The Four Main Causes of Acne

One of the most popular questions we receive on the topic of acne is "what causes it?" The question makes sense. If you understand the cause of something you can more effectively address it. But in the case of acne, there often isn't just one cause. There often aren't even just two. Rather, there are four main causes of acne and the degree to which these factors plays a role differs from person to person. (Now you understand why treating acne can be such a challenge.)

Regardless of an individual's age, one or more of the following factors play a role in your acne:

Follicular Keratinization

Those with acne tend to have skin cells that are abnormally “sticky” and, thus, the process of shedding dead skin cells is compromised. Instead of falling away, these dead cells have a tendency to clump together, blocking pores and causing a backup of sebum (oil) in the follicle.

Excess Sebum Production

Acne is often associated with enlarged sebaceous glands that produce higher quantities of sebum than is normal.

Prevalence of Acne Bacteria

Cutibacterium Acnes (C. acnes) is the bacteria responsible for acne. While it is present on the skin of nearly all healthy adults, that of some individuals is more hospitable to its presence.


Within the skin of all individuals, free radical damage causes a release of inflammatory chemicals, which are intended to repair this damage. In some individuals, however, the inflammation response is overly vigorous. This creates a scenario whereby the skin environment is modified, making it perfectly suited for the colonization of C. acnes. What’s more, when inflammatory processes intensify, the follicular wall can rupture and leak sebum, keratin, bacteria, and cellular debris into the dermis. These substances are recognized as foreign invaders to the dermis and, thus, in an attempt to offset the potential for damage, inflammation at this deeper layer occurs. This deeper inflammation leads to the development of nodulocystic acne lesions.

Those that suffer from chronic acne are shown to have more diminished levels of antioxidants, such as vitamin A and vitamin E, than is normal. Because antioxidants act like soldiers that fight free-radical damage, it is clear that a diminished antioxidant count and increased inflammation response go hand-in-hand.

To address the four main causes of acne, several steps should be taken:

1. Utilize skincare products that address all four of the main causes of acne. This is vital to minimizing the potential for future acne breakouts after you get acne symptoms under control.

2. While diet is not a direct cause of acne, certain dietary choices can lead to development of one of the four main causes of acne. Therefore, it is advised that consumption of high-glycemic foods like dairy products, white flour, soda and sugary snacks be reduced and replaced with fruits, vegetables and other foods rich in antioxidants.

3. Ensure skin inflammation is minimized. This includes limiting sun exposure, the use of irritating topical products, exposure to cigarette smoke and pollution, and more.

4. Again, while not a direct cause, studies have shown that stress can activate the direct causes of acne. Therefore, take care to get enough sleep, exercise and enjoy practices like yoga and meditation that calm the mind and body.