Breakouts are upsetting whether they’re big or small. But they’re not as mysterious as you might think. There are common causes for those annoying pimples.
“Heredity rules,” Dr. Neal Schultz, a dermatologist in New York City, tells Acne.com. “To get acne you need three things: oil, bacteria and clogging. Oil production and stickiness of dead cells that leads to clogging are both genetically determined.”
In addition to your genes, hormones are a main cause of those upsetting breakouts. “Hormones are the main culprit,” says Dr. Schultz. “Oil drives acne and hormones drive oil. Bacteria and clogging are the other culprits, but without oil production you can’t have acne.”
To tell if you have a hormonal issue, you can look at your breakout history. Does your acne get worse with stress or during your period? Do you break out along the jawline or upper neck? “These are indicative of hormonal acne,” he adds. “If we are still unsure, we can do a blood test to determine if that’s the cause.”
Because hormones are one of the main causes of acne, many people believe that birth control will make a difference. “Birth control pills will help acne if it’s the right combination of hormones and the doses are right,” notes Dr. Schultz. “But I only consider that approach if my patient also wants the benefits of contraception. Of the four different types of internal medicine this is my last one because birth control pills affect your whole system.” Other patients may want to try isotretinoin, but that should only be used when prescribed properly by a doctor.
But what about those classic blackheads and whiteheads that most of us get? “Blackheads and whiteheads are non-inflammatory acne and are strictly clogs of dead skin cells, sebum and bacteria,” says Dr. Schultz. “The reason a blackhead is black is because the clog is open to air, which oxidizes the melanin in the dead skin cells, turning it black. Whiteheads are closed. So there’s no oxidation.”
On the other end, there’s cystic acne, which is a form of inflamed acne. “The bacteria, which tends to live down by the oil gland, take the normal oil or triglycerides, and it splits triglycerides into free fatty acid,” adds Dr. Schultz. “Free fatty acids are very irritating to the skin. And just the way a splinter will often cause a puss bump, free fatty acids cause an accumulation of puss. Take that underneath the skin and you’ve got a cyst.”
This is super-important because the cause helps determine the treatment. “Now that we understand what’s going on with our acne, we can understand why certain treatment works,” says Dr. Schultz. “If you use exfoliants, that take dead cells, those can help dissolve the clog and allow the oil to flow helping to treat non-inflammatory acne like whiteheads and blackheads. For cysts, antibiotics are a better course of treatment because they treat the root of the problem.”