Causes of pimples include genetic factors, the use of oil-based skin care products, excessive sun exposure, and hormone changes related to adolescence, pregnancy, or premenstrual syndrome (PMS).
These conditions can cause oily skin and a buildup of sebum and dead skin cells that can plug the hair follicles, leading to inflammation and growth of bacteria like Cutibacterium acnes that can cause breakouts.
Keeping your skin clean and using products to control excess oil production can help prevent pimples, in addition to using topical or oral medications prescribed by a dermatologist based on the type of acne and severity of symptoms.
Common causes
The main factors that can cause pimples are:
1. Adolescence
Adolescence is the most common stage for acne, particularly between the ages of 12 and 18. This is due to the increased production of androgens, like testosterone, during this phase.
These hormones stimulate the sebaceous glands in the skin to produce more sebum, resulting in oily skin and clogged pores. This leads to inflammation and rapid growth of bacteria like Cutibacterium acnes.
What to do: a dermatologist can assess your skin and recommend the most appropriate treatment, which may involve topical antibiotics and antibacterial agents, such as benzoyl peroxide, or retinoids, such as isotretinoin.
2. Poor skin hygiene
Not cleaning your skin properly can result in a buildup of oil that clogs the pores and leads to the formation of comedones (whiteheads and blackheads) and pimples.
What to do: wash your face at least twice a day, in the morning and even more importantly at night, to remove excess sweat and oil from the skin. This should ideally be done with products specific to your individual skin type as recommended by a dermatologist.
3. Not removing makeup
Makeup should be removed as soon as possible to prevent clogging the pores and causing breakouts of comedones and pimples. This is especially true for oil-based products.
What to do: people with acne-prone skin should use makeup that is water-based and made specifically for people with oily skin, although ideally the skin should be left as natural as possible. Make sure to always wash your face and remove all of your makeup with a makeup remover as soon as you get home.
4. Oil-based skin care products
Greasy, oil-based sunscreens and moisturizers are not ideal for every skin type, and can end up causing pimples and blackheads.
What to do: always try to choose products specific to your skin type that are labeled "noncomedogenic", which means they are less likely to clog the pores.
5. Eating inflammatory foods
Inflammatory foods like milk, sweets, carbohydrates, and fried foods can increase the risk for pimples due to skin inflammation.
What to do: avoid foods high in carbohydrates and fats and focus on anti-inflammatory foods like fruits, vegetables, leafy greens, omega-3s, and water, which also have antioxidant effects.
6. Excessive sun exposure
UV rays can accelerate inflammation and increase oil production in the skin that leads to breakouts.
What to do: avoid spending too much time in the sun, especially during peak hours, which are usually between 10AM and 4PM. Remember to always apply sunscreen with an SPF of 30 or higher that is suitable for your skin type.
7. Genetic predisposition
Genetics are one of the main causes of pimples, as they can determine the amount of fatty acids contained in sebum, leading to clogged pores and inflammatory lesions of the skin.
What to do: treatment involves topical agents prescribed by a dermatologist and may also include oral medications like antibiotics or isotretinoin in more severe cases (acne grades II through IV, for example).
8. PMS
Premenstrual syndrome (PMS), which can occur 1 to 2 weeks prior to your period, can also cause pimples. This is because decreasing levels of estrogen and progesterone may trigger the sebaceous glands to produce more oil.
What to do: it is important to keep the skin clean by washing it at least twice a day (morning and night) and using topical preparations prescribed by your dermatologist. In some cases, your gynecologist or other women's health provider may recommend the use of contraceptives (birth control) containing progestins like drospirenone or dienogest that can be used to treat acne.
9. Pregnancy
The normal increase in estrogen and progesterone levels during pregnancy increases sebum production, making the skin oily and causing pimples to develop.
Pregnancy acne is typically worse during the first trimester and tends to resolve at the end of pregnancy.
What to do: it is recommended to cleanse the skin with a gentle or neutral soap twice a day and apply an alcohol-free toner without acids, making sure to wash and dry the skin first. Avoid oral medications, acids, and aesthetic procedures during this time unless approved by your OBGYN or midwife.
10. Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women and people assigned female at birth (AFAB). High testosterone levels stimulate oil production in the skin, making people with PCOS more prone to breakouts.
What to do: the treatment of PCOS is managed by a gynecologist. Depending on symptoms, treatment may involve the use of birth control pills, spironolactone, clomiphene (Clomid), letrozole, or gonadotropins.
11. Menopause
Some people experience pimples during menopause due to decreased levels of estrogen and increased testosterone, which can result in oily skin and breakouts.
What to do: it is important to keep the face clean by washing it twice a day and applying a toner afterward. In some cases, a dermatologist may prescribe the use of topical antibiotics or retinoids.
If necessary, a gynecologist can also prescribe hormone replacement therapy (HRT).
12. Medication side effects
Pimples caused by inflammation are a side effect of some medications, including corticosteroids, anticonvulsants, anabolic steroids, lithium, and antidepressants.
What to do: talk to your prescribing provider to discuss the possibility of switching your medication or changing the dose. Do not stop taking any medications without first consulting your doctor or healthcare provider.
Adopt skin care habits to reduce acne while taking these medications, like using cleansers or creams containing retinoic acid that prevents the formation of pimples.
Preventing breakouts
The following care tips can help prevent breakouts of pimples:
- Washing the face with a gentle or neutral soap, at least twice a day;
- Applying toner after washing your face to clean and unclog the pores;
- Using oil-free moisturizers after applying a toner;
- Avoiding excessive sun exposure, especially during peak hours;
- Applying oil-free sunscreen, SPF 30 or higher, even on cloudy days;
- Exfoliating the skin once or twice a week to remove dead skin cells;
- Avoiding makeup, moisturizers, or shampoos that are very greasy or oily;
- Avoiding sweets and fried foods, in addition to alcoholic drinks and carbonated beverages;
- Drinking at least eight 8-oz glasses of water per day to keep the skin hydrated.
In addition, following a diet rich in omega-3s, zinc, and antioxidants, like salmon, sunflower seeds, fruits, and vegetables, can also help reduce skin inflammation.
Treatment options
Treatment of pimples is managed by a dermatologist and varies according to the type of acne and severity of symptoms.
In general, treatment consists of a daily skin care regimen as well as topical preparations prescribed by a dermatologist containing salicylic acid, adapalene, or benzoyl peroxide that have anti-inflammatory and/or antibacterial effects.
Oral antibiotics or isotretinoin may be prescribed for more serious cases of acne.