Why does acne develop?

Acne develops through four interacting mechanisms: excess sebum production, follicular hyperkeratinisation (the pore becoming blocked), colonisation by Cutibacterium acnes bacteria, and inflammation. Hormonal fluctuations — particularly androgens — drive sebum production, explaining the prevalence of acne during puberty, around menstruation, and in conditions such as PCOS. Genetic factors influence sebaceous gland sensitivity. Diet, stress, certain medications, and skincare products can all influence acne severity.

Does diet affect acne?

Evidence has strengthened for a dietary influence on acne, particularly for high-glycaemic foods and dairy. Diets high in refined carbohydrates and sugar raise insulin and IGF-1 levels, which stimulate sebum production and inflammation. High dairy intake — particularly skimmed milk — has been associated with increased acne risk in several studies, possibly through hormonal growth factors in milk. A low-glycaemic, plant-forward diet may benefit some people with acne, though individual responses vary.

What is the psychological impact of acne?

The psychological burden of acne is frequently underestimated. Research consistently shows that people with moderate-to-severe acne have rates of anxiety, depression, and low self-esteem comparable to those with chronic medical conditions. Social withdrawal, avoidance of physical contact, reduced willingness to pursue relationships or opportunities, and significant preoccupation with skin appearance are all documented. Addressing the psychological dimension — not just the physical — is an important component of comprehensive acne care.

When should acne be treated by a dermatologist rather than managed at home?

Seek professional assessment for: moderate-to-severe acne (widespread inflamed pustules, nodules, or cysts); acne that is not responding to three months of consistent over-the-counter treatment; acne producing significant scarring; acne with a major psychological impact; or acne associated with other symptoms of hormonal imbalance (irregular periods, excess facial hair, or rapid weight change). Early intervention reduces the risk of scarring, which is much harder to treat than active acne.

Skinlow Risk

Acne vulgaris

Acne vulgaris develops when hair follicles become blocked with sebum and dead skin cells, creating spots, blackheads, and cysts influenced by hormones, bacteria, diet, and stress. Nutritional therapy, gut microbiome supp

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Reviewed by Dr. Ciara Magee · Integrative Midwifery26 March 2026Emerging evidence

Quick answer

Do any of these feel familiar?

Acne vulgaris is most frequently experienced as a mix of blocked pores, inflamed spots, and sometimes deeper, painful cysts — particularly on the face, chest, and back
The physical discomfort ranges from mild to significant, but the psychological impact often far exceeds the physical
Many people describe heightened self-consciousness, avoidance of photographs, reluctance to socialise without makeup, and a preoccupation with skin that occupies considerable mental energy
Acne can profoundly affect self-esteem during formative years
The unpredictability of flares — often triggered by hormonal changes, stress, or diet — adds a layer of frustration to what is already a distressing experience

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Hormonal Imbalance

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