Acne Breakouts: What Causes Spots and Pimples

What acne spots look like

Acne produces a mix of spot types. Recognizing them helps choose treatment:

• Blackheads (open comedones): small dark plugs. The color is oxidized oil and skin pigment, not dirt.
• Whiteheads (closed comedones): small skin-colored or white bumps with a closed surface.
• Papules: small red, tender bumps.
• Pustules: red bumps with a white or yellow center of pus.
• Nodules and cysts: large, deep, painful lumps under the skin that last weeks and are most likely to scar.

For the biology of acne, its grades and the full range of medical treatments, see the condition page on acne.

What causes breakouts

Hormones

Androgens (male-type hormones present in everyone) make oil glands enlarge and produce more sebum. That is why acne starts at puberty, often flares in the week before a period, and can appear or worsen in pregnancy. Women with acne along the jaw and chin, irregular periods and extra hair growth may have polycystic ovary syndrome.

Clogged pores

Dead skin cells stick together inside the follicle instead of shedding, plugging it with oil. Thick, oily cosmetics, hair products (spots along the hairline) and sunscreen not labeled "non-comedogenic" can add to blockage.

Bacteria and inflammation

The skin bacterium Cutibacterium acnes thrives in clogged, oily follicles and triggers inflammation, turning comedones into red pimples.

Friction and pressure

Helmets, chin straps, backpacks, tight collars, face masks and phone screens can cause acne where they rub (acne mechanica).

Medicines and supplements

Steroids (tablets, injections and anabolic steroids), lithium, some anti-epileptic drugs, testosterone, some progestin-only contraceptives, and high-dose vitamin B12 or whey protein supplements can trigger breakouts.

Diet and other factors

Evidence links high-glycemic diets and skim milk to acne in some people, though the effect is modest. Stress can worsen existing acne. Genetics matter: acne in a parent raises your risk. Picking and squeezing spots spreads inflammation and increases scarring.

Acne by age and location

Spots that are not acne

Spots on the back of the tongue are not acne. The tongue has normal raised bumps (papillae) at the back, which can look prominent or swollen after irritation or a cold. Any tongue sore that lasts more than 3 weeks needs a doctor or dentist to look at it.

What helps at home

• Cleanse gently twice a day with a mild, non-soap cleanser and lukewarm water. Scrubbing irritates the skin and worsens inflammation.
• Benzoyl peroxide (2.5% to 5% wash or gel) kills acne bacteria and does not cause resistance. It can bleach towels and clothing.
• Adapalene 0.1% gel, available over the counter, unclogs pores. Apply a pea-sized amount to the whole area at night. Expect dryness and some worsening in the first few weeks.
• Salicylic acid helps blackheads and whiteheads.
• Moisturize with a non-comedogenic product, and use a non-comedogenic sunscreen.
• Do not pick or squeeze. It drives inflammation deeper and leaves marks and scars.
• Be patient. Any acne treatment takes 6 to 12 weeks to show its full effect.

Adapalene and other retinoids should not be used in pregnancy without medical advice.

When to see a doctor

See a primary care doctor or dermatologist if acne is moderate or severe, is leaving scars or dark marks, has not improved after 2 to 3 months of over-the-counter treatment, or is affecting your mood. Effective prescription options include stronger topical retinoids, combination gels, short courses of oral antibiotics, hormonal treatments for women and isotretinoin for severe or scarring acne. Early treatment prevents acne scars, which are much harder to treat than the acne itself.

Frequently asked questions

What causes acne breakouts?

Breakouts happen when oil and dead skin cells clog hair follicles, acne bacteria multiply and inflammation develops. Hormones drive the oil production, which is why acne starts at puberty and flares before periods. Heavy cosmetics, friction, stress, some medicines and genetics can make it worse.

Why am I getting acne as an adult?

Adult acne is common, especially in women, and often affects the jawline and chin. Hormonal changes around periods, pregnancy, stopping birth control and PCOS are frequent causes. Stress, new skincare or hair products, and medicines or supplements can also trigger it.

How long does it take for acne to clear?

Most treatments take 6 to 12 weeks to work fully, and skin may look worse for the first few weeks with retinoids. Once acne is controlled, continuing a maintenance treatment such as adapalene helps prevent it from returning.

Is it bad to pop pimples?

Yes. Squeezing pushes bacteria and inflamed material deeper into the skin, prolongs healing and increases the risk of dark marks, scars and infection. A dermatologist can safely extract stubborn comedones or inject a painful cyst to settle it quickly.

Can diet cause acne?

Diet is not the main cause, but high-glycemic foods such as sugary drinks and white bread, and dairy, especially skim milk, are linked to worse acne in some people. Changing diet may help a little alongside treatment but rarely clears acne alone.