Cedars-Sinai Blog
Why Am I Breaking Out?
Acne is a fact of life for many of us, with glaring pimples seemingly erupting at the exact moments you want to look your best. Whether at a birthday party, your graduation or wedding, a breakout can be embarrassing and put a damper on the day.
When skin doesn’t clear up for weeks or months, especially into adulthood after most people think acne should resolve on its own, the frustration can grow. As many as 88% of acne patients feel self-conscious. Also widespread are anxiety, depression and low self-esteem.
“People wonder, ‘What’s wrong with me?’” said Narat Eungdamrong, MD, a Cedars-Sinai dermatologist. “But it’s actually not uncommon into your 30s, 40s or even 50s.”
Dermatologists encourage you not to despair, no matter how stubborn your acne. The skin condition is treatable, and you deserve to be at peace with your reflection in the mirror.
Narat J. Eungdamrong, MD
Underneath the Skin
Acne begins at the skin’s pores, the hair follicle-containing pockets that allow an oily substance known as sebum to flow from the sebaceous glands underneath to moisten the skin. These pores are most dense within the “T-zone,” a facial area across the forehead, nose and chin, as well as cheeks.
Blemishes occur when dead skin cells collect and combine with sebum and bacteria to block them.
“There’s a bottleneck effect, where all of that creates a micro-comedone, or essentially a plugged ball,” said Stephanie Chapman, MD, another Cedars-Sinai dermatologist.
The congestion causes:
1. Whiteheads and blackheads
This involves dead skin oxidizing in the air (the same chemical process as rusting) and turning dark brown or black, creating “blackheads.” These bumps can also be white or skin-toned.
Comedonal acne often appears during adolescence, Eungdamrong said. Youthful skin is oily, which can trigger many whiteheads or blackheads on the face, chest and back.
2. Pimples
Bacteria infiltrates and breeds more rapidly in clogged, damp pores. The immune system reacts with inflammation that shows up as a swollen pimple. In some cases, the pimple can fill up with pus (called a pustule).
“P. acnes” come from follicular bacteria. Other cases stem from germs hiding inside everyday skincare products, make-up or applicators (such as dirty brushes or sponges).
“Anything that has bacteria can potentially cause inflammatory acne,” Eungdamrong cautioned.
“People wonder, ‘What’s wrong with me?’ But it’s actually not uncommon into your 30s, 40s or even 50s."
Hormone changes, such as those during puberty, menstruation, pregnancy or menopause, are another major driver. Androgen hormones activate oil glands, spurring sebum production and inflaming the surrounding follicles and pores.
This link means that women in their late 20s or early 30 are prone to flare-ups, as are those on certain types of hormonal contraception or who have a hormonal condition such as polycystic ovarian syndrome.
A breakout can be bewildering if you made it through your teen years unscathed, only to suddenly develop blemishes decades later.
3. Cysts and nodules
Cystic acne is the most severe form, according to dermatologists. These red, sensitive cysts are typically much bigger and deeper than shallow pimples. After swelling, they rupture and frequently scar.
The American Academy of Dermatology suggests you may be vulnerable if a parent or close relative also had cystic acne.
Still, dermatology breakthroughs mean professional treatment can permanently clear skin in around 60% to 70% of patients, Eungdamrong said.
Caring for Your Skin
Prolonged stress, sweat and restrictive clothing or sports gear (such as helmets) also can exacerbate breakouts.
A simple way to get to the root of the problem: Keep your skin clear.
Cedars-Sinai dermatologists suggest washing your face with a gentle skin cleanser twice a day and after any time you exercise or work up a sweat.
At the same time, don’t skip moisturizer. While excessive oil aids acne, so can dryness (and over-use of cleansers, toners and exfoliants). Just be sure to use a light, water-based moisturizer: Chapman added that too many thick creams and serums can further clog pores.
With cosmetics, tinted moisturizer or powder is also healthier for your skin than full coverage. Make-up tools should be cleaned with a mild detergent every seven to 10 days, the American Academy of Dermatology urges.
To avoid permanent damage, never squeeze or drain any blemishes on your own, and don’t cover them with an unmedicated bandage. Instead, dermatologists recommend over-the-counter treatments containing benzoyl peroxide, salicylic acid or sulfur soap.
Stephanie A. Chapman, MD
Consistency Is Crucial
Skincare regimens vary and should be closely followed for the best results.
“I love when people tell me the skin treatments they’re using, but the next question always has to be, ‘How are you using it?’” Chapman said. “Because there are so many misconceptions.”
Topical treatments should be used across your face and skin, not just on spots; spot treatments are only for blemishes. Acne also does not heal overnight. It can take up to eight weeks to improve.
If you are closely following a skincare routine, and still having acne flare-ups—or if your efforts are irritating or inflaming your skin—seek out a dermatologist for a full evaluation. Eungdamrong added that intervention is useful even earlier if your skin is scarring or darkening in patches. That condition, known as hyperpigmentation, is more prevalent among people who have skin higher in melanin pigment, including many who are Black, Asian or Latino.
Depending on an evaluation of your skin and medical history, and the likely cause of acne, dermatologists can prescribe individualized treatment. This typically includes a combination of:
- Topical retinoids (tretinoin, adapalene), vitamin A-based compounds used nightly that chemically exfoliate the skin, empty clogged pores and purge sebum
- Topical and oral antibiotics (doxycycline, minocycline)
- Hormonal treatments (oral contraceptives and spironolactone, an anti-androgen blood pressure medication for female patients)
- Accutane, a strong dose of vitamin A used to completely overhaul skin and follicular structure in persistent cystic acne
“Treatment can transform mood, confidence and basically everything about how someone may carry themselves,” Chapman emphasized.
Read: How to Protect Your Skin
