Acne ABCs: When It Starts, Why It Happens, and What Actually Helps

Devesh Garole
Sep 15
5 min read

Acne isn’t about age, effort, or hygiene. It’s a biological condition that responds to understanding, not panic.

Acne is one of the most common skin conditions in the world – and also one of the most misunderstood. Despite its prevalence, the conversation around acne is often riddled with confusion, shame, and misinformation.

Many of us experience acne at some point. For some, it’s a short-lived rite of passage. For others, it lingers well into adulthood or appears suddenly in midlife. It affects all genders, all skin types, and all ethnicities – though it doesn’t always look or behave the same.

At Skin IQ, we believe clear skin starts with clarity of information. This guide is not a list of miracle products or harsh fixes. It’s an overview of acne’s real causes, how it evolves with age, and what thoughtful treatment actually looks like.

WHEN: When Does Acne Start – and Why Doesn’t It Always End?

Teens (12–18):

Most people associate acne with adolescence, and for good reason. Around puberty, hormonal changes – especially a surge in androgens – stimulate the skin’s oil glands. Sebum production increases. Pores become more prone to clogging. And if C. acnes bacteria is present, inflammation follows.

During this time, acne typically shows up on the forehead, nose, and chin (the "T-zone") and can range from mild congestion to inflamed pustules and cysts.

Early Adulthood (18–25):

For some, breakouts subside after high school. For others, they continue or even intensify. Triggers like college stress, sleep disruption, dietary changes, and cosmetic experimentation can keep the skin in a reactive state. Hormonal fluctuations are still settling, especially for those on or transitioning off birth control.

At this stage, acne may begin shifting from the T-zone toward the lower face and jawline, often showing signs of deeper, more painful cystic lesions.

Late 20s to Early 40s:

This is the phase where adult hormonal acne becomes more common, especially in women. Many experience new breakouts despite a consistent routine. This is often due to the complex interplay of:

Menstrual cycle fluctuations
Birth control adjustments
Pregnancy or postpartum hormone shifts
Work stress and cortisol dysregulation
Underlying PCOS or metabolic shifts

Adult acne tends to present as deep, persistent breakouts along the chin, jawline, and cheeks, and often leaves post-inflammatory marks behind.

After 40:

Though less common, acne after 40 is real – and often surprising. It may be triggered by perimenopause, certain medications, or simply chronic barrier disruption after years of overuse of active ingredients.

At this stage, acne frequently coexists with signs of aging like fine lines, pigmentation, and skin thinning – which means treatments need to be gentler but still targeted.

WHY: What Causes Acne to Begin – and What Keeps It Going?

Despite what marketing may suggest, acne isn’t random. It emerges when four physiological factors combine:

Increased oil (sebum) production
Abnormal skin cell turnover, leading to clogged pores
Overgrowth of acne-related bacteria (C. acnes)
Inflammation, triggered by the immune system’s response

Together, these create a feedback loop. Oil and dead cells clog a follicle, bacteria multiply in the trapped environment, and the body responds with inflammation – resulting in redness, swelling, tenderness, or pus.

But that’s not the whole picture. Acne is also influenced by:

Genetics – If one or both parents had acne, your likelihood increases.
Hormones – Especially androgens like testosterone and DHEA.
Diet – High-glycemic foods and dairy may influence hormonal responses in some individuals.
Cosmetics and hair products – Certain ingredients (like silicones, isopropyl myristate, or lanolin) are highly comedogenic.
Stress – Elevates cortisol and can exacerbate oil production.
Sleep – Impacts skin repair and hormonal balance.

The skin doesn’t break out to punish you. It breaks out because something, internally or externally, has disrupted its normal cycle.

TYPES: Not All Acne Is the Same

Understanding the type of acne you’re dealing with helps determine what treatments will work best.

Type of Acne	Description	Common Triggers
Comedonal Acne	Blackheads and whiteheads	Oil buildup, slow cell turnover
Inflammatory Acne	Red, swollen pimples	Bacterial activity + inflammation
Cystic Acne	Deep, painful nodules under the skin	Hormonal imbalance, genetics
Hormonal Acne	Recurring acne on jaw/chin, cycles with menstruation	Estrogen/progesterone shifts
Fungal Acne (technically folliculitis)	Small, uniform bumps, often itchy	Yeast overgrowth from heat or humidity

Each type has a different response to actives like salicylic acid, benzoyl peroxide, or retinoids. That’s why understanding the nature of your acne is more important than copying someone else’s skincare routine.

WHAT TO DO: A Framework That Actually Works

There is no one-size-fits-all acne solution. But there is a framework grounded in dermatology and clinical skincare:

1. Support the Barrier First

Many people over-treat acne. They dry it out, scrub at it, and flood it with harsh actives – only to end up with a damaged skin barrier and worse breakouts.

Begin with:

A gentle, non-foaming cleanser
A non-comedogenic, lightweight moisturizer
Daily SPF (yes, even on oily skin)

2. Introduce Proven Active Ingredients

Once your skin is stable, introduce targeted treatments. Start slow, build tolerance, and don’t mix everything at once.

Benzoyl Peroxide: Kills bacteria and reduces inflammation. Use in low concentrations to avoid irritation.
Salicylic Acid: Oil-soluble BHA that clears pores and reduces congestion.
Retinoids: Normalize skin cell turnover. Excellent for comedonal acne, post-acne marks, and prevention.
Azelaic Acid: Anti-inflammatory, antibacterial, and safe for sensitive skin or rosacea-prone clients.
Niacinamide: Helps regulate oil and reduce redness, and pairs well with almost anything.

3. Avoid Over-Exfoliating and Product Hopping

Acne-prone skin is already inflamed. Weekly exfoliation may help, but daily scrubs, chemical peels, or mixing five actives can backfire. Stick to a routine for at least 8-12 weeks before making changes.

4. Don’t Skip Sunscreen

Many acne treatments increase sensitivity to UV light. Daily sunscreen not only prevents dark spots and scars but helps reduce inflammation overall. Opt for oil-free, non-comedogenic formulas.

5. Consider Professional Guidance

For persistent, cystic, or scarring acne, in-clinic treatments may be necessary. Options like:

Prescription retinoids or antibiotics
Hormonal therapy (like spironolactone or birth control)
In-office chemical peels, LED therapy, or microneedling
Lifestyle adjustments and ingredient audits

Acne is not just a product problem. It often requires a plan, not a guess.

EMOTIONAL IMPACT: Acne Is More Than Skin Deep

Acne affects more than just appearance. It can impact confidence, relationships, work, and mental health. That’s why we always encourage our clients to be kind to themselves during flare-ups.

You’re not lazy. You’re not dirty. You’re not doing something wrong.

You're experiencing a skin condition with real physiological roots – and you’re not alone.

Final Thoughts

Acne is complex. It can feel unfair, confusing, and slow to resolve. But it's not untreatable. With the right approach – barrier support, targeted actives, consistency, and compassion – most acne can be managed effectively.

Whether you’re in your first breakout phase or dealing with adult flare-ups, you deserve care that looks beyond the surface and meets your skin where it is.

Patience matters. Clarity is possible.