Acne: Causes, Types & Triggers

Why Your Acne Won’t Go Away | Causes, Types & Triggers Explained

Acne is one of the most common—and at the same time most misunderstood—skin concerns. Why is it that some people manage to clear their breakouts quickly, while others struggle with acne for years? Hi, my name is Maria. I'm an esthetician and beauty expert at Metodica Med Spa. In this video, I’ll explain why acne can affect people not just in their teens, but also in their 20s, 30s, and even 40s. We’ll talk about how to recognize acne, what causes it, the different types and stages, what happens to your skin if you leave it untreated, and which triggers can cause new breakouts. If you’re ready to dive deep and start your journey toward clear, healthy skin—keep watching.

How do you know if what you have is acne?

Let’s start by identifying whether what you’re dealing with is actually acne. The key signs are comedones, inflammation, and oily skin. Comedones come in two types. Open comedones—also known as blackheads—usually appear on the nose and forehead. They form when pores get clogged with oil and dead skin cells, and the surface oxidizes, turning dark. Closed comedones are small white bumps under the skin with no visible opening—they can become inflamed over time.

Then come the inflammatory lesions. There are multiple types—take a look and see which ones you have. Papules are red bumps without pus. Pustules are pimples with a whitehead. Nodules and cysts are deeper, more painful forms of acne that are typical in severe cases. skin becomes oily, especially in the T-zone—the forehead, nose, and chin. After breakouts heal, you may be left with dark spots or scarring.

While acne typically appears on the face, it can also affect the back, chest, and shoulders. Even if you only have a few breakouts—on your cheeks or forehead, for example—and they come and go regularly, it still counts as acne.

What causes acne?

The biggest question is: why does acne happen? And more importantly—what's the cause in your specific case?

The most common background for acne is seborrhea. It’s an overproduction of sebum (oil) and changes in its composition. This happens in people with a genetic predisposition and typically shows up during three key life stages—infancy, adolescence, and adulthood between 40 and 60. Seborrhea is most active during hormonal shifts, especially when there's an imbalance between male and female hormones.

So what’s going on in your skin?

Sebaceous glands go into overdrive under the influence of androgens—male hormones. Testosterone in the skin converts into dihydrotestosterone (DHT), which increases gland size and oil production. In women, this may be tied to lower estrogen levels. Seborrhea can also result from adrenal disorders or hyperandrogenism. Some medications—like anabolic steroids or corticosteroids—can trigger it as well.

But hormones aren't the only cause. Acne is a multifactorial condition.

There’s also the psychological component—stress directly affects oil production. Stress causes a spike in biologically active substances, including cortisol, which ramps up oil production and inflammation.

Then there’s the immune factor. People with acne often have a different immune profile than those with healthy skin. Their skin and gut microbiomes may be off balance. That’s why probiotics are sometimes included in treatment. Acne-prone skin is often more reactive to irritation, and the immune system may overreact even to mild triggers.

There’s also a biochemical factor. Acne sufferers often have issues with lipid metabolism—their skin produces more sebum, more inflammatory mediators, and less linoleic acid, which helps maintain a strong skin barrier.

Anatomical factors also matter. Everyone’s sebaceous glands empty into hair follicles. If those ducts are especially long or narrow, it can make it harder for sebum to flow freely—leading to clogs and inflammation.

Finally, the microbiological factor. Everyone has Cutibacterium acnes on their skin. In healthy skin, these bacteria don’t cause problems. But in oily, congested skin, they thrive. They increase inflammation, disrupt skin cell turnover, and create a biofilm that damages the skin barrier and slows down the healing.

Types of Acne

Let’s go over the main types of acne. The mildest form is comedonal acne—just blackheads and whiteheads, no inflammation. Then there’s papulopustular acne, which includes red pimples and whiteheads. More severe cases involve nodulocystic acne—deep, painful breakouts that often leave scars. The most extreme type is conglobate acne—where nodules merge into larger, pus-filled clusters, severely affecting the skin.

Each type requires a different treatment plan.

What happens if you don’t treat acne?

If you don’t treat acne, breakouts will keep coming back. It won’t go away on its own. As you get older, the acne may persist and continue to affect your appearance and self-esteem.

Untreated acne often leads to post-acne marks or scarring. Even if you eventually clear the acne, you’ll be left with lasting signs. Many people feel the need to cover these up with makeup, which can become exhausting. Severe acne can even spread to the chest, back, and shoulders—and may lead to social anxiety, low confidence, or isolation.

So don’t wait. Get help. I’ll explain how to start treatment in the next video.

Acne Triggers

Let’s wrap up by talking about triggers—things that can make acne worse or cause new breakouts. One major factor is stress. It raises cortisol and other hormones, which stimulate oil glands and inflammation.

Another one is UV exposure. The sun might seem to dry out your skin at first, but it ultimately worsens acne. UV rays weaken your skin’s immunity, thicken the outer layer, and lead to post-inflammatory pigmentation.

Hot and humid climates create the perfect environment for bacteria and excess oil. Using the wrong skincare products is another problem—heavy, comedogenic creams, alcohol-based toners, or harsh cleansers can damage your skin barrier and increase breakouts.

Inconsistent skincare routines can also trigger acne—neglecting cleansing allows buildup, while over-cleansing can weaken the skin. Your diet matters too: excess sugar, spicy food, dairy, deli meats, and fast food all spike insulin and IGF-1 levels, which boost sebum production and inflammation.

Hormonal fluctuations and medications—like steroids and anabolic agents—can also act as triggers. That’s why treating acne isn’t just about skincare—it’s about looking at your whole lifestyle.

In future videos, we’ll go over proven treatments and what really works to clear your skin. So make sure to subscribe, give this video a thumbs up, and I’ll see you again soon!