Acne Awareness Unveiled: Common Culprits Aggravating Acne and Hindering Treatment Success

Acne is a prevalent skin condition affecting millions of people worldwide. While June is recognized as Acne Awareness Month, the importance of understanding acne's contributing factors and the obstacles to effective treatment should be a year-round focus. In this article, we'll delve into the common factors that exacerbate acne symptoms and minimize treatment efficacy, empowering you with the knowledge to take control of your skin health.

Unmasking Acne: A Brief Overview

Acne vulgaris, commonly referred to as acne, is a chronic inflammatory skin condition characterized by comedones (blackheads and whiteheads), papules, pustules, nodules, and cysts (1). Acne typically affects areas with a high concentration of oil glands, such as the face, chest, and back. Various factors contribute to acne development, including increased sebum production, abnormal skin cell shedding, inflammation, and the proliferation of the bacteria Cutibacterium acnes (2).

Common Factors that Exacerbate Acne Symptoms

  1. Hormonal Fluctuations

Hormonal changes are a major driver of acne development, particularly during puberty, menstruation, and pregnancy (3). Androgens, such as testosterone, stimulate sebum production, leading to clogged pores and the formation of acne lesions. Hormonal imbalances, such as those seen in polycystic ovary syndrome (PCOS), can also contribute to acne symptoms (4).

  1. Diet

Emerging evidence suggests a link between diet and acne severity. High-glycemic index (GI) foods, such as sugary beverages, white bread, and pasta, can cause blood sugar and insulin levels to spike, triggering inflammation and sebum production (5). Additionally, dairy consumption, particularly skim milk, has been associated with an increased risk of acne (6).

  1. Stress

Stress can worsen acne symptoms by increasing sebum production and inflammation. The release of stress hormones, such as cortisol, can stimulate the production of sebum and exacerbate acne (7). Moreover, stress can impair the skin's barrier function, making it more susceptible to bacterial infection and inflammation (8).

  1. Inadequate Skincare Routine

An improper skincare routine can exacerbate acne symptoms. Over-cleansing or using harsh, abrasive products can strip the skin of its natural oils, leading to increased sebum production and irritation (9). Conversely, not cleansing the skin sufficiently can result in the buildup of dead skin cells, oil, and bacteria, contributing to acne development.

  1. Cosmetic and Hair Products

Some cosmetic and hair products contain ingredients that can clog pores and trigger acne breakouts. These ingredients, known as comedogenic, include isopropyl myristate, lanolin, and certain oils (10). Opt for non-comedogenic and oil-free products to minimize the risk of pore-clogging and acne exacerbation.

Factors that Minimize Acne Treatment Efficacy

  1. Inconsistency in Treatment

Consistency is crucial for the success of acne treatments. Skipping doses or not using the treatment as directed can prolong the time it takes to see improvement and reduce overall efficacy (11). It is important to adhere to your prescribed treatment regimen and be patient, as it may take several weeks to notice significant results.

  1. Irritating Skincare Products

Using skincare products that irritate the skin can hinder the effectiveness of acne treatments. Products containing harsh ingredients, such as alcohol, fragrances, or physical exfoliants, can cause skin irritation and compromise the skin's barrier function, reducing the efficacy of acne treatments (12).

  1. Overuse of Topical Treatments

Overusing topical acne treatments, such as benzoyl peroxide or salicylic acid, can lead to skin irritation, dryness, and redness, which may ultimately reduce the treatment's effectiveness (13). It is essential to follow the recommended usage instructions for topical acne treatments and consult with a dermatologist if you experience excessive skin irritation.

  1. Self-Treatment without Professional Guidance

Attempting to self-treat acne without seeking professional advice can hinder treatment success. Over-the-counter treatments may not be sufficient for moderate to severe acne, and improper use of acne medications can exacerbate symptoms or cause side effects (14). It is crucial to consult with a dermatologist to develop a personalized treatment plan tailored to your specific needs and skin type.

  1. Premature Discontinuation of Treatment

Discontinuing acne treatment before completing the recommended course can lead to a relapse of acne symptoms and reduce treatment efficacy. It is important to continue using your acne treatment even after your skin clears up, as this helps to maintain the results and prevent future breakouts (15).


Acne is a complex skin condition with numerous contributing factors and potential obstacles to effective treatment. By understanding the common factors that exacerbate acne symptoms and the elements that can minimize treatment efficacy, you can take proactive steps to manage your acne and achieve clearer, healthier skin.


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  2. Bhate, K., & Williams, H. C. (2013). Epidemiology of acne vulgaris. British Journal of Dermatology, 168(3), 474-485.

  3. Zouboulis, C. C. (2004). Acne and sebaceous gland function. Clinics in Dermatology, 22(5), 360-366.

  4. Azziz, R. (2003). Polycystic ovary syndrome, insulin resistance, and molecular defects of insulin signaling. The Journal of Clinical Endocrinology & Metabolism, 88(6), 2396-2398.

  5. Smith, R. N., Mann, N. J., Braue, A., Mäkeläinen, H., & Varigos, G. A. (2007). The effect of a high-protein, low glycemic–load diet versus a conventional, high glycemic–load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. Journal of the American Academy of Dermatology, 57(2), 247-256.

  6. Adebamowo, C. A., Spiegelman, D., Danby, F. W., Frazier, A. L., Willett, W. C., & Holmes, M. D. (2005). High school dietary dairy intake and teenage acne. Journal of the American Academy of Dermatology, 52(2), 207-214.

  7. Chiu, A., Chon, S. Y., & Kimball, A. B. (2003). The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Archives of Dermatology, 139(7), 897-900.

  8. Garg, A., Chren, M. M., Sands, L. P., Matsui, M. S., Marenus, K. D., Feingold, K. R., & Elias, P. M. (2001). Psychological stress perturbs epidermal permeability barrier homeostasis. Archives of Dermatology, 137(1), 53-59

  9. Draelos, Z. D. (2013). The effect of a daily facial cleanser for normal to oily skin on the skin barrier of subjects with acne. Cutis, 92(1), 48-54.

  10. Kligman, A. M. (1972). The comedogenicity of cosmetics. Journal of Investigative Dermatology, 59(3), 268-272.

  11. Thiboutot, D., & Zaenglein, A. (2007). Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris. UpToDate. Retrieved from

  12. Dreno, B., Fischer, T. C., Perosino, E., Poli, F., Viera, M. S., Rendon, M. I., ... & Bettoli, V. (2011). Expert opinion: efficacy of superficial chemical peels in active acne management—what can we learn from the literature today? Evidence-based recommendations. Journal of the European Academy of Dermatology and Venereology, 25(6), 695-704.

  13. Del Rosso, J. Q. (2008). What is the role of benzoyl peroxide cleansers in acne management? The Journal of Clinical and Aesthetic Dermatology, 1(4), 48-51.

  14. Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., ... & Keri, J. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945-973.

  15. Tan, J. K., & Tang, J. (2005). Maintenance therapy for acne vulgaris: the fine balance between efficacy, cutaneous tolerability, and adherence. Skin Therapy Letter, 10(4), 1-4.

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