Why is My Acne Getting Worse?
If you feel like your acne is getting worse instead of better, you're not alone. Many people find themselves dealing with unexpected acne breakouts, even as adults. Acne can be frustrating, painful, and seem impossible to control.
- Your Skincare Routine Needs Adjustment
- You're Not Treating All Types of Acne
- You're Not Being Consistent
- You're Not Addressing the Root Cause
- You Have Undiagnosed Acne Types
- You're Not Adjusting to Seasonal Changes
- You're Not Managing Stress Properly
- You Have a Hormonal Imbalance
- You Have An Underlying Health Condition
- You're Not Changing Pillowcases Frequently Enough
- You're Using Impure Skin/Haircare Products
- You're Not Exfoliating Enough
- You're Touching Your Face Too Much
- You're Not Changing Your Diet
- You Have An Underlying Allergy or Sensitivity
- You're Not Drinking Enough Water
- You're Not Managing PCOS or Endometriosis
- You're Not Addressing Your Mental Health
- Key Takeaways
Frequently Asked Questions About Worsening Acne
- What are the most common reasons acne gets worse in adults?
- My acne was clear but now I'm breaking out again. Why?
- I never had acne before. Why am I suddenly breaking out now?
- Why do my breakouts keep getting cystic and more inflamed?
- What changes should I make to my skincare routine when acne worsens?
- What lifestyle changes can help get worsening acne under control?
- When should I see a dermatologist for my acne?
- What prescription medications and treatments can clear up worsening acne?
- Are there any supplements that can help get acne under control?
- How can I tell if a skincare product is likely to clog pores and cause acne?
- Does hormonal birth control help with acne? How?
But don't lose hope. With some detective work, you can get to the bottom of what's causing your acne to flare up. Here's a guide to understanding the possible reasons why your acne seems to be getting worse and what you can do about it.
Your Skincare Routine Needs Adjustment
One of the most common reasons acne gets worse is using the wrong skincare products or routine. If you've recently changed your skincare, that could be the culprit. Here are some things that can make acne worse:
- Using a product that's too harsh - Overly drying cleansers, toners with alcohol, and strong exfoliants can strip and irritate your skin, triggering more oil production and breakouts.
- Not moisturizing enough - Many acne treatments are drying. Not replenishing moisture can make your skin oily and acne-prone.
- Using pore-clogging ingredients - Watch out for thick creams, oils, and silicones that can clog pores. Non-comedogenic or oil-free products are better options.
- Over-exfoliating - Excess scrubbing and use of chemical exfoliants can cause inflammation and irritation.
The fix? Assess your current routine. Dial back on harsh products. Focus on gentle cleansing, oil-free hydration, and occasional chemical exfoliation if needed. Don't try to do too much at once. A basic, non-irritating routine is best.
You're Not Treating All Types of Acne
There are different types of acne, like whiteheads, blackheads, papules, pustules, nodules, and cysts. Many acne treatments only target one type.
For example, if you're using a topical antibiotic gel meant for inflammatory pimples, it may not help clear non-inflammatory blackheads and whiteheads. Or if you're using a BHA exfoliant for whiteheads, it may not improve painful cysts.
Look closely at your breakouts. Then select treatments that work on all types of acne you have:
- Blackheads/whiteheads - BHA exfoliants, retinoids
- Papules/pustules - Benzoyl peroxide, topical antibiotics
- Cystic acne - Oral antibiotics, birth control pills, isotretinoin
Using products that target your specific acne types makes a big difference. A combined approach works best for clearing all acne.
You're Not Being Consistent
Acne treatments take time to work. They also require diligent, daily use. It usually takes 4-6 weeks to see improvement, and 12 weeks for full clearing.
If you're sporadic with your routine, like skipping days or weeks, your acne will likely get worse again. Acne thrives on inconsistency!
Be patient and stick to your treatments daily. Don't give up too soon. Set phone reminders if needed. The key is persistence and consistency for the long haul.
You're Not Addressing the Root Cause
Sometimes acne is a surface symptom of a deeper internal cause. Common internal acne triggers include:
- Hormonal fluctuations - In women, acne can flare before periods due to hormonal changes. Puberty, pregnancy, and perimenopause can also trigger breakouts.
- High stress levels - Stress hormones like cortisol increase sebum production, leading to more clogged pores and acne.
- Blood sugar imbalances - A poor diet high in refined carbs can cause blood sugar spikes, which drive up oil production and inflammation.
- Gut health issues - Imbalances in gut bacteria and inflammation in the gut may manifest as skin inflammation.
- Medications - Some medications like steroids and lithium are acne-inducing.
If your acne seems resistant to topicals, look within. Treating the internal root cause along with acne treatments leads to better success. Lifestyle changes, dietary modifications, hormones, supplements, or medications may help.
You Have Undiagnosed Acne Types
There are various types and sub-types of acne that require specific treatments:
- Hormonal acne - Flares monthly around the chin, jawline, and neck in adult women. Managed with anti-androgens, birth control pills, or supplements.
- Fungal acne - Small uniform bumps often on the forehead, chest, and back. Cleared with antifungal treatments.
- Acne cosmetica - Caused by makeup, skincare products, and hair products. Avoid pore-cloggers.
- Acne mechanica - Breakouts along jawline or forehead from friction or pressure, like helmets, backpacks, tight collars. Requires gentleness to area.
- Steroid-induced acne - Caused by oral/topical steroids or hormone treatments. Needs dose adjustment and topical retinoids.
If standard acne treatments aren't working, see a dermatologist. Getting the right diagnosis leads to the right solution. Don't struggle - get help identifying your specific acne type.
You're Not Adjusting to Seasonal Changes
Acne can fluctuate with seasonal changes. Here's how to adjust your routine:
Summer - More sun exposure can dry skin, causing oil overproduction. Use lightweight oil-free hydrators like gels and serums.
Fall - Lower humidity can exacerbate dryness. Add hydrating serums and facial oils to retain moisture.
Winter - Dry indoor heat saps moisture, worsening flakiness. Use richer creams and sleeping masks to replenish hydration overnight.
Spring - More sunshine and sweat leads to clogged pores. Exfoliate gently 2-3 times a week to unclog pores.
Pay attention to what your skin needs seasonally, and adjust accordingly. Staying one step ahead of climate changes helps prevent acne breakouts.
You're Not Managing Stress Properly
Stress is one of the most common acne triggers. Unmanaged stress leads to elevated cortisol and inflammation, setting the stage for breakouts.
When you're stressed:
- Limit inflammatory foods - Sugar, refined carbs, and dairy trigger inflammatory pathways linked to acne.
- Hydrate - Dehydration stresses skin and slows cellular turnover. Drink plenty of water.
- Sleep - Lack of sleep ramps up cortisol. Get your beauty rest.
- Exercise - Working up a sweat helps reduce acne-causing stress hormones.
- Try relaxing practices - Yoga, meditation, journaling...find what works for you.
- Seek support - Talk to friends, family, therapist. Don't bottle up stress.
Learning stress management tools along with skincare makes a winning anti-acne combo.
You Have a Hormonal Imbalance
Hormonal fluctuations are a major cause of adult acne. Here are key hormones that influence breakouts:
- Androgens like testosterone increase sebum production and inflammation. Excess androgen is a key acne driver.
- Insulin surges from high sugar/carb intake trigger increased androgen output.
- Cortisol released during stress causes more oil production.
- Estrogen helps control acne by counterbalancing androgens. Low estrogen can trigger breakouts.
Getting to the bottom of any hormone imbalances is crucial for clear skin long-term. Blood tests, dietary changes, supplements, or medications may be needed to achieve hormonal balance. See an endocrinologist or women’s health specialist for testing and advice.
You Have An Underlying Health Condition
Sometimes acne is a sign of an internal health condition that needs medical attention. Acne can be a symptom of:
- Thyroid disorders - Both overactive (hyperthyroidism) and underactive thyroids (hypothyroidism) cause hormonal shifts that stimulate oil production and breakouts.
- Polycystic ovarian syndrome (PCOS) - Excess androgens overstimulate oil glands, exacerbating acne.
- High insulin and blood sugar - Increased insulin spikes oil secretion and inflammation. Prediabetes and diabetes are linked to acne.
- Gut issues - Food sensitivities, gut inflammation, SIBO, and Candida overgrowth are possible acne triggers.
Don't dismiss acne as just a skin problem. Talk to your doctor and get necessary blood work done to check for any medical conditions. Treating the underlying issue leads to lasting clear skin.
You're Not Changing Pillowcases Frequently Enough
Dirty pillowcases harboring oil, bacteria, dirt, and dead skin cells can transfer back to your skin nightly, clogging pores and causing acne breakouts. To prevent this:
- Wash pillowcases in hot water at least twice a week
- Use a fresh, clean towel over your pillow nightly
- Wash your face thoroughly before bed to remove oil and grime
It may seem trivial, but keeping pillowcases fresh helps minimize acne triggers from your sleep environment.
You're Using Impure Skin/Haircare Products
Many products contain hidden acne-triggers like pore-clogging oils, fragrances, and chemicals. Read labels carefully and avoid harsh or questionable ingredients. Seek non-comedogenic, non-irritating, fragrance/dye free options. Natural products are often better skin-friendly choices.
Ingredients to avoid:
- Silicones - Dimethicone, cyclomethicone
- Coconut oil and coconut-derived ingredients
- Heavy oils and butters - Mineral oil, lanolin
- Synthetic fragrances and dyes
Sticking to pure, non-irritating products prevents breakouts caused by product reactions. It pays off to scrutinize labels.
You're Not Exfoliating Enough
Dead skin cell buildup clogs pores, leading to more acne. But over-exfoliation can irritate and worsen breakouts too.
Find the right balance with gentle exfoliation 2-3 times per week. Use either:
- Manual exfoliants - Soft washcloths, muslin cloths, or gentle scrubs with soft natural beads like jojoba beads. Avoid harsh scrubs with plastic microbeads.
- Chemical exfoliants - AHAs like glycolic, lactic, mandelic acids. BHAs like salicylic acid. Start with lower percentages and slowly work up.
Gentle daily cleansing also helps remove pore-clogging dead cells. Just don't overdo it. Exfoliating done right keeps skin clear, not inflamed.
You're Touching Your Face Too Much
Hands transfer a lot of dirt and bacteria to the face throughout the day. Avoid unconsciously touching, resting on, or picking at your face, which spreads germs leading to breakouts.
Be mindful of keeping hands away from the face as much as possible. Stop face leaning and picking. Wash hands frequently with antibacterial soap. Keep hands busy with activities like fidget spinners.
Make the effort to touch your face less. Your skin will thank you through reduced acne.
You're Not Changing Your Diet
What you eat shows on your skin. A poor diet high in refined carbs, sugars and unhealthy fats promotes inflammation, hormonal fluctuations and acne. For clearer skin, make dietary adjustments:
- Cut back refined carbs - Bread, cereals, pasta, sugar cause blood sugar spikes that drive up oil secretion and inflammation.
- Eat low glycemic index foods - Vegetables, legumes, nuts, seeds, lean proteins. These slow-burning carbs minimize blood sugar swings.
- Load up on antioxidants - Fruits and vegetables rich in vitamins A, C and E protect skin and control inflammation.
- Increase healthy fats - Salmon, avocados, olive oil, nuts contain omega-3s that reduce acne.
- Stay hydrated - Drink 8-10 glasses of water daily for health and acne prevention.
A healthy anti-inflammatory diet high in skin-loving antioxidants and omega-3s creates the ideal environment for clear, acne-free skin from within.
You Have An Underlying Allergy or Sensitivity
Food sensitivities as well as topical allergies can trigger acne. Common culprits include:
- Dairy - The whey and hormones in milk products stimulate oil glands.
- Gluten - Found in wheat, barley and rye, gluten can cause inflammation and gut issues leading to acne.
- Fragrances - Synthetic perfumes and scented products irritate skin.
- Sunscreen chemicals - Ingredients like oxybenzone and avobenzone cause reactions in some.
Keep a food and product journal. Note any connections between specific foods/products and breakouts. Identifying and avoiding personal acne triggers is key.
You're Not Drinking Enough Water
Water has amazing benefits for skin and acne:
- Flushes out toxins - Carries away bacteria, oil and cellular debris from pores.
- Hydrates skin - Plumps up skin, reduces dryness and flakiness.
- Calms inflammation - Douses inflammatory fires aggravated by dehydration.
Aim for 8-10 glasses of water daily minimum. Cut out dehydrating caffeine and alcohol. Infuse water with lemon, cucumber or mint for a hydrating boost. Proper water intake prevents acne caused by cellular waste buildup and inflammation.
You're Not Managing PCOS or Endometriosis
Women with PCOS or endometriosis often struggle with hormonal acne. The excess androgens and inflammation drives breakouts.
See a gynecologist for proper testing and treatment. Lifestyle adjustments, medication, supplements, or hormonal birth control may be recommended to balance hormones and keep acne in check.
Left untreated, these conditions cause continuous acne issues. Don't ignore painful cystic acne - get to the underlying hormonal imbalance.
You're Not Addressing Your Mental Health
Mental health influences acne in many ways:
- Higher stress - Elevated cortisol increases oil production.
- More inflammation - Mental health conditions like anxiety and depression ramp up inflammatory chemicals called cytokines that aggravate acne.
- Poorer self-care v- Low motivation leads to skipping skincare, unhealthy diet, lack of exercise.
- Increased picking - Skin picking and hair pulling (trichotillomania) make acne worse.
See a therapist and treat any mental health issues simultaneously with acne. Your skin will benefit hugely from a mind-body approach. Don't ignore the mind-skin connection.
- Assess your current skincare routine - improper products or methods can worsen acne.
- Make sure you're treating all types of acne present - combine targeted ingredients.
- Be persistent and consistent with treatments - acne needs diligent daily care.
- Look for any underlying causes like hormones, lifestyle factors, health conditions.
- Make any needed seasonal adjustments to your regimen.
- Manage stress levels and mental health for clear skin.
- Change diet, sleep and other lifestyle habits fuelling acne.
- See a dermatologist or doctor to diagnose the specific cause.
With some trial and error, you can uncover the reasons behind your worsening acne. Personalized adjustments and professional help as needed can get breakouts under control for good. Don't give up - solving the acne puzzle is worth it.
Frequently Asked Questions About Worsening Acne
What are the most common reasons acne gets worse in adults?
The leading causes of acne worsening in adults include:
- Using the wrong skincare products or routine that irritate skin
- Inconsistent use of acne treatments
- An underlying health condition like PCOS or gut inflammation
- Hormonal fluctuations related to stress, menstrual cycles, or medications
- Poor diet high in refined carbs/sugar that spike insulin and inflammation
- External factors like change of seasons, not washing pillowcases
My acne was clear but now I'm breaking out again. Why?
There are a few possible reasons your clear skin has once again become acne-prone:
- You stopped using your acne treatments. Acne needs consistent, long-term care.
- Your menstrual cycle, higher stress, or other hormonal shifts triggered breakouts.
- You're taking a new medication that's causing acne.
- You've started using a new skincare or haircare product that's clogging pores.
- You've slacked off on a healthy diet and lifestyle habits that were keeping acne away.
Restart your full acne regimen, make any needed adjustments to diet, fitness or stress management, and see your doctor if you suspect a hormonal or medication-related cause.
I never had acne before. Why am I suddenly breaking out now?
Some potential reasons for new onset adult acne include:
- Hormonal changes - Perimenopause, stopping birth control pills, pregnancy, and other hormonal fluxuations can initiate breakouts.
- New medications - Steroids, lithium, DHEA, etc can trigger acne flares.
- Stress - Increased inflammation from high stress leads to clogged pores.
- Dietary changes - A diet higher in sugars, unhealthy fats or dairy may cause new acne.
- Underlying health condition - Thyroid disorders, PCOS, SIBO and other conditions spur acne.
- Inherited predisposition - Genetics that were dormant can surface later in life.
See your doctor to determine the cause. Blood tests, medication adjustment, supplements, dietary changes or a good skincare regimen can get new acne under control.
Why do my breakouts keep getting cystic and more inflamed?
Worsening inflammatory acne marked by painful cysts, nodules and lesions indicates that some internal factors need attention:
- Hormonal imbalance - Excess androgens, estrogen deficiency, insulin resistance fueling inflammation.
- High glycemic diet - Sugary, high-carb foods feed acne-causing inflammation.
- Stress, low sleep - Increased inflammatory chemicals aggravate cystic acne.
- Genetic tendency - Family history of severe acne makes you more predisposed.
Seek medical help to balance hormones, lower inflammation internally and externally, and better manage stress. Severe inflammatory acne usually needs prescription systemic or oral medication. Don't hesitate to see a dermatologist.
What changes should I make to my skincare routine when acne worsens?
Adjust your skincare routine by:
- Going back to basics with a gentle cleanser, acne treatment, non-clogging moisturizer. Don't overcomplicate your routine.
- Stop using any products that seem to irritate or dry your skin. Stick to non-comedogenic hydrating formulas.
- Applying your acne treatment to the whole area, not just active breakouts. This prevents new acne from forming.
- Using acne treatments consistently and exactly as directed. Don't skip days.
- Exfoliating 2-3 times a week with a gentle scrub or chemical exfoliant if your acne is largely clogged pores.
- Seeing a derm if OTC treatments aren't working so you can get prescription-strength products.
What lifestyle changes can help get worsening acne under control?
Lifestyle tweaks to help clear acne include:
- Exercise - Working out lowers stress hormones like cortisol that trigger breakouts.
- Healthy diet - Cut sugar, refined carbs, dairy and eat more skin-clearing foods like antioxidant and omega-3 rich fruits, vegetables and fish.
- Stress relief - Try yoga, meditation, deep breathing, journaling. Seek counseling if needed.
- More sleep - Aim for 7-9 hours per night minimum to avoid acne caused by sleep deprivation.
- Supplements - Ask your doctor about supplements that reduce acne like zinc, vitamin A, D, E and probiotics.
- Changing pillowcases - Switch to fresh, clean pillowcases twice a week.
A holistic approach that combines acne skincare, internal wellness and lifestyle habits offers the most success at stopping worsening breakouts.
When should I see a dermatologist for my acne?
See a dermatologist if you have:
- Acne that keeps worsening or not improving with over-the-counter medications and home care
- Cystic, nodular or scarring acne
- Acne along with other symptoms like irregular periods, excess hair growth, thinning hair, dark patches on the skin. These may indicate PCOS or another underlying condition.
- Acne before or after stopping oral contraceptives or other hormonal treatments
- Acne mainly concentrated on chin, jawline and neck area, which indicates hormonal acne
- Acne after taking a new medication
A dermatologist can help identify the cause, create a tailored treatment plan for your acne type, and get severe or resistant acne under control.
What prescription medications and treatments can clear up worsening acne?
Prescription options include:
- Oral antibiotics - Help reduce inflammatory acne bacteria. Usually doxycycline or minocycline.
- Topical retinoids - Powerfully unblock pores and reduce oil like tretinoin, adapalene, tazarotene.
- Hormonal anti-androgens - Spironolactone, oral contraceptives reduce excess androgen hormones causing acne.
- Isotretinoin - Extremely effective oral retinoid for severe, cystic acne.
- Light and laser therapy - Help kill acne bacteria and reduce inflammation.
- Chemical peels - Glycolic, salicylic acid, and TCA peels exfoliate and destroy acne-causing bacteria. Can be combined with light therapy.
- Steroid injections - Directly injected into large cysts and nodules to decrease size and inflammation quickly.
Prescription therapies help resolve even the most stubborn, worsening acne when OTC options fail. See your dermatologist!
Are there any supplements that can help get acne under control?
Yes, the following supplements may improve acne:
- Zinc - Helps reduce oil production and inflammation. 30mg daily recommended.
- Omega-3s - Anti-inflammatory essential fatty acids from fish oil or algal sources. 2 grams daily.
- Vitamin A - Retinol and retinoic acid forms help unblock pores. Use only under doctor supervision at 10,000 IU daily max.
- Vitamin D - Immune regulating effects may reduce acne. 2,000-5,000 IU daily. Get levels tested.
- Vitamin E - Potent antioxidant action alleviates acne. 400 IU daily.
- Probiotics - Support gut health and immune functioning. Look for strains like Lactobacillus and Bifidobacterium.
Always consult your dermatologist before starting any new supplements, especially vitamin A. While promising, more research is still needed on acne supplements.
How can I tell if a skincare product is likely to clog pores and cause acne?
Avoid products containing:
- Oils - Coconut oil, mineral oil, lanolin, almond oil
- Silicones - Dimethicone, cyclomethicone, cyclopentasiloxane
- Thick creams and butters - Shea butter, cocoa butter
- Heavy waxes - Beeswax, cetyl alcohol
- Synthetic fragrances, dyes, alcohols
- Comedogenic ingredients like isopropyl myristate, isopropyl palmitate
Instead choose oil-free, non-comedogenic, fragrance/dye free options suitable for acne-prone skin. Check the label closely. When in doubt, avoid.
Does hormonal birth control help with acne? How?
Birth control pills that contain estrogen and progestin can improve acne by:
- Decreasing androgen hormone production that stimulates oil glands
- Increasing estrogen levels which counterbalance excess androgen effects
- Keeping hormone levels steady and avoiding fluctuations
- Reducing inflammation
Low estrogen contraceptives like progestin-only pills or Mirena IUD tend to worsen acne. Combined oral contraceptives usually help, but effects vary individually. Speak to your gynecologist.