Why Am I Breaking Out?
Causes of Facial or Whole-Body Breakouts From Acne and Similar-Looking Conditions
Medically reviewed by William Truswell, MD
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.
Phynart Studio / Getty Images
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)
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.
Related: Vitamins for Skin Health
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).
Chemicals in Your Clothes
If you’re breaking out all over or just in sensitive areas around your body, it could be due to your laundry detergent. The chemicals in detergent can cause irritated skin or even allergic reactions. This is called contact dermatitis.
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.
Related: Is Popping Pimples Bad?
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.
Learn More: Hormonal Acne: What You Should Know
Hormonal Acne
People who menstruate are especially likely to have acne breakouts:
Just before a menstrual period
During the first trimester of pregnancy
After menopause (when menstrual cycles have not occurred for 12 consecutive months)
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:
Hormonal contraception (injected, implanted, or “the pill”)
Testosterone
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:
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:
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.
The Chocolate Myth
Many people used to believe chocolate caused acne. Studies revealed that chocolate itself isn’t responsible for breakouts, but the ingredients (e.g., milk, sugar) often added to commercial chocolate are.
Learn More: Acne and Diet: A Decade of Research
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.
Learn More: How to Improve Your Sleep Habits
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:
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.
What Is AKN?
AKN is named for the appearance and location of the outbreak. It looks similar to acne and to keloid scars (a thick, raised scar). "Nuchae" is the medical term for the back of your neck.
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.
Learn More: Are You Allergic to Your Deodorant?
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.
Related: The 13 Best Acne Spot Treatments
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.
Learn More: The Best Treatments for Adult Acne
Read the original article on Verywell Health.