What Really Causes Acne? Beyond Skincare and Serums

If you’ve tried every cream, spot treatment and serum and still struggle with breakouts, you’re not alone. Millions of people follow complex skincare routines but see little relief. Why? Because most treatments address the symptoms, not the root causes of acne. In this guide, we’ll explore what causes acne besides skincare and how understanding your body’s internal signals can help you finally achieve clear skin.

The Problem with Skincare

Traditional skincare targets the surface—clogged pores, bacteria and inflammation—but doesn’t address what’s happening inside your body. Prescription medications often come with side effects, and switching products can drain your wallet. Without getting to the root causes, you might continue to cycle through treatments without lasting results.

Why Surface‐Level Solutions Fail

Symptom masking: Many creams simply reduce redness or dry out pimples temporarily.
No internal insights: They don’t tell you why you’re breaking out—whether hormones, stress or diet are playing a role.
Financial frustration: Constantly buying products that don’t work can feel like throwing money away.
Side effects: Prescription medications can cause dryness, irritation or other issues, yet still miss the underlying problem.

Root Causes of Acne

Acne isn’t just a “skin issue”—it’s often a reflection of your body’s internal environment. Recent research shows that hormonal imbalances, chronic stress, nutritional deficiencies and insulin resistance can significantly influence breakouts. Let’s unpack these acne root causes so you can identify what’s happening beneath the surface.

Hormonal Imbalances

Hormones like testosterone, estrogen and progesterone regulate oil (sebum) production. When they’re out of balance, they can over‑stimulate the sebaceous glands. A 2025 systematic review on adult female acne found that androgens (male hormones present in all genders) stimulate sebaceous gland growth and increase sebum secretion. High glycemic diets raise insulin and insulin‑like growth factor‑1 (IGF‑1), which further increases sebum and activates androgen synthesis.

Signs your acne may be hormone‑driven:

Breakouts around the jawline or chin, especially before your period.
Adult acne persisting into your 30s or 40s.
Cystic or nodular lesions that are deep and painful.
Symptoms of polycystic ovary syndrome (PCOS) such as irregular periods or excess hair.

A dermatologist from Nebraska Medicine notes that hormone imbalances—particularly fluctuations in estrogen and progesterone—are a common trigger for cystic acne. Women with PCOS often exhibit hyperandrogenism, which can exacerbate breakouts.

Stress and Cortisol

Ever noticed a breakout during exams or a high-pressure project at work? Stress isn’t just in your head—it shows up on your skin. A Stanford University study found that college students experienced more severe acne during exams, correlating stress levels with flare‑ups. Dermatology experts explain that sebum‑producing cells have receptors for stress hormones; when cortisol spikes, these cells increase oil production.

Stress-related acne often appears with:

Sudden flare‑ups during stressful periods.
Oily skin despite diligent cleansing.
Picking or touching your face more when anxious (which can worsen lesions).
Difficulty sleeping and feeling “wired but tired.”

Chronic stress also increases inflammation throughout the body, which may exacerbate acne’s redness and swelling. Recognizing stress triggers—work deadlines, relationship conflicts or lack of sleep—can help you manage them proactively.

Nutrient Deficiencies

Your skin relies on vitamins, minerals and fatty acids to stay healthy. Research shows that people with acne often have lower levels of certain nutrients compared to those without acne. In a 2024 case–control study, acne patients had significantly lower serum levels of zinc, selenium and vitamin D than controls. Lower nutrient levels correlated with more severe acne.

Vitamin D influences immune function and regulates keratinocyte and sebocyte proliferation; deficiencies may contribute to acne. Another study found that acne patients had lower serum vitamin D than healthy controls (with a significant p‑value of 0.003). Additionally, research notes that essential fatty acids like omega‑3s have anti-inflammatory effects, while Western diets high in omega‑6s may promote inflammatory acne.

Possible signs of nutrient-related acne:

Dry, flaky or easily irritated skin.
Slow wound healing or scarring.
Fatigue or muscle weakness.
Frequent illnesses (linked to low vitamin D).
Diets low in fish, nuts, seeds or leafy greens.

Insulin & Blood Sugar

High-sugar diets and insulin resistance can drive acne by raising IGF‑1 and androgens. A systematic review concluded that high‑glycemic diets increase insulin, which in turn boosts IGF‑1, leading to greater sebum production and keratinocyte proliferation. In a 2023 study, acne patients had significantly higher HOMA‑IR (a measure of insulin resistance) than controls; insulin resistance was more common among acne patients. The authors observed that lifestyle changes like low‑glycemic diets reduce IGF‑1 and decrease acne severity.

Clues that blood sugar might be impacting your skin:

Frequent cravings for sugary or high‑carb foods.
Energy crashes after meals.
Breakouts worsening after eating sweets or refined carbs.
Being overweight or having PCOS.

By stabilizing blood sugar—through balanced meals, fiber and regular exercise—you may reduce insulin and IGF‑1 levels, thereby decreasing sebum production.

The Science Behind It

Understanding acne requires connecting these internal factors to the biological processes occurring in your skin. Let’s break down the science without the jargon.

Hormonal Pathways

Androgens & Sebum: Androgens (e.g., testosterone) bind to receptors in sebaceous glands, stimulating growth and oil production. Excess oil mixes with dead skin cells and bacteria, clogging follicles and creating pimples.
Estrogen & Progesterone: Rising progesterone in the luteal phase can increase sebum, while dropping estrogen may lead to inflammation. This is why many women experience premenstrual flare‑ups.
Insulin & IGF‑1: High insulin levels activate IGF‑1, which further increases sebum production and stimulates androgen synthesis. Thus, sugar spikes translate to oily skin.

Inflammation & Stress

Stress triggers the release of cortisol and adrenaline. Sebum glands have receptors for these hormones; when activated, they ramp up oil production. Stress also increases inflammatory cytokines, making existing pimples redder and more painful. In two independent studies, acne severity correlated with stress during exam periods.

Nutrient & Metabolic Links

Zinc: A trace mineral essential for immune function and skin integrity. Deficiency can increase conversion of testosterone to dihydrotestosterone (DHT), leading to higher sebum production and inflammation.
Vitamin D: Regulates keratinocyte differentiation and sebocyte activity. It has antioxidant and anti-comedogenic properties; deficiency correlates with acne prevalence.
Selenium: Modulates sebum production and possesses anti-inflammatory properties.
Essential Fatty Acids: Omega‑3s (from fish oil, flaxseed) reduce inflammation and modulate sebum composition, while an excess of omega‑6s can promote inflammatory mediators.

Frequently Asked Questions

Can stress really cause acne?

Stress doesn’t cause acne by itself, but it can worsen existing breakouts. Research shows that students experience more severe acne during exam periods, and sebum‑producing cells have receptors for stress hormones. When cortisol spikes, oil production and inflammation increase, leading to more flare‑ups. Stress also triggers behaviors like skin picking, which aggravates lesions.

Do certain foods or deficiencies trigger breakouts?

Yes. High‑glycemic diets increase insulin and IGF‑1, leading to increased sebum and androgen activity. Case–control studies show that acne patients often have lower levels of zinc, selenium and vitamin D. Essential fatty acid imbalances (low omega‑3s, high omega‑6s) are also linked to inflammatory acne. However, not everyone reacts to food the same way; testing your biomarkers can reveal personal triggers.

Why Testing Matters

Creams and medications treat symptoms but rarely provide insights into why you have acne. Without understanding your internal imbalances, you’re guessing at treatments. Biomarker testing offers clarity and empowers you to take targeted action.

Benefits of Identifying Root Causes

Personalized insights: Discover whether hormones, stress, nutrient levels or insulin sensitivity are driving your breakouts.
Tailored nutrition and lifestyle plans: Correcting nutrient deficiencies or adopting a low‑glycemic diet can reduce inflammation and sebum production.
Efficient treatment: Focusing on the real causes reduces time wasted on ineffective products.
Peace of mind: Knowing your exact imbalances removes the frustration and uncertainty of trying random solutions.

How the Acne Root Cause Test Helps

BreakoutLabs’ Acne Root Cause Test is designed to identify the hidden factors behind your breakouts. It’s more than an “acne test at home”—it’s a comprehensive diagnostic kit that measures key biomarkers and delivers actionable recommendations.

What’s Included

Seven biomarkers measured: The test looks at hormones (including testosterone, estrogen and progesterone), cortisol (stress hormone), vitamin D, zinc, selenium and insulin markers.
Convenient home collection: Samples are collected at home using a simple kit, then processed in CLIA‑certified labs.
Doctor-reviewed results: Board‑certified physicians interpret your results to ensure accuracy and relevance.
Clear Skin Blueprint™: You’ll receive a personalized report with dietary, lifestyle and supplement recommendations based on your biomarkers.
Ongoing support: BreakoutLabs provides education and resources to help you implement changes and track progress.

Ready to uncover your unique acne triggers? Order your Acne Root Cause Test today and take control of your skin health.

Conclusion

Acne isn’t just skin-deep—it often reflects the health of your hormones, stress response, nutrient levels and metabolic balance. Research shows that hyperandrogenism, high‑glycemic diets and nutrient deficiencies contribute to acne. Stress can worsen breakouts by increasing oil production and inflammation. Lower zinc, selenium and vitamin D levels are common in acne patients, and insulin resistance correlates with more severe acne.

But knowledge is power. By identifying what causes acne besides skincare, you can address the root causes rather than masking symptoms. BreakoutLabs’ Acne Root Cause Test offers a simple, at‑home way to uncover hormonal imbalances, stress levels, nutrient deficiencies and metabolic factors. Armed with these insights—and supported by a personalized Clear Skin Blueprint—you can finally take the steps needed for lasting clear skin.

Ready to stop guessing and start healing? Learn more about the Acne Root Cause Test and empower yourself with real answers.