Teen Acne Causes: Genetics, Hormones, Skin Type, Diet, Stress, and Skincare Habits

Acne vulgaris affects ~85% of adolescents. Severity varies due to multiple interacting factors.

Contributing Factors

• Genetics: Heritability ~80%; influences sebum production, follicular keratinization, inflammatory response.
• Androgens: Puberty increases DHEA-S, testosterone → sebaceous gland hyperplasia → excess sebum.
• Skin Type: Oily skin (high sebum) predisposes to comedones.
• Diet: High glycemic load (sugar, refined carbs) and dairy (especially skim milk) associated with worse acne in some studies.
• Stress: Increases cortisol and androgens → more sebum and inflammation.
• Medications: Corticosteroids, lithium, androgens, some contraceptives (progestin-only) can flare acne.
• Hygiene/Habits: Over-washing, harsh scrubs, picking, occlusive cosmetics worsen barrier function and inflammation.

Evidence-Based Management

• Gentle cleanser BID; non-comedogenic moisturizer/sunscreen.
• Topical retinoid (adapalene, tretinoin) + benzoyl peroxide or clindamycin.
• Oral antibiotics (doxycycline, sarecycline) for moderate-severe inflammatory acne.
• Combined oral contraceptives (estrogen + anti-androgenic progestin) for females.
• Isotretinoin for severe, scarring, or refractory cases.
• Low-glycemic diet, stress reduction, adequate sleep as adjuncts.

See a dermatologist if OTC measures fail after 8–12 weeks, or if scarring/psychological distress occurs.