What Really Causes Acne - And What Actually Clears It, According to a San Diego Dermatologist

If you are dealing with persistent acne, you are not alone. As a dermatologist in Encinitas and San Diego, I see patients every single week who have tried every cleanser, cream, and 'miracle' product on the market - and are still breaking out. Here is what is actually happening in your skin, and more importantly, what we can do about it.

What Is Acne - Really?

Acne is not caused by dirty skin. This is one of the most damaging myths in dermatology. Acne is a complex inflammatory condition involving four main factors: excess sebum (oil) production, clogged pores (comedones), overgrowth of a bacteria called Cutibacterium acnes, and your immune system's inflammatory response.

What Triggers Acne Breakouts?

In my practice, the most common triggers I see are:

• Hormonal fluctuations - especially androgens, which drive oil production. This is why acne spikes during puberty, menstrual cycles, pregnancy, and perimenopause.
• Diet - high-glycemic foods and dairy (particularly skim milk) have strong clinical evidence linking them to acne flares.
• Stress - cortisol triggers sebaceous glands to produce more oil.
• Certain medications - including steroids, lithium, and some birth control formulations.
• Occlusive products - heavy moisturizers and certain sunscreens can trap oil and bacteria against the skin.

What Are the Most Effective Acne Treatments in 2026?

The right treatment depends entirely on your acne type and severity. Here is how I approach it:

• Mild comedonal acne: Topical retinoids (tretinoin or adapalene) are the gold standard. They normalize cell turnover and prevent pores from clogging.
• Moderate inflammatory acne: Combination therapy - topical retinoid plus benzoyl peroxide or a topical antibiotic. Often paired with azelaic acid for patients with darker skin tones prone to hyperpigmentation.
• Severe/cystic acne: Oral isotretinoin (Accutane) is the most effective long-term solution. For women, spironolactone can be remarkably effective by addressing the hormonal root cause.
• Acne scarring: Once active acne is controlled, we address scarring with fractional laser resurfacing, microneedling with PRP, or chemical peels depending on scar type.

When Should You See a Dermatologist for Acne?

If over-the-counter products have not produced improvement within 8 to 12 weeks, if you have cystic or nodular acne, or if your acne is leaving scars or dark spots - please do not wait. Early, targeted treatment prevents scarring, which is far more difficult to treat than the acne itself.

Frequently Asked Questions

Q: Does diet cause acne?
A: Yes - with caveats. High-glycemic foods and dairy have the strongest evidence. I recommend a low-glycemic diet as part of every acne treatment plan.

Q: Can adults get acne?
A: Absolutely. Adult acne is increasingly common, particularly in women in their 30s and 40s. Hormonal fluctuations and stress are the main drivers.

Q: How long does acne treatment take to work?
A: Most topical retinoids take 8–12 weeks to show meaningful results. Do not stop early - the improvement continues for 6 months or longer.

Q: Does washing your face more often help acne?
A: Over-washing can actually worsen acne by stripping the skin barrier and triggering more oil production. Twice daily with a gentle cleanser is ideal.

- The content of this article is educational only and does not constitute medical advice.
- Please consult your dermatologist for diagnosis and personalized treatment recommendations.

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