Let's Talk About Acne and Breakouts

Think you have to live with breakouts? Think again! Photo by Anna Nekrashevich

Acne and breakouts are one of the most common complaints when we are talking about facial skin.  The types you hear about the most and may experience are blackheads, whiteheads, cysts (cystic acne), hormonal breakouts, and fungal acne.

In this post I will discuss what causes each and what ingredients or product types you can add to your skincare routine which are proven to help.

Blackheads, also called open comedones (pronounced "comma DOW knees" if you are curious) are caused by a combination of factors that lead to clogged pores. Here's a breakdown of what specifically causes them:

• Excess oil production (sebum) - Your skin’s sebaceous glands produce oil to keep it moisturized. When too much oil is produced, it can accumulate in the pores.

• Dead skin cell buildup - Normally, skin cells shed naturally. But if they don’t shed properly, they can mix with sebum and get trapped in the pore.

• Clogged hair follicles (pores) - Each pore is the opening of a hair follicle (who knew?).  When excess oil and dead skin cells collect in the follicle opening, they form a soft plug.

• Oxidation of the pore plug - Unlike whiteheads (aka closed comedones), blackheads stay open to air. The surface of the plug oxidizes, turning dark—that’s not dirt, it’s oxidized melanin.

• Hormonal shifts - Especially during puberty, menstruation, or stress, hormonal fluctuations can increase oil production, making blackheads more likely.

• Certain skincare or makeup products - Comedogenic products (those that clog pores) can contribute to blackhead formation, especially if not properly removed.

To prevent or reduce blackheads:  These pointers may help to lessen or eliminate blackheads, and I have listed the best products to use, if applicable, for each.  Let’s dive in:

• Use salicylic acid (BHA) to dissolve the plug inside the pore (also known as the clog).  Two really good choices for this are Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant (a cult favorite for blackhead control, alcohol- and fragrance-free, with 2% salicylic acid) and The Ordinary Salicylic Acid 2% Solution (budget-friendly, OTC max strength, and praised for clearing breakouts quickly).

• Avoid pore-clogging ingredients (look for non-comedogenic on your labels).  Try Dermalogica Daily Microfoliant (a nice, rice-based enzyme powder that gently exfoliates without clogging pores, highly rated at several beaty outlets) or ArtNaturals Salicylic Acid Serum – lightweight serum with 2% BHA and hyaluronic acid; non-comedogenic formula and softens texture.

• Exfoliate 2–3x per week to remove dead skin.  Paula’s Choice and The Ordinary solutions are perfect for exfoliation days, use 2–3 times weekly, then hydrate.  Alternatively, Dermalogica Daily Microfoliant can be used daily as a gentle enzyme exfoliant.

• Use retinoids just before bedtime to normalize cell turnover.  These over-the-counter products will save you getting a prescription, but they do pack a punch nonetheless, so start slow – only two or three times per week to begin with, then work your way up to nightly if tolerated.  My first choice is 100,000 IU Retinol Cream, an oil-soluble, rich textured, vitamin A-packed night cream with solid user feedback.  Another good choice is Cosmedica Retinol Night Cream, with 2.5% retinol plus botanicals, giving your skin hydration while refining texture. Other options are Puritan's Pride Retinol Cream 100,000 IU, a well-rated classic vitamin A moisturizer delivering 100,000 IU per ounce, or Vitamin World Retinol Cream 100,000 IU 2 oz with a smaller jar size but same potent formula.

• Keep skin hydrated with an oil-free moisturizer or serum (dehydrated skin can trigger more oil production).  Some of the top dermatologist recommended non-comedogenic options include CeraVe PM Facial Moisturizing Lotion (lightweight, with ceramides + niacinamide for barrier repair) and Neutrogena Hydro Boost Water Gel (gel texture, hyaluronic acid, water-based hydration).  Other solid picks: La Roche Posay Effaclar Mat, Cetaphil Pro Oil Absorbing SPF 30, EltaMD UV Clear, all of these are oil free and acne safe.

How to integrate these into your skincare routine:

• Exfoliant at night 2 to 3 times weekly: Choose either BHA serum (Paula’s Choice or The Ordinary) or Microfoliant. Stick with one or the other to see how it works for you. Switch to another if you don't like your results or if you have a sensitivity to one in particular.

• Retinoid nights: Stick to 2–3× per week, on non-exfoliant nights.

• Moisturize daily: Use CeraVe PM or Neutrogena Hydro Boost morning & night.

• Spot treatment: Apply a dab of salicylic or retinoid serum directly on persistent blackheads.

Whiteheads (also known as closed comedones) are caused by a mix of internal and external factors that lead to clogged pores beneath the skin’s surface.  Here’s a detailed breakdown of what specifically causes them, many of which also are above in the causes of blackheads as well:

• Excess oil (sebum) production.  Overactive sebaceous glands produce too much oil, often triggered by hormones, genetics, or dehydration (which paradoxically signals your skin to make more oil).

• Dead skin cell buildup.  When your skin doesn’t shed dead cells properly, they mix with the excess oil and form a soft plug inside the pore.

• Clogged pores that remain closed. Unlike blackheads, whiteheads stay covered by a thin layer of skin, so the contents don’t oxidize and turn dark. This closed surface traps the gunk inside, which can sometimes be seen just under the surface, thus giving us the name “whiteheads”.

• Hormonal fluctuations.  Especially during puberty, menstruation, pregnancy, or stress, hormone surges (especially androgens) increase sebum production, making clogged pores more likely.

• Certain ingredients or products.  Just like with blackheads, comedogenic skincare and makeup can block pores and cause whiteheads. Occlusive or heavy creams, silicones, and some oils (like coconut oil) are common culprits.

• Friction or occlusion (aka “acne mechanica”).  Constant rubbing from tight hats, pillowcases, or mask-wearing can trap sweat and oil against the skin, creating whiteheads

To treat and/or prevent Whiteheads: The steps are the same as the treatments for blackheads, but here we feature effective and well-loved formulas for each of those steps specifically targeting whiteheads:

• Again, use salicylic acid (BHA) to dissolve oil and plugs. CeraVe Renewing SA (Salicylic Acid) Cleanser is a gentle, 2% SA cleanser with ceramides and niacinamide, non-comedogenic and widely recommended by dermatologists. The Inkey List Salicylic Acid Cleanser is another nice option for whiteheads, a cult-favorite gel cleanser which is a little bit stronger at 5% SA and has been praised in Allure as ideal for whiteheads.

• Add a gentle retinoid to support balanced skin regeneration. Another product from CeraVe is the Resurfacing Retinol Serum with a 4.8 star rating. This serum has encapsulated retinol, plus ceramides and licorice to refine texture and fade post-acne marks. An alternative is Good Molecules Gentle Retinol Cream, a lightweight cream (recommended at Ulta) designed for sensitive skin, which smooths and calms while easing skin into retinol. Good Molecules enjoys a 4.8★ rating as well.

• Stick with those non-comedogenic products. COSRX Oil‑Free Ultra Moisturizing Lotion features lightweight hydration, won't clog pores, and is another best selling product that has a 4.8★ rating by consumers. La Roche-Posay Toleriane Double Repair Matte Moisturizer (one of my favs) is a gem - dermatologist-approved, non-comedogenic, and oil-free gel-cream with niacinamide.

• Exfoliate two to three times weekly. Your salicylic acid cleansers above (CeraVe, Inkey) also double as exfoliants 2–3× per week to sweep away dead skin and prevent clogged pores.

• Moisturize with oil-free hydration. Two great choices are Cetaphil Moisturizing Lotion (lightweight, non-greasy, fragrance-free lotion with humectants & emollients suitable for acne-prone skin) and Obagi Hydrate Facial Moisturizer (non-comedogenic cream with tara seed extract, shea & mango butters for smooth, long-lasting moisture - a little pricey but worth the spend).

Adding these to your routine has a few subtle differences to target whiteheads:

• Cleanser: Use your salicylic acid cleanser twice daily, once in the morning and once after dinner, as this gives your skin time to calm down before you put on any retinoids. If you have sensitive skin, start out at 2 to 3 times per week after dinner, and do not use your retinoid before bed. From there, work up to twice daily if possible. Listen to your skin and adjust accordingly - no skincare regimen is ever set in stone.

• Retinoid: Apply at night, 2–3× weekly.

• Moisturizer: Morning and night both—choose lightweight lotions (Cetaphil) or richer creams (Obagi) depending on dryness.

• Optional spot-prone nights: Use a dab of retinoid on stubborn whiteheads.

Cystic acne—especially on the face—is one of the most severe forms of acne and is caused by a deeper, more intense version of the typical acne process. Here's exactly what causes facial cysts:

• Hormonal fluctuations (especially androgens). Elevated androgen levels increase sebum (oil) production, which can lead to clogged pores and inflammation. Hormonal fluctuations are most common during puberty, menstrual cycles, pregnancy, PCOS, or high-stress states. This is why cysts often form along the jawline, chin, and cheeks— as these are areas with high oil gland concentration and hormone sensitivity.

• Trapped oil and dead skin deep in the pore. When oil and dead skin cells don’t just clog the surface (as in whiteheads/blackheads) but instead build up deep within the follicle, the blockage triggers intense swelling and infection.

• Bacterial overgrowth. Cutibacterium acnes, a skin-dwelling bacteria, multiplies in the clogged, oxygen-deprived environment, leading to severe inflammation.

• Inflammatory immune response. The body sees the clogged, infected pore as a problem and mounts an aggressive inflammatory response, forming a painful, red, often pus-filled lump (cyst) under the skin.

• Genetic predisposition. Some people simply produce more oil, shed more dead skin cells, or respond more aggressively to bacteria and inflammation—making them more prone to cystic breakouts.

Here’s a guide to treating and preventing facial cysts which may benefit, including top-selling products that can effectively help:

• Use benzoyl peroxide to reduce bacteria and inflammation. Benzoyl peroxide kills Cutibacterium acnes and reduces inflammation and infected pores, which is particularly effective for cysts. Dr Song 10 % Benzoyl Peroxide Acne Wash is a Micro‑BP formula designed to penetrate deep into clogged pores and treat moderate to severe cystic breakouts, and is backed by strong customer reviews. AcneFree Oil‑Free Cleanser 2.5 % BP is an Amazon favorite, benzoyl peroxide cream cleanser that kills acne-causing bacteria without overdrying, which is important because you don't want to trigger more oil production! Benzoyl peroxide is clinically shown to address severe inflammatory acne - including cysts.

• Incorporate a topical retinoid (adapalene) to prevent future cysts. Adapalene is widely recommended as a first-line defense for both treating and preventing cystic lesions. Differin Adapalene 0.1 % Gel is the No. 1 OTC retinoid recommended by dermatologists for treating and preventing cystic acne; combines anti-inflammatory and comedolytic effects. La Roche-Posay Effaclar Adapalene Gel 0.1% Acne Treatment is dermatologist developed, oil-free and fragrance free and non comedogenic.

• Apply a targeted spot treatment or mask for deep cysts. Clay/sulfur spot treatments are effective for deep lesions that need targeted extraction and drying. TreeActiv Cystic Acne Spot Treatment combines sulfur, bentonite clay, and tea tree oil to draw out and dry stubborn cysts and is designed specifically for deep inflammatory spots. Earth’s Care 5 % Sulfur Acne Treatment Mask contains 5 % sulfur + kaolin clay to deeply absorb debris and fight bacteria without over-drying. Customer reviews highlight its ability to calm cysts and minimize pores.

There are a few key adjustments which you can incorporate into your routine to effectively target cystic acne, which tends to form deeper under the skin and requires a gentler but more strategic approach:

• Cleanser: Use a benzoyl peroxide (BP) cleanser once daily to start—preferably in the evening after dinner—so your skin has time to settle before applying any other actives. BP helps kill acne-causing bacteria and reduce inflammation that fuels cysts. If you’re sensitive, start with every other day and work up to once or even twice daily as tolerated. Stronger BP (like 10%) can be very drying, so always follow with a moisturizer. Try something like Dr. Song 10% BP Wash or AcneFree Oil-Free Cleanser.

• Retinoid: Apply a topical retinoid (such as Differin/adapalene 0.1%) at night, 2–3× per week. Retinoids speed up skin cell turnover and help keep pores clear before cysts can form. Ease into it gradually to prevent irritation. Don’t layer it on the same nights as your BP cleanser until your skin can handle it.

• Moisturizer: Use a non-comedogenic moisturizer morning and night—lightweight lotions like CeraVe PM or COSRX Oil-Free Lotion are great for balancing hydration while keeping pores clear. If your skin feels tight, flaky, or irritated, increase your moisturizer use and reduce active treatments temporarily.

• Optional spot-prone nights: When you feel a cyst forming (painful, red bump under the skin), dab on a targeted spot treatment like TreeActiv Cystic Acne Spot Treatment, Earth’s Care 5 % Sulfur Acne Treatment Mask, or CONTROL CORRECTIVE Sulfur Calming Mask. These help draw out the blockage and calm inflammation before it worsens.

• Bonus – Sunscreen: If you’re using BP or retinoids, daily SPF is non-negotiable. Sun exposure can worsen scarring and irritation. Try EltaMD UV Clear or Neutrogena Clear Face SPF 60—both are designed for acne-prone skin and won’t clog pores.

Hormonal breakouts are a frustrating type of acne that often feels like it operates outside the rules of your usual skincare routine—but understanding what drives them makes them much easier to manage. Here's a full breakdown:

Hormonal acne is triggered by fluctuations in hormones, particularly androgens like testosterone. These hormones increase sebum (oil) production, which can clog pores and feed bacteria—leading to inflammation and painful, often cystic breakouts. Breakouts can occur most often around your jawline, chin, cheeks, and neck, as these areas have a high density of oil glands and are especially responsive to hormone shifts. Hormonal fluctuations can be caused by:

• Menstrual cycles (breakouts often 1–2 weeks before your period)

• Polycystic Ovary Syndrome (PCOS)

• Pregnancy or postpartum hormone shifts

• Discontinuing or starting birth control

• Chronic stress (raises cortisol → affects androgens)

• Perimenopause or menopause

Preventative treatments for Hormonal Acne entail lifestyle and hormonal support, along with a decent skincare regimen. Some treatments for hormonal acne can include:

• Spironolactone (prescription): A first-line oral medication for many women with hormonal acne. It blocks androgen receptors and reduces oil production.

• Oral contraceptives: Certain birth control pills regulate hormones and reduce breakouts.

• Diet: Reducing dairy, high-glycemic foods, and processed sugar may help some people.

• Stress management: Sleep, mindfulness, adaptogens like ashwagandha, and cutting back on caffeine/alcohol can support hormone balance.

A typical skincare routine for hormonal breakouts could look something like the following. Adding these to your routine helps regulate oil, calm inflammation, and prevent clogged pores without overstripping the skin:

• Cleanser: Use a salicylic acid cleanser once or twice daily. It penetrates oil and helps keep pores clear—essential for combating the buildup that hormones can trigger. If your skin is sensitive or dry, start 3× per week after dinner, and work up gradually. Try: CeraVe Renewing SA (Salicylic Acid) Cleanser or Inkey List Salicylic Acid Cleanser.

• Retinoid: Use a topical retinoid (like adapalene) at night, 2–3× per week. Retinoids help regulate skin cell turnover and prevent clogged pores that lead to cysts. They also reduce the long-term risk of post-acne pigmentation. Try: Differin Adapalene 0.1 % Gel.

• Moisturizer: Morning and night, choose a non-comedogenic, oil-free moisturizer. Hormonal breakouts don’t mean your skin doesn’t need hydration—in fact, over-drying can make acne worse. Try: La Roche-Posay Toleriane Double Repair Matte Moisturizer (for oily skin) or CeraVe PM.

• Optional Spot Treatment or Mask: For deep, painful bumps along the jaw or chin, use a sulfur or clay-based spot treatment 2–3× per week. These help reduce inflammation and draw out cysts. Try: TreeActiv Cystic Acne Spot Treatment, Earth’s Care 5 % Sulfur Acne Treatment Mask, or CONTROL CORRECTIVE Sulfur Calming Mask.

• Sunscreen: A must, especially when using retinoids or exfoliants. Sun exposure can darken post-inflammatory hyperpigmentation and increase irritation. Try: EltaMD UV Clear or Neutrogena Clear Face SPF 60.

Fungal Acne isn’t true acne—it’s technically called Malassezia folliculitis. It’s caused by an overgrowth of yeast (specifically Malassezia) that lives naturally on your skin. When this yeast gets out of balance—often due to excess oil, sweat, humidity, or antibiotics—it can infect the hair follicles and cause breakouts that mimic acne.

Fungal acne has several different characteristics that are not shared with other types of breakouts, such as: Tiny, uniform bumps—often on the forehead, chest, back, or along the hairline; it tends to itch, (a classic giveaway—bacterial acne usually isn’t itchy); it doesn’t respond to typical acne treatments like benzoyl peroxide or salicylic acid; and it worsens with sweat, heat, or oily products.

Fungal acne flareups can be caused by several factors:

• Humid weather or excessive sweating

• Occlusive skincare such as oils, heavy creams, or silicone-based products

• Antibiotics which kill good bacteria and allow yeast to grow unchecked

• Wearing sweaty clothes too long (e.g., after workouts)

• High-sugar diets, because yeasts love sugar

Fungal acne thrives in moist, oily environments, so the key to treating and/or preventing fungal acne is to reduce excess oil, avoid yeast-feeding products, and gently rebalance your skin. Fungal acne is not acne vulgaris, so acne treatments like benzoyl peroxide, oils, and occlusive creams may make it worse. Consistency, as well as ingredient awareness are essential. If you have tried a good skincare routine for fungal acne (outlined in the following paragraph) and your symptoms persist, you may want to ask your doctor about oral antifungal meds like fluconazole or itraconazole.

A good skincare routine for fungal acne looks much like our previous discussion, but for the sake of those that just want to zero in on this particular skin annoyance, I have these suggestions:

Cleanser: Use a gentle antifungal cleanser daily. Look for pyrithione zinc or selenium sulfide as these help kill Malassezia (yeast) without disrupting your skin barrier. Try: Noble Formula 2% Pyrithione Zinc Bar (great for face and body) or Nizoral Anti-Dandruff Shampoo (yes, really) and leave it on your skin for 3–5 minutes before rinsing.

Exfoliant: If your skin tolerates it, add a chemical exfoliant twice weekly. Avoid fatty acids and oils that can feed fungal yeast. Try: Stridex Maximum Strength Pads (BHA) – oil-free and fungal-safe. Avoid: Lactic acid, fatty alcohols, or shea butter.

Moisturizer: Use a lightweight, oil-free moisturizer with fungal-safe ingredients. Look for gel textures that hydrate without feeding yeast. Try: Neutrogena Hydro Boost Water Gel or La Roche-Posay Toleriane Fluide. Avoid: Coconut oil, esters, polysorbates, or fermented ingredients.

Optional spot-prone nights: If you have itchy or stubborn bumps, apply a sulfur-based treatment two or three times weekly. Sulfur helps calm inflammation and suppress yeast overgrowth. Try: De La Cruz 10% Sulfur Ointment or Vichy Normaderm S.O.S Acne Rescue Spot Corrector.

Bonus – Body Care (if needed): If you get breakouts on your chest, shoulders, or back, cleanse with Nizoral Shampoo three times weekly and wear breathable clothing. Rinse off sweat right after workouts to prevent flare-ups.

The Wrap Up: Acne can feel like that one guest who shows up uninvited, brings friends, and overstays their welcome—but luckily, the more you understand about the type of acne or breakout you're dealing with, the easier it is to show it the door (politely, but firmly). Whether you're battling blackheads that won't budge, hormonal breakouts that crash your monthly party, or fungal acne that popped up just to be different, there’s a strategy—and some great serums—for that.

Remember, skincare is a journey, not a sprint (and definitely should not be viewed as a punishment). Start slow, pay attention to what your skin likes, and adjust as needed. You’re not failing if a product doesn’t work—you’re just getting closer to what does.

If you're feeling stuck or your skincare shelf is starting to look like a science lab, I’m here to help you sort it out. If you're feeling overwhelmed, or unsure about what to try next, don’t hesitate to reach out—I’d love to help you troubleshoot or guide you toward what works best for your skin’s unique needs. Because glowing skin shouldn’t feel like a full-time job—even if you are the CEO of your bathroom mirror.

Treat your skin like a houseplant—water it right, give it the proper nutrients, and don’t forget to talk to it nicely. You've got this!!