Acne: Causes, Treatments, and Mental Health

Medically reviewed by Elizabeth Erban, LMFT, IMH-E
Updated January 10, 2023by BetterHelp Editorial Team

Acne is a commonly experienced skin condition. In fact, it’s the most common skin condition in the United States! About 85% of people between the ages of 12 and 24 experience acne at some point--so if you’re currently dealing with acne, know that you’re not the only one. If you need support over acne-related self-consciousness, reaching out to an online therapist is a great way to get help.

What Causes Acne?

A breakout occurs when pores called sebaceous glands (or sometimes hair follicles) are blocked. Whiteheads and blackheads are the most common and least severe forms of acne. Meanwhile, papules, pustules, cystic acne or lesions, acne vulgaris, and nodules are more severe. Acne is commonly referred to as pimples or zits and a doctor can usually diagnose acne just by looking at your skin.

There are several different causes of acne. These include:

  • Genetics

  • Hormonal changes (such as puberty and pregnancy)

  • Excess production in oil glands

  • Inflammation

  • Bacteria

  • A diet with lots of refined sugars and carbohydrates

  • High stress levels

  • Certain medications (like birth control and corticosteroids)

  • Use of oil-based cosmetics

  • Ineffective skincare

  • Musculoskeletal and skin diseases

  • Skin cancer

There are plenty of ways that those little pink bumps can be treated, both at home and by a dermatologist.

How Is Acne Treated?

Most cases of acne can be resolved using over-the-counter treatments and basic lifestyle adjustments.

Over-The-Counter Topical Solutions

Some of the most effective products to treat moderate acne contain salicylic acid and benzoyl peroxide. You can find all sorts of affordable products with these active ingredients at your local drugstore. Keep in mind that a little goes a long way! If you use a salicylic acid cleanser followed by a salicylic acid toner and then add a salicylic acid gel on top, you’re only going to irritate the surface of the skin more and potentially clog pores, making your acne worse. 

Instead, apply topical solutions in a thin layer underneath your moisturizer. Yes, you should be using moisturizer! It might seem counterintuitive to moisturize when your face is oily, but if you don’t use moisturizer, your skin will produce even more oil to compensate for the dryness created by topical solutions like benzoyl peroxide and salicylic acid.

Typically, the best skincare routine for mild to moderate acne is to wash your face using a gentle cleanser in the morning and follow up with an oil-free moisturizer. At night, carefully remove any makeup, and then wash your face using the same gentle cleanser. Apply a thin layer of your acne-fighting topical solution of choice (typically one containing salicylic acid or benzoyl peroxide) and complete your skincare routine with an oil-free moisturizer.

If you like to wear makeup, don’t worry; you don’t have to give it up! You can still use cosmetics as long as they are oil-free and non-comedogenic. One helpful resource is cosDNA, a website where you can type in any of your skincare products or cosmetics to check them for acne-causing ingredients. Of course, make sure to remove your makeup every night before bed.

Long hair that touches your face should be shampooed regularly, and you may want to tie it back so that any oils from your hair aren’t transferred to your face. Try to avoid wearing hats and tight headbands, which can trap dirt and oil against your skin and lead to breakouts. It’s also a good idea to avoid touching your face as much as possible, and don’t pop or pick at your pimples. This can slow down the healing process and lead to developing acne scars.

Lifestyle Changes

Aside from skincare, there are some changes you can make to your lifestyle that will make you and your skin healthier overall. Firstly, when you’re dealing with acne, you’ll want to make sure to change your pillowcase once or twice a week. Bacteria and oil build up on pillowcases very quickly, so changing your pillowcase is a simple and easy way to combat any breakouts that are caused by resting your face on a bacteria-filled pillow. It’s also important to clean your phone on a regular basis.


Making sure to drink lots of water will not only keep you hydrated, but it also promotes clear skin. Green tea is another great drink that contains antioxidants and reduces inflammation. Plus, it contains caffeine, but not enough to make you feel wired and jittery. Replacing coffee and soda with green tea and water can make a difference in your skin’s health.


When it comes to the food you eat, try to eat sugary and carbohydrate-dense foods in moderation. Whole grains, fruits, vegetables, nuts, and seeds are all great options when you’re in search of a snack. Healthy fats like the ones found in eggs and fatty fish are also awesome additions to your diet.


Staying active and getting plenty of exercise can also contribute to better health. You don’t have to do hardcore workouts; just taking a walk, shooting a few hoops, or dancing to your favorite music is enough. Try to get your body moving on a daily basis. However, if you work up a sweat, wash your face immediately afterward so that the sweat doesn’t clog your pores.

Stress Management

Managing stress is very important while dealing with acne. This can definitely be a challenge and can sometimes turn into a vicious cycle: You break out, feel stressed about breaking out, the stress makes your breakout worse, and then you get even more stressed. That’s why it’s essential to take control of your stress by using healthy coping mechanisms. These can range from getting exercise to taking a walk to journaling about your feelings. Meditation and mindfulness are also amazing tools to employ.

Dermatological Solutions

If you feel like you've tried every at-home acne treatment but aren't seeing improvement, there are still options for you! It'll be necessary to see a dermatologist to determine which acne medication is the best choice. Dermatologists will often start off with prescription-strength topical creams like adapalene cream, tretinoin, retinoic acid, and high concentrations of benzoyl peroxide. There are many other topical creams used for treating acne, as well.

Sometimes, dermatologists will also prescribe oral antibiotics to take in addition to using topical solutions for moderate to severe acne. Many of these antibiotics can cause an upset stomach, so it's generally best to take them with food, and it may be best for you to take them at night so that any side effects don't interfere with your daily responsibilities. Always speak to your dermatologist regarding medications and side effects.

Depending on your age, dermatologists may recommend birth control pills or spironolactone for girls with acne. These acne treatments control the hormones that can develop acne.

A final option is isotretinoin, which is often referred to by its previous brand name, Accutane. This is a Vitamin A-based medication, and it's generally only used for very severe cases of acne because it can have serious side effects and even worsen acne if used improperly.

How Does Acne Affect Mental Health?

Acne affects more than just your skin. Numerous studies have shown that acne has effects on mental health as well. These effects range from low self-esteem and poor self-image to depression and anxiety. Many people with acne also report decreased quality of life and a feeling of being all alone. It’s common for people who have acne to feel self-conscious, embarrassed, and unattractive.

Acne doesn’t have to be severe for people to experience mental health effects. Even mild to moderate acne can cause distress, especially in teenage girls. Fortunately, there are ways to treat mental health problems like low self-esteem, anxiety, and depression.

How Can You Remain Confident While Dealing with Acne?

If you have acne, know that it does not affect your worth. You are still a person who deserves happiness and fulfillment. 

But it’s easy to disregard statements like these when you’re experiencing acne. That’s why it’s essential to bring in a mental health professional if your acne is causing mental health problems. There’s even a field called psychodermatology, which examines the link between skin conditions and mental health. Psychodermatology provides dermatological solutions alongside psychological support such as Cognitive Behavioral Therapy. But even if you’re not able to find a psychodermatologist near you, a counselor or therapist can provide the help you need.

Talking with a counselor can lift your confidence and improve your self-esteem. A mental health professional can help you knock out negative thought patterns and replace them with more positive ones. They can also assist you in finding stress management techniques that work for you--and in most cases, reduced stress leads to reduced acne.

Although you may think holing up in your room until your skin clears is the best option, don’t let acne keep you from enjoying life! Try to get out of the house regularly and keep up communication with friends and loved ones. You can also talk to people you trust about your feelings surrounding acne. You’re likely to find that the people who are important to you don’t look at you any differently just because of a few pimples.

Online Therapy For Those With Acne

At the end of the day, self-worth comes from within. Try making a list of your accomplishments and positive attributes, and reread it whenever your skin has you feeling down. Remind yourself that acne is temporary, but your character is not. As stressful and upsetting as acne can be, trust that it will clear up eventually--and until then, you can still find confidence within yourself.

If you’re experiencing acne that’s led to mental health issues, don’t hesitate to reach out to a mental health professional for help. BetterHelp (18+) or TeenCounseling (13-19) are both great places to get started, and you don’t even have to leave the house! While online therapy does not replace medical advice from your doctor, your therapist can provide a listening ear and help you work through the stress and emotions surrounding your acne experience. They can also suggest effective methods for managing stress and other challenging emotions while aiding you in improving your self-esteem and confidence.

Additionally, online therapy has been proven to be just as effective as in-person therapy for a variety of mental health conditions, including mood disorders associated with self-worth and self-esteem. Online therapists have the same level of training and experience as in-person therapists, so offer the same level  of professional assistance.

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Acne is an incredibly common skin condition that affects people of all ages and lifestyles across the world. While some acne can be managed with simple lifestyle changes, other cases may require medical attention. Regardless of the severity of your acne from a medical perspective, if you feel that it is impacting your mental health, consider speaking with a professional to help you regain your confidence and build your self esteem.

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