Why do I suddenly have acne?

What changed before the breakout?

• Hormones: Breakouts can accompany puberty, periods, pregnancy, the transition to menopause or menopause itself. Starting or stopping birth control pills can also trigger acne.
• Stress: Stress can worsen acne. Stress hormones stimulate oil glands and hair follicles, which helps explain flare ups during stressful stretches.
• Products: Review new moisturizers, sunscreen, makeup and hair products, particularly oily or greasy products. Hair care belongs in the product check too, despite being filed in a different department of the bathroom.
• Medicines and supplements: Corticosteroids, testosterone, some contraceptives, lithium and vitamins B6 or B12 can cause or aggravate acne. Keep taking prescribed medicine and ask the prescriber whether acne is a possible side effect.
• Pressure and humidity: Tight headgear, chin straps and high humidity can worsen acne. For body acne, choose loose, breathable clothing, especially during exercise or sweating.

Look for labels such as "noncomedogenic," meaning formulated not to clog pores, or "oil free"; these are more useful than a bottle promising a new personality. Products with these labels are less likely to cause acne. A family history of acne also increases susceptibility, even without an obvious new trigger.16

Could food be responsible?

Some studies link acne with skim milk, whey protein and diets high in sugar. Diet is difficult to study, and changing food does not always help. Chocolate and greasy foods are often blamed, but there is little evidence that food has much effect on acne in most people. A breakout alone is not a reason to cut out whole food groups.356

What should I do now?

1. 1Review recent product, medicine and hormonal changes. Discuss a suspected medicine trigger with its prescriber rather than stopping it yourself.
2. 2Wash with a gentle cleanser twice a day and remove makeup at the end of the day. Stop scrubbing, and do not pick or squeeze spots because this can cause scars.
3. 3For mild acne, choose one acne treatment and follow its instructions. Salicylic acid suits blackheads and whiteheads; benzoyl peroxide is especially useful for small pimples. Start benzoyl peroxide at 2.5% to reduce irritation.
4. 4Apply a thin layer of acne medication across the acne prone area, not just visible spots. Use the treatment consistently for 6 to 8 weeks before adding another product.

When treatment works, fewer breakouts usually appear within 4 to 8 weeks; clearing can take about 16 weeks. If you are pregnant or trying to become pregnant, consult a dermatologist before treating acne yourself because some treatments available without a prescription are unsafe during pregnancy.7

When should I see a doctor?

Arrange an assessment for a sudden, severe outbreak, especially in adulthood; a clinician can check for an underlying condition. Get help for deep painful lumps, scarring, persistent dark marks, or acne that is not improving after a few months. Seek medical care for hot, swollen, red skin suggesting infection, or if acne affects your mental health.267