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Preventing or Treating Acne Outbreaks

By Megan Griffith

Reviewed for medical accuracy by Dr. Jaggi Rao,
MD, FRCPC Double board-certified dermatologist

Do you spend hours and hours on skin care but still suffer sudden acne breakouts that seem to happen for no reason at all? The fact is, some of the things well-intentioned experts recommend for treating acne actually make it worse. Knowing what causes your breakouts is essential to stopping them.

acne outbreak
There are many things that can cause a sudden outbreak of acne like changes in temperature, taking antibiotics, and eating foods like dark chocolate.


  • A splash of alcohol on your face to disinfect acne may actually increase the production of skin oils.
  • Eating dark chocolate can cause acne breakouts of 4 to 80 pimples in less than a week.
  • Health conditions that increase testosterone production in women can trigger acne.
  • Testosterone injections in men can trigger a serious form of acne known as acne fulminans.
  • Sudden changes in temperature can trigger rosacea.
  • Oral antibiotics can trigger acne by killing bacteria in the colon that help keep inflammation in check all over the body.
  • Scrubbing the skin (which is not the same thing as using a skin scrub) can trigger acne.

1. Acne breakouts can be triggered by rubbing alcohol.

Rubbing alcohol, also known by its chemical name, isopropyl alcohol, is not unusual in many acne products. It cools the skin as it evaporates, and it leaves the skin feeling tingly. Many acne care products add alcohol to make it feel as if they cause a “skin healing action,” but the action of alcohol on the skin is usually anything but healing1.

Alcohol dries out the skin and kills skin cells in the delicate linings of pores. When the skin senses destruction of healthy tissue, it protects itself—by making more sebum. This can set off a cycle of cleansing and excess oil production2. You keep using the product, but it never does you any good.

2. Acne breakouts can be triggered by eating dark chocolate.

It used to be accepted as commonsensical truth that chocolate makes your skin break out3. Then commentators who didn’t entirely understand the issue reasoned that chocolate is rich in the amino acid arginine and that arginine activates herpes viruses, so what was really happening was the chocolate makes cold sores break out.

Chocolate actually does make cold sores break out, but a recent study at the University of Miami found that it makes pimples break out, too. As many as 80 pimples can break out after eating just three dark chocolate bars. The offending ingredient seems to be theobromine, which is also the constituent of chocolate that makes it, well, yummy. Dark chocolate is more of a problem than milk chocolate.

3. Acne breakouts can be triggered by hormonal changes, especially those related to testosterone.

Millions of women have a condition known as polycystic ovarian syndrome, or PCOS. This health issue may or may not involve cysts in the ovaries but it always involves a hormonal imbalance involving over-production of testosterone by the ovaries4. Excess testosterone makes the skin more sensitive to stress chemicals, which in turn increase skin oil production and create allergy-like symptoms in the skin even when there is no allergen to activate the allergy.

In men, testosterone injections sometimes cause a dangerous condition called acne fulminans5, involving not just the skin but also joints. In both cases, however, the secret to controlling acne is lowering testosterone. Usually women with PCOS respond to low-calorie diets, and men with acne fulminans begin to recover when they stop using steroids and testosterone.

4. Acne breakouts can be triggered by sudden changes in temperature.

Rosacea is a form of acne6 that comes on suddenly after changes in temperature. When the skin cools, blood vessels dilate. They take in more blood to bring it close to the skin so the bloodstream can bring the skin back down to the same temperature as the rest of the body. In rosacea, the linings of tiny capillaries in the skin over the cheeks and nose leaks, causing redness, or break, causing purple streaks. If you notice reddening or breakouts in the middle of your face after you are exposed to heat, you may help keep your skin clear by:

  • Covering your face when you go out in the cold, so it will not rewarm too quickly when you come back in.
  • Avoiding hot drinks and spicy foods, especially hot peppers, which activate a nerve at either side of the face that affects blood vessels.
  • Never, ever rubbing the skin with ice.
  • Avoiding drafts from either heaters or air conditioners.

5. Acne breakouts can occur after physically scrubbing the skin.

The kind of “scrub” that is used to treat acne does not involve mechanically rubbing or scrubbing the skin. An acne scrub refers to the use of a product that removes dead skin or particles of hardened oil from the skin by a very mild abrasive action—usually without the helping of working the product into the skin.

The reason not to scrub the skin with a washcloth, or, even worse, a brush, is that the skin protects itself by creating more sebum, and in turn the newly created sebum clogs pores. Scrubbing blemish-free skin has the effect of creating new blemishes.

6. Acne breakouts can occur after stress.

When we experience physical or emotional7 stress, the brain releases corticotrophin stimulating hormone8, which instructs the adrenal glands to make adrenalin. The skin can also release corticotrophin stimulating hormone, causing it to release histamine9, the same chemical released in an allergy attack. This reddens and irritates the skin, highlighting existing pimples, and blocking previously open pores.

7. Acne breakouts can be triggered by yeast infections.

Yeast infections sensitize the immune system. Sometimes the immune system is activated by a yeast infection to attack skin10 on the back, chest, and shoulder with tiny red blotches of psoriatic acne, also known as guttate psoriasis. Acne bacteria are not involved in the formation of these pimples. They are solely due to the action of the immune system in the skin. Treatment for this kind of acne usually requires the use of steroids, or waiting a considerable time for the skin to heal itself.

8. Acne breakouts can be triggered by either smoking or drinking.

Chinese researchers have found that Chinese teens, in particular, are more likely to have acne breakouts after a weekend of drinking11 and smoking12. Whether these findings are also valid for teens with other skin types remains to be scientifically determined, but it seems likely.

9. Acne can be triggered by a “stomach bug.”

The bacterium Helicobacter pylori is implicated as one of the causes of both stomach ulcers and the form of acne13 known as rosacea. Treating the stomach infection often clears up acne. You are most likely to be exposed to this bacterium if you have drunk tap water in Latin America, especially Nicaragua.

10. Acne can caused by oral antibiotic treatment.

Sometimes doctors prescribe oral antibiotics to treat acne. Ironically, these treatments sometimes make acne worse.

The colon is home for helpful, symbiotic bacteria like Lactobacillus. These bacteria interact with the immune system to reduce the production of inflammatory chemicals, keeping the skin clear14. Antibiotics taken to kill acne bacteria from the inside out have the undesirable side effect of killing helpful bacteria in the gut, and increasing skin inflammation at the same time they control skin infection.


  1. Dréno, B. , Bettoli, V. , Araviiskaia, E. , Sanchez Viera, M. and Bouloc, A. (2018), The influence of exposome on acne. J Eur Acad Dermatol Venereol, 32: 812-819.
  2. 10 skin care habits that can worsen acne | American Academy of Dermatology. 2019
  3. Chalyk N, Klochkov V, Sommereux L, Bandaletova T, Kyle N, Petyaev I. Continuous Dark Chocolate Consumption Affects Human Facial Skin Surface by Stimulating Corneocyte Desquamation and Promoting Bacterial Colonization. J Clin Aesthet Dermatol. 2018 Sep;11(9):37-41.
  4. Lerchbaum E, Schwetz V, Rabe T, Giuliani A, Obermayer-Pietsch B. Hyperandrogenemia in polycystic ovary syndrome: exploration of the role of free testosterone and androstenedione in metabolic phenotype. PLoS One. 2014 Oct 13;9(10):e108263.
  5. Perez M, Navajas-Galimany L, Antunez-Lay A, Hasson A. When strength turns into disease: acne fulminans in a bodybuilder. An Bras Dermatol. 2016 Sep-Oct;91(5):706.
  6. Picardo M, Eichenfield LF, Tan J. Acne and Rosacea. Dermatol Ther (Heidelb). 7(Suppl 1):43-52.
  7. Zari S, Alrahmani D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. 2017 Dec 5;10:503-506.
  8. Ranabir S, Reetu K. Stress and hormones. Indian J Endocrinol Metab. 2011 Jan-Mar;15(1):18-22.
  9. White MV. The role of histamine in allergic diseases. J Allergy Clin Immunol. 1990 Oct;86(4 Pt 2):599-605.
  10. Omran AN, Mansori AG. Pathogenic Yeasts Recovered From Acne Vulgaris: Molecular Characterization and Antifungal Susceptibility Pattern. Indian journal of dermatology. Medknow Publications & Media Pvt Ltd; 2018.
  11. Study: Alcohol consumption increases rosacea risk in women | American Academy of Dermatology [Internet]. 2019.
  12. Lynn DD, Umari T, Dunnick CA, Dellavalle RP. The epidemiology of acne vulgaris in late adolescence. Adolesc Health Med Ther. 2016 Jan 19;7:13-25.
  13. Yang X. Relationship between Helicobacter pylori and Rosacea: review and discussion. BMC Infect Dis. 2018 Jul 11;18(1):318.
  14. Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future? Gut Pathog. 2011 Jan 31;3(1):1.
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