Normal hormone changes at puberty. A change in hormones occurs just before puberty in boys and girls. This is quite normal and results in an increase of sebum from the grease glands. This is typical around the age of 11–14 years, but may be earlier in some people, as puberty is starting earlier in both boys and girls. Increasing levels of androgens, growth hormone and a factor called insulin growth factor-1 (IGF-1) may all affect acne. The oil produced by the grease glands acts as a ‘food’ to the Propionibacterium acnes (P. acnes) bacteria. More sebum leads to more P. acnes which in turn causes inflammation.

Heredity. Acne can run in families. If your parent, brother or sister has or had acne, you are more likely than average to have it yourself. Studies of twins have suggested that acne is genetic.

Smoking. Studies on the effects of smoking on acne have been contradictory, with the exception of those that have shown that adult females who smoke tend to get more severe problems with acne around the lower jaw line and an increased number of blocked pores.

Medications. Some drugs can cause acne. The best-known example is anabolic steroids taken by body-builders, but phenytoin (for epilepsy), vitamin B12 (for anaemia) and lithium (for mood swings) can also produce acne. Occasionally, chemicals in the workplace, such as industrial oils, are responsible. Some recent reports have suggested that some protein and whey shakes may contain ingredients that trigger or exacerbate acne.

Skin-lightening creams may contain strong steroids that can exacerbate acne and cause skin infections. ALWAYS consult your doctor before using these products!

Contraceptive pill. Combined oral contraceptives contain both oestrogen and a progestin. Oestrogen usually improves acne, whereas some progestins can make it worse. There are various types of progestin, some of which are better than others. Check the label on your pill packet: ‘gestodene’, ‘desogestrel’, ‘norgestimate’ and the pill containing ‘drospirenone’ (Yasmin) are better choices if you have acne. A medication called Dianette contains a progestin called cyproterone acetate. This is good at reducing hormones called androgens and is available for severe acne in the UK. It also acts as a contraceptive and is licensed for this use in some parts of Europe but not in the UK.

Polycystic ovary syndrome. If you are a woman and you have irregular and/or missed periods as well as an increase in hairiness and acne, you might have polycystic ovary syndrome. It is important to see your doctor if you suspect this diagnosis!

Make-up. Some make-ups are ‘comedogenic’ and make acne worse. Look for ‘anti-comedogenic’ products when selecting a make-up or treatment that you apply to the skin. If the product is comedogenic, it may cause acne that is made up of lots of blackheads and whiteheads all over the face. It is important for anyone with acne to select oil-free make-up. Foundations containing silicone are preferable, and matt powders can reduce a shiny skin texture.

Environment. Hot and humid environments at work can worsen acne. Moving to a hot humid country can make acne worse. For this reason, the armed forces are reluctant to enlist individuals who have moderate/severe acne in case they have to be posted to the tropics. Candidates with acne that may affect the ability to wear military clothing or to operate military equipment should normally be excluded or entry deferred until the disease is successfully treated. Candidates under treatment with isotretinoin may be graded fit eight weeks after completing treatment and after the side effects have settled.


First published on:
Reviewed and edited: Fiona Elliott
Last updated: December 2020

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