age. Some potential causes may surprise you—they can include sweating at the gym, genetics, stress, or even taking a trip.

Clogged pores can lead to a variety of acne blemishes, such as:

• Blackheads: Small black dots inside your pores
• Whiteheads: White or flesh-colored bumps 
• Papules (early pimples): Form when oil, bacteria, and dead cells go deeper into the skin
• Pustules (pus-filled pimples): Like papules but containing a yellowing fluid
• Nodules and cysts (deep pimples): Deep penetrating blemishes that can cause scarring, such as pockmarks

You can also have breakouts that don’t involve acne blemishes at all. This article looks at many causes of breakouts, location-specific breakouts, and what to do about them.

Why You Could Be Breaking Out: 14 Causes

Some causes of acne breakouts are directly related to your skin and skin-care regimen. Others are related to your health or other medical causes, and some are due to your lifestyle.

Cosmetics, Skin-Care, and Hairstyling Products

Some cosmetic, skin-care, and hairstyling products can clog your pores and cause acne. This is called acne cosmetica.

This type of acne typically causes breakouts of tiny bumps across your cheeks, chin, or forehead. It often involves whiteheads and some pimples.

Acne cosmetica can develop even if you’ve been using the same products for several months. This can make it difficult to know for sure whether it’s the makeup or something else. Using makeup to conceal breakouts can then make your acne even worse.

Sunscreen

While sunscreen is a necessary part of protecting your skin from damage, some sunscreens can cause or contribute to acne. However, some of them are safe for acne-prone skin.

When choosing sun protection, consider:

• Cosmetics labeled for their sun protection factor (SPF)
• Fragrance-free products
• Sunscreen containing zinc, lactic acid, or white tea
• Lightweight, non-oily sunscreens

Also consider what feels good on your skin. That will make you more likely to use it.

Facial Hair Growth or Removal

Beard acne can form in or around facial hair. This happens because the hair traps oil, dead cells, and bacteria next to your skin. It can also make the skin underneath harder to cleanse.

Facial hair removal can also lead to breakouts. These may be acne or folliculitis, a rash caused by irritated hair follicles.

Both acne and folliculitis can be caused by:

• Shaving
• Depilatory (hair-removing) chemicals
• Anything that damages the hair follicles

A bumpy outbreak in an area where you shave could also be razor burn or pseudofolliculitis barbae (chronic inflammation from ingrown hair).

Picking at the Skin

Picking at your skin may be a natural response to having blemishes, but it can make your breakouts worse. Some people have difficulty not picking at raised or rough areas of skin, and they can cause severe damage.

Acne resulting from picking is called excoriated acne. It can involve open sores, red bumps or scratches, crusting, and scabbing. It can also cause scarring due to permanent damage. 

Skin picking can be a hard habit to break. If you cannot stop on your own, talk to a healthcare provider. You may benefit from treatments, including mental health counseling.

Prolonged Contact and Friction

Prolonged contact between your skin and a variety of things can lead to acne breakouts. Common culprits include:

• Your hands (such as sitting with your chin perched on your palm)
• Your phone
  

Likely a bigger contributor, though, is friction-caused acne, called acne mechanica. It's caused by anything that traps heat and sweat against your skin and rubs against it.

Items that can lead to acne mechanica include:

• Sweatbands
• Hats/headbands
• Football helmets
• Bra straps
• Tight-fitting garments
• Face masks

During the COVID-19 pandemic, the term “mascne” was coined to describe the breakouts many people had from wearing a mask all day.

Hormones

Hormones and hormonal changes can cause or contribute to acne. Teen hormones probably come to mind right away, but age-related hormonal changes can also lead to breakouts—especially in people with ovaries.

During puberty, testosterone levels increase in people of all sexes. In people with testicles (often assigned male at birth), it makes the penis and testicles develop. In people with ovaries (often assigned female at birth), it promotes bone and muscle development.

Hormones produced in the ovaries, such as estrogen, decline as you get older, which changes the balance of your sex hormones. This also happens to people who take testosterone for medical reasons and as part of gender-affirming treatment.

In people with ovaries, estrogen keeps androgen hormones such as testosterone and dihydrotestosterone in check. When testosterone levels go up for any reason:

• Oil production increases
• Oils become thicker
• Pores may appear larger

These changes can mean more clogged pores, which can lead to acne.

Stress

Stress can also alter hormone levels and contribute to acne breakouts. This isn’t due to estrogen and testosterone, though.

Cortisol is one of your primary stress hormones. When you’re under stress, your body produces more cortisol than usual.

Cortisol can weaken your immune system and lead to inflammation throughout your body—including your skin. And those factors can either trigger acne or make it worse.

Genetics

A tendency to develop acne runs in families. Research suggests that if both of your parents had acne, you’re more likely to:

• Have acne
• Develop it at a young age
• Have a severe case
• Have it as an adult

Research has uncovered two groups of genes that influence your risk of acne. These include genes that regulate inflammatory responses and sebaceous (oil) gland activity.

Medications

Certain medications—especially those containing hormones—can cause or contribute to acne. Those suspected of causing it include:

• Corticosteroids
• Anabolic steroids
• Hormonal contraception (injected, implanted, or “the pill”)
• Testosterone
• Thyroid hormone

Medications that may worsen acne include some:

• Halogens (iodine, bromine, fluorine, chlorine)
• Anti-seizure drugs (carbamazepine, phenytoin, phenobarbital)
• Tuberculosis drugs (ethionamide, isoniazid, rifampicin)
• Antidepressants (lithium, amoxapine)
• Immunosuppressants (ciclosporin, azathioprine)
• High doses of vitamins B6 and B12

Even if your acne becomes bothersome, don’t go off of your medications or change their dosage without first talking to your healthcare provider.

Underlying Illness

Sometimes, acne is a symptom of an underlying illness, including:

• Obesity
• Diabetes
• Hypertension (high blood pressure)
• High cholesterol
• Endocrine (hormone-related) disorders such as polycystic ovarian syndrome (PCOS), hyperprolactinemia (high levels of the hormone prolactin), and insulin resistance (when cells no longer respond well to the hormone insulin and can’t take up glucose from the blood, requiring more insulin)

Symptoms that could point to a systemic condition (one affecting one or more body parts) include:

• Hair loss (alopecia) or excessive hair growth (hirsutism)
• Irregular menstrual cycles
• Rapid weight gain or loss
• Rapid acne onset when you’ve never had it before

If you notice these or any other symptoms during a breakout, talk to a healthcare provider. They may want to run some tests.

Smoking

Smoking cigarettes may cause changes in your skin that alter the makeup of natural oils on your face. Strong ties have been found between non-inflammatory adult acne, especially in those with a female hormone profile.

Adult female smoking-related acne is especially likely to cause large, cyst-like pimples scattered all over the face. These are uncommon in other cases of adult acne.

Diet

Your diet can directly impact your risk of acne breakouts. According to research, you’re more likely to have acne if you consume:

• Milk and other dairy products
• Sugar/high glycemic index foods (those that raise blood sugar fast)

Other foods research has linked to acne include:

• Alcohol
• Refined grains
• Red meat
• Egg protein
• Saturated fats

Experts believe this is because these foods can cause inflammation and oil overproduction, as well as allowing bacteria to thrive.

Staying hydrated is important for skin health. Your skin can become dehydrated, and dehydrated skin can produce too much oil, which often leads to acne.

Poor Sleep Habits

Research suggests that poor sleep may contribute to skin inflammation, which is a known component of acne.

In one study, poor sleep predicted the presence of acne, and vice versa. This is a complex relationship that’s not yet well-understood. However, insufficient sleep is linked to many systemic inflammatory diseases.

Sweaty Activities

Anything that makes you sweat a lot can lead to clogged pores and acne breakouts. This includes:

• Exercising
• Spending time outside in hot weather
• Working in a hot environment

Sweaty skin is especially likely to trap dirt and bacteria on your skin.

Traveling

The air on airplanes is especially dry. If you already have dry skin, this can lead to irritation. If you have oily skin, it may produce excess oil production to counter the dryness.

When you’re away from home, you may also encounter either more or less humidity than you’re used to, jet lag or poor sleep, and unusual food choices. Travel can also be stressful. All of those scenarios can lead to acne breakouts soon after you arrive at your destination.

While traveling, you may have short-term exposure to air pollution, which research has implicated in some cases of adult acne.

Causes of Breakouts by Location

Sometimes, the location of your breakout provides clues to what’s causing it.

Hairline/Forehead Acne

If you’re breaking out on your forehead or along your hairline, hairstyling products may be to blame. This is where they’re most likely to come into contact with your skin.

Oily products are more likely than nonoily ones to cause acne. The condition is sometimes called pomade acne, named for a type of hair product that’s often greasy or waxy.

Tight hats such as baseball caps can also cause irritation and trap dirt, which can clog pores and result in acne along the hairline or forehead.

U-Zone and Front-of-Neck Acne

Small nodules on the chin and cysts in the U zone of the face are typical of adult female acne. The U zone is the area from beneath your eyes down to your jaw.

This type of acne sometimes includes the front of your neck, as well.

Jawline Acne

Research suggests that acne along the jawline is related to higher levels of androgen hormones. If you were born with ovaries and have jawline acne, it may be related to hormonal imbalances from:

• PCOS
• Going on or off hormonal birth control or other hormone therapy
• Pregnancy
• Menopause
• Gender-affirming treatment

If you’re anticipating a hormonal shift and have a history of acne, ask a healthcare provider, such as a dermatology specialist, what you can do to head off an outbreak.

Beard acne can also occur along the jawline if you grow hair there.

Back-of-Neck Acne

If you have something that looks like acne or razor bumps on the back of your neck, it could be acne keloidalis nuchae (AKN). The bumps sometimes spread up onto the scalp, as well. Other symptoms include:

• Scarring
• Patchy hair due to scarring
• Infection

This common skin condition tends to get worse over time. It's most common in Black males between puberty and about age 25. It can be caused by:

• Frequently shaving the area
• Wearing a helmet or similar headwear
• Laser hair removal

If you notice a breakout on the back of your neck, you should see a dermatologist for treatment, which include:

• Prescription medication
• Medicated shampoo
• Corticosteroid creams

If it's a more advanced case and all noninvasive therapies fail, excision and skin grafting may be done.

Armpit Acne/Bumps

The skin in your armpits is especially sensitive. If you have an armpit breakout, you have a few possible causes to consider.

Because you have sweat glands there, armpits are one of the sweatiest areas of your body. That alone can lead to acne and skin irritation.

The area is also especially prone to contact dermatitis. This could be from antiperspirant or deodorant, which go directly onto the armpit skin, or irritating laundry products. While your clothing touches you all over, those chemicals may only cause problems in sensitive areas like this.

If you shave under your arms, you may develop razor burn or ingrown hairs. These aren’t acne, but they can look like it.

Warm and moist areas like armpits are also prone to yeast and other fungal infections.

Hidradenitis suppurativa (HS), also called acne inversa, is a skin condition involving painful lumps that are deep in your skin. They’re most common in areas where skin rubs against skin, such as your armpits and inner thighs.

HS is often mistaken for acne because the pumps can look like pimples. Without proper treatment, though, it can lead to abscesses (pockets of pus) that can break open, leak, and leave scars. 

If you think you may have HS, it’s important to see a healthcare provider. They may refer you to a dermatologist for proper diagnosis and treatment.

Swimsuit Areas

If you have a breakout after swimming or sitting in a hot tub in the area where your skin was in contact with a swimsuit, you may have folliculitis. 

This skin infection can occur between about 12 and 48 hours after your soak. It’s caused by bacteria that thrive in warm, wet places, and especially in hot tubs made of wood.

A folliculitis rash is:

• Itchy
• Bumpy
• Red

The bumps may turn darker and fill with pus. You may feel sick and have a fever and/or swollen lymph nodes.

Treatment for Different Types of Breakouts

Common acne treatments include:

• Topical retinoid medications to unclog pores
• A benzoyl peroxide or salicylic acid wash to kill acne-causing bacteria
• Prescription acne treatments

If you don’t see results after six to eight weeks of treatment, see a dermatologist.

Other treatments may be available depending on the type or cause of your breakouts.

Acne Cosmetica, Beard, or Facial Acne

Proper skin care is important for treating breakouts and preventing future ones. 

For acne cosmetica, beard acne, or other types of acne on your face, you may want to:

• Look for products that are labeled oil-free or non-comedogenic (won’t clog pores).
• Apply makeup and skin-care products gently so you don’t irritate your skin.
• Clean makeup brushes once a week.
• Don’t share brushes with anyone.
• Don’t wear makeup to bed.
• Wash your face twice a day with a mild cleanser.
• Cleanse after sweaty activities.
• Don’t scrub your skin, which can make acne worse. Use a gentle touch.
• Include your beard area in your cleansing routine.

For acne caused by a product used on your skin, hair, or clothes, the best treatment is eliminating the product and finding a replacement that doesn’t break you out.

Dietary improvements may help, too. Experts recommend limiting:

• Sugar and high glycemic index foods
• Milk and other dairy products
• Saturated fat
• Sugary breakfast cereals
• Fast food

They recommend increasing:

• Water
• Omega-3 fatty acids (through diet or supplements)
• Omega-6 fatty acids (through diet or supplements)
• Zinc (through diet or supplements)
• Fruit
• Vegetables

If you have trouble making dietary changes, talk to your healthcare provider. They may be able to provide guidance or refer you to a nutritionist.

Your skin (and the rest of you) may benefit from certain lifestyle changes. These include:

• Not smoking
• Getting better sleep
• Reducing stress or learning new coping mechanisms
• Keeping your hands off of your face
• Not picking at your skin or blemishes

Medication- or Illness-Caused Acne

If you’re taking a medication that causes acne, talk to your healthcare provider about options. You may be able to switch to a different medication, or you may need to stay on the drug but add acne treatments to your regimen.

For acne caused by an underlying illness, you must get a proper diagnosis and treatment. You may need to treat the acne, as well.

Summary

Acne is the result of pores being clogged by excess oil, dirt, and bacteria. It can be caused by many things, including skin-care products, picking, hormones, stress, medical issues, smoking, diet, and more. Some areas of your body are prone to certain types of acne, as well.

Other types of breakouts may look similar to acne but have different causes and require different treatments. You may need a healthcare provider to determine why you’re breaking out and what to do about it.

Acne treatments include special washes, using the right cleansing techniques, finding products that don’t break you out, dietary and lifestyle changes, and treatment for any underlying illnesses.