When I was sixteen, I thought acne was just something you outgrow — like braces or bad haircuts. My mom said it would clear up after high school, my biology teacher blamed hormones, and the internet was full of miracle products promising smooth skin in seven days. Fast forward to my mid-thirties, and I was still waking up to surprise breakouts on my chin before job interviews, weddings, or worse — dates. The worst part? I was doing “everything right.” At least, I thought I was.
Acne has this unfair reputation of being a teen thing, like prom or TikTok trends. But the truth is messier. It's not just a phase, and it's not always about dirty skin or greasy food — though I once believed both. In reality, acne is a complex inflammatory skin condition that doesn’t really care how old you are, how much water you drink, or how religiously you double cleanse. It’s more of a skin chemistry equation than a hygiene issue.
Here’s how it was explained to me by a dermatologist who completely changed how I understood my own face. Every pore in our skin is like a tiny little chimney attached to a sebaceous (oil) gland. These glands produce sebum, which — in a healthy world — makes its way to the skin’s surface to keep everything nice and moisturized. But sometimes, that chimney gets clogged. Dead skin cells, sticky sebum, and bacteria team up, and instead of escaping, everything gets trapped inside. That’s when the real fun begins — inflammation, redness, swelling, tenderness, and in the worst cases, painful cysts that feel like they’re pulsing with every heartbeat.
I remember talking to my friend Chris after a gym session. He was wearing a tight compression shirt, sweating buckets, and by the next day, had angry breakouts across his back. “Bacne,” he muttered with a sigh. That’s another cruel twist of acne — it doesn’t just stop at the face. Chest, shoulders, back — anywhere with oil glands is fair game.
There are so many kinds of acne, and none of them are invited. The classic whiteheads stay hidden just below the surface, while blackheads open up to the air and oxidize, turning dark. Then there are the angry red bumps we call papules, the ones that scream when you touch them. Pustules are those yellow-topped volcanoes that practically dare you to pop them — please don’t. Then come the big leagues: nodules and cysts. These are deep, painful, and they linger, both physically and emotionally.
For women, adult acne is especially persistent. I’ve had patients in their forties who are still navigating hormonal breakouts, usually along the jawline or chin — right before their period hits. Hormones are the puppeteers behind so many flare-ups. Androgens, a type of hormone that increases during puberty (and yes, also during pregnancy and menstruation), rev up the oil glands. More oil = more chances for clogs.
But it's not just hormones. Genetics play a card too. If your parents had acne, chances are, you’re more likely to deal with it. My dad used to joke that I inherited his stubbornness — turns out, I also inherited his T-zone flare-ups.
And then there’s lifestyle. Acne loves to latch onto bad habits, but not always in the way people think. No, eating one slice of pizza won't give you a zit — that’s a myth. But certain diets, especially ones high in refined sugars and dairy, can make inflammation worse in some people. Stress? Yep, cortisol (your stress hormone) can trigger flare-ups too. Sleep deprivation, constantly touching your face, wearing sweaty gear (looking at you, cyclists and helmet-heads), using pore-clogging makeup or skincare — all of it contributes to the chaotic little party happening in your pores.
I had a client named Rachel who was constantly scrubbing her face raw with exfoliating pads, convinced her skin just wasn’t clean enough. In reality, she was stripping her skin’s protective barrier, pushing her oil glands into overdrive. More oil, more breakouts — it’s a vicious cycle. Gentle is the name of the game. Acne isn’t a dirt problem, it’s a skin environment issue. And you can’t scrub your way out of it.
The trick, I’ve learned, is not to fight your skin like it’s the enemy. It’s to listen to it — calmly, consistently, without panic. That means building a routine with ingredients that work (like benzoyl peroxide, salicylic acid, retinoids, niacinamide), staying hydrated, and avoiding the urge to wage war on every bump. It also means being patient — which, let’s be honest, is the hardest part.
And the emotional toll? That’s real too. Acne isn’t just a physical condition — it impacts confidence, dating, professional interactions. I’ve had people cancel vacations because of a breakout, or avoid mirrors for weeks. I’ve been there myself, slathering on concealer, keeping eye contact just slightly off-center. It’s more than vanity — it’s vulnerability.
But here’s the good news: acne is manageable. It might not disappear overnight, but with the right knowledge and care — and sometimes medical help — it gets better. My skin isn’t perfect now, but it’s peaceful. And after years of war, peace is enough.
So no, it’s not just a phase. But it’s not forever either. And if you’re still fighting the same battle you thought would end with high school graduation? You’re not alone. You’re just human. And your skin — for all its rebellion — is trying its best to protect you.
Treat it with kindness. It remembers.