Acne and Pimples: Causes, Types, and What Actually Works

You're not a teenager anymore, but your skin didn't get the memo. Or maybe you had perfect skin growing up and acne showed up in your 20s or 30s like an unwelcome surprise. Either way, if you're dealing with pimples, cysts, or persistent breakouts, you're far from alone.

Studies show more than 50% of women experience adult acne. And it's not just women - acne affects people of all ages, genders, and skin types. The good news? We understand acne way better than we used to, and the treatment options in 2025 actually work.

Let's talk about what's really happening with your skin and what you can do about it.

What It Feels Like

Acne isn't just one thing. Depending on the type and severity, it can feel different:

Mild acne (whiteheads/blackheads): Small bumps or clogged pores. Might be barely noticeable or just annoying. Not usually painful.

Inflammatory acne (papules/pustules): Red, raised bumps that might be tender to touch. The ones with white centers (pustules) are what most people call "pimples." These can be sore and definitely noticeable.

Cystic acne: Deep, painful lumps under the skin. These are the worst - they hurt, they're big, they take forever to heal, and they're way more likely to scar. If you've had one, you know.

Hormonal acne: Usually shows up on the lower face - jawline, chin, around the mouth. Tends to flare up around your menstrual cycle if you're female. Deep, stubborn, and frustrating as hell.

Beyond the physical sensation, acne can seriously mess with your confidence. It's visible, sometimes painful, and can feel like your skin is betraying you no matter what you do.

Common Causes

Acne happens when oil and dead skin cells clog your pores. But why does that happen? It's more complicated than just "dirty skin."

Hormonal Fluctuations

This is the big one, especially for adult acne. When your androgen hormones (like testosterone) increase, your sebaceous glands produce more oil. More oil = more clogged pores = more acne.

Common triggers:

• Menstrual cycle (the week before your period)
• Pregnancy
• Polycystic ovarian syndrome (PCOS)
• Starting or stopping birth control
• Menopause and perimenopause

About 50% of women in their 20s and 25% in their 40s deal with hormonal acne.

Genetics

If your parents had acne, you're more likely to have it too. Genetics influence how much oil your skin produces, how your immune system responds to bacteria, and how easily your pores get clogged.

Stress and Cortisol

Stress doesn't directly cause acne, but it makes it worse. When you're stressed, your body releases cortisol, which triggers oil production. High cortisol also increases inflammation, making existing acne more red and angry.

Diet and Lifestyle

The relationship is complicated and individual, but some patterns are clear:

• High-glycemic foods (white bread, sugar, processed carbs) can spike insulin and trigger breakouts
• Dairy, especially skim milk, seems to worsen acne for some people
• Lack of sleep disrupts hormones and increases inflammation
• Not changing pillowcases or touching your face transfers bacteria

Skincare Products

Ironically, products meant to help can make things worse. Heavy moisturizers, comedogenic oils, or over-using harsh treatments can all trigger breakouts.

Medications

Some medications can cause or worsen acne:

• Corticosteroids
• Testosterone or anabolic steroids
• Some birth control pills (though others help acne)
• Lithium

Types of Acne

Not all acne is created equal. Knowing what type you have helps with treatment.

Non-inflammatory (comedonal) acne:

• Blackheads: Open clogged pores (dark because of oxidation, not dirt)
• Whiteheads: Closed clogged pores

Inflammatory acne:

• Papules: Small red, raised bumps (no white head)
• Pustules: Red bumps with white/yellow pus centers
• Nodules: Large, painful lumps deep under the skin
• Cysts: Deep, pus-filled lumps (most severe type)

Location matters too:

• Face (especially T-zone): Often hormonal or related to product use
• Jawline/chin: Classic hormonal acne
• Back/chest ("bacne"): Often triggered by sweat, friction, or body products
• Hairline/forehead: May be from hair products

When to See a Doctor

See a dermatologist if:

• Over-the-counter treatments haven't worked after 12 weeks
• You have painful cystic acne (these need prescription treatment and are likely to scar)
• Your acne is widespread or severe
• It's affecting your mental health or self-esteem
• You suspect it's related to a medical condition like PCOS
• You're experiencing sudden adult-onset acne without clear cause
• You notice signs of scarring

Treatment and Management

The right treatment depends on the type and severity of your acne. Here's what actually works:

Over-the-Counter Options

Benzoyl peroxide (2.5-10%):

• Kills acne-causing bacteria
• Reduces oil production
• Available in cleansers, spot treatments, and leave-on gels
• Start with lower strength to avoid irritation
• Can bleach fabrics (watch your towels and pillowcases)

Salicylic acid (0.5-2%):

• Exfoliates inside pores to prevent clogs
• Good for blackheads and whiteheads
• Gentler than benzoyl peroxide
• Available in cleansers, toners, and treatments

Retinol (OTC retinoid):

• Increases cell turnover to prevent clogged pores
• Helps with acne and aging
• Start slow (few times a week) to build tolerance
• Makes skin sensitive to sun - wear SPF

Niacinamide:

• Reduces inflammation
• Regulates oil production
• Gentler option that works well with other treatments

Prescription Treatments

Topical retinoids (tretinoin, adapalene):

• Gold standard for acne prevention
• Tretinoin requires prescription and is highly effective
• Adapalene (Differin) is now OTC in lower strength
• Takes 12 weeks to see full results - stick with it

Topical antibiotics:

• Kill bacteria causing inflammation
• Usually combined with benzoyl peroxide to prevent resistance
• Clindamycin and erythromycin are common options

Oral antibiotics:

• For moderate to severe inflammatory acne
• Usually doxycycline or minocycline
• Temporary use (3-6 months) to get acne under control
• Must be paired with topical treatments

Spironolactone:

• Oral medication that blocks androgen hormones
• Highly effective for hormonal acne in women
• Can take 3-6 months to see full results
• Requires monitoring but generally safe for long-term use

Birth control pills:

• Certain types help regulate hormones that trigger acne
• Takes 3-4 months to see improvement
• Not right for everyone (discuss risks with your doctor)

Isotretinoin (Accutane):

• The nuclear option for severe, scarring, or treatment-resistant acne
• Only medication that attacks all causes of acne
• Highly effective but has significant side effects
• Requires close monitoring and pregnancy prevention
• Usually 4-6 month course

In-Office Procedures

For active acne:

• Steroid injections for painful cysts (shrinks them fast)
• Extraction of comedones by a professional
• Chemical peels
• Laser and light therapies

For acne scars:

• Microneedling
• Laser resurfacing
• PRP (platelet-rich plasma) treatments
• Fillers for deep scars

Prevention

Can you prevent acne? Not entirely if you're prone to it, but you can reduce frequency and severity.

Skincare basics:

• Cleanse twice daily with gentle, non-comedogenic cleanser
• Don't skip moisturizer even if you're oily (dehydrated skin overproduces oil)
• Always wear SPF (many acne treatments make skin sun-sensitive)
• Remove makeup before bed, every single night
• Change pillowcases weekly

Avoid triggers:

• Don't pick or squeeze (causes scarring and spreads bacteria)
• Keep hair products off your face
• Clean anything that touches your face regularly (phone, makeup brushes)
• Shower after sweating
• Be cautious with new products - introduce one at a time

Lifestyle factors:

• Manage stress through exercise, sleep, meditation, or therapy
• Consider dietary triggers (keep a food diary if suspicious)
• Get adequate sleep (7-9 hours)
• Stay hydrated

Be consistent: The biggest mistake people make is switching treatments every few weeks. Most acne treatments take 12 weeks to work. Give things time.

The Bottom Line

Acne is frustrating, but it's also very treatable. The key is understanding what type you have and using the right combination of treatments for you.

If OTC options aren't cutting it after 3 months, see a dermatologist. There's no reason to suffer through severe acne when prescription options can help - and the sooner you treat it, the less likely you are to develop scarring.

Be patient with the process. Be consistent with your routine. And remember that clear skin is possible, even if it takes some trial and error to get there.

References

1. Cleveland Clinic - Hormonal Acne: What Is It, Treatment, Causes & Prevention
2. NIH/NCBI - Hormonal Therapies for Acne: A Comprehensive Update for Dermatologists (2025)
3. WebMD - Cystic Acne: Definition, Causes, Treatment, and Prevention
4. Cosmopolitan - How to Treat Hormonal Acne in 2025, According to Dermatologists
5. Nebraska Medicine - Can You Prevent Cystic Acne?
6. Aurora Health Care - Hormonal Acne Symptoms & Treatment