Why am I breaking out? A dermatologist reveals the many complicated reasons

I’m familiar with a lot of things about my body. For instance: Certain foods (especially of the processed variety) make me bloated. Not washing my hair for precisely three days makes it look really good. And approximately one zillion things I do can lead to a breakout.

So, yeah—you could say that when it comes to pimples, things can get really complicated. I’ve been dealing with them for roughly two decades, and it’s still hard to determine the underlying culprits behind my zits and how to get rid of them on the fly. After over three years as a beauty journalist, however, I’ve learned one thing for certain: Breakouts happen for so, so many reasons. And that’s exactly why acne affects upwards of 50 million people every year.

The main thing to know is that acne is an extremely complex thing—even dermatologists acknowledge that it’s a tough situation to deal with. That said, there are some very real reasons why you breakout, which are helpful to know about so that you can keep pimples at bay.

Why am I breaking out?

“There are four things that need to happen in order to breakout: follicular occlusion (a clogged pore), microbe overgrowth in the follicle (bad bacteria in your pores), sebum production (AKA oil), and inflammation,” explains Purvisha Patel, MD, a board-certified dermatologist and founder of Visha Skincare. Or, in layman’s terms: “Breakouts may be caused by a number of factors including but not limited to hormones, stress, excessive sweating, and even certain skin-care ingredients,” says dermatologist Marnie Nussbaum, MD.

And while the how of it is clear, the why of it remains cloudier. “Acne is ultimately determined by your genes, but several factors may make it worse. High levels of hormones can stimulate oil glands. This may occur during times of stress or around your menstrual cycle,” explains  says Joshua Zeichner, MD, a New York-based board-certified dermatologist. “Certain foods have also been shown to promote breakouts. Food with a high glycemic index or sugar load as well as cow’s milk have been shown to promote inflammation in the skin and lead to breakouts.”

So to sum it all up for you, acne can be caused by clogged pores, stress, hormones, your genetics, inflammatory foods, sweat, or some combination of all of these. And while these factors can all contribute to breakouts, day-to-day habits can as well. “Not washing your face—especially if you work out and sweat, or have makeup on, means the pores get clogged and breakouts happen,” says Dr. Nussbaum.

On the beauty product front, if you’re already excessively producing oil, your skin can break out if you’re using products that your skin (for whatever reason) doesn’t like. “Adding products to your face that can be occlusive or edible—like coconut oil, olive oil, fruits, and vegetables—can exacerbate the above process,” adds Dr. Nussbaum. “Getting rid of two of the four above factors can help to get rid of acne.”

Breakdown of acne-causing factors

Hormones:Hormonal acne is a breed of stubborn breakouts that stem from your hormones—but more specifically, when you’ve got changes in your cycle, during pregnancy or around that time of the month. “Hormonal changes in your cycle can also cause surges in sebum production, two weeks before there’s a progesterone surge,” explains Dr. Patel. “This can increase the deeper pimples that occur with follicular occlusion. Testosterone supplementation also increases oil production and can increase acne.” Then there’s stress, which can create an uptick in another breakout-causing hormone. “Stress causes excess cortisol,” says Dr. Nussbaum, who notes that this can create a hormonal imbalance that can bring on the zits.

Food: The foods that can lead to breakouts are all those that cause inflammation: sugar, wheat, and dairy, primarily. “Diets high in dairy and sugar make people prone to breakouts,” says Dr. Patel. “In terms of dairy, cows are given hormones to produce milk, and humans respond to these by releasing growth factors and increasing sebum production in the skin.” Anything that’s fried or extra greasy can also spike up inflammation.

Oil: Having too much oil on your face will block your pores, which leads to breakouts—and this excessive oil can come from your own pores (AKA sebum), the wrong types of facial oils (comedogenic ones can be problematic), or sweat. “Once the sweat and oil sits on top of the skin, the pores get clogged and produce inflammation,” says Dr. Nussbaum. “The excess oil also allows for growth of P. acnes, the bacteria which causes acne.”

How to actually fight those breakouts

Once you are faced with a breakout, though, there’s a whole brigade of treatment options that’ll get your skin back to radiance—and they range from beauty products you can use in your own bathroom to professional-grade treatments.

Kill the bacteria: Topically, it’s helpful to slather on antibacterial agents to kill the acne-causing bacteria. “Tea tree oil helps with breakouts because of its antiseptic properties,” says Dr. Patel. “Use an exfoliating cleanser such as Visha Skincare Purifying Cleanser ($30), which has tea tree oil and helps to decrease the oil production, and in turn decrease breakouts.” Other antibacterial ingredients to use are echinacea, ginger, honey, and lavender.

Exfoliate: One of the key methods of fighting breakouts also keeps it at bay if you do it on the reg: exfoliation. Dr. Patel says that you can use salicylic acid and glycolic acid to exfoliate the skin, decrease microbe growth, and shrink oil glands. “Salicylic acid is a beta-hydroxy acid that removes excess oil from the surface of the skin to keep the pores clear,” says Dr. Zeichner. So you can opt for something like Glyderm Solution 12 percent ($43), which has glycolic and salicylic acid in it to both treat and prevent. Or, if you’re more of a physical exfoliant kinda person, you can incorporate a facial scrub into your regimen to physically slough off dead skin cells and keep your pores clear. Just opt for more gentle exfoliants like jojoba beads or sugar as opposed to walnut scrubs, which can be damaging.

Professional-level acne treatments: There are a plethora of in-office treatments you can turn to if you’re dealing with pimples. “Certain chemical peels can be helpful,” says Dr. Patel. “Getting light glycolic acid peels can help with breakouts, as can acne-targeted facials that use lasers and blue light treatments which both zap pimple-causing microbes.”

Use retinol in your skin-care routine: Retinol’s a superstar skin-care ingredient for anti-aging and keeping your skin glowy in general—but it can also be helpful in treating breakouts. “The newest topical acne medication available from the dermatologist is Altreno lotion,” says Dr. Zeichner. “Tretinoin is a prescription-strength topical retinoid that prevents skin cells from sticking together and blocking the pores, and helps calm the inflammation of the skin. The downside is potential skin irritation. The specialized Altreno formulation was designed to deliver the proven effectiveness of tretinoin while minimizing irritation.“ If you’re not looking for a prescription-strength retinoid, you could always use a more gentle, over-the-counter retinol serum, which can help to do the same, with a slightly gentler formula.

Cleanse your face thoroughly: Not washing your face can lead to clogged pores, which leads to breakouts. “It’s important to cleanse the skin twice daily—upon waking up and prior to bedtime,” says Dr. Nussbaum. “Also, you should cleanse your face immediately after exercising or sweating to remove excess oil and dirt.” Double cleansing can also be good to totally ensure gunk-free skin.

Visit yourdermatologist: “If over-the-counter treatments are not helping your face after a few weeks, make sure to visit a board-certified dermatologist for a tailored prescription regimen,” says Dr. Zeichner. “Your dermatologist has prescription topical medications that can help when OTC products cannot.” There are also oral prescription options, such as Spironolactone—which works with your hormones to stop hormonal breakouts in their tracks (something I’ve personally been taking for almost a year with really great success). But regardless of what solution you’re trying, know that there are many, many things that cause acne and you’re far from alone in working to squelch it once and for all.

A common misconception in acne treatment is that you need to lay off the moisturizers—not true. Here’s the deal on using moisturizers on acne, straight from the pros. And this is why, if you’re using medicine for acne treatment, that’s totally fine—everyone’s skin is different.