When a breakout or blemish appears on your skin, it can be difficult to determine the cause. While some cases of acne are hormonal, there are other factors, including bacterial infections, that can also contribute to acne. To complicate matters more, they are not mutually exclusive and your acne can be both hormonal and bacterial.

Board-certified dermatologist, cosmetic surgeon and Mohs surgeon, Dr. Daniel Schlessinger explains, “While mild acne or scattered comedones and blackheads are often the result of a hormonal imbalance or clogged pores, many, many cases of acne are actually caused by bacteria or yeast living on the skin.”

Navigating such a common, yet complex skin condition like acne can be challenging, but scheduling a visit with a board-certified dermatologist is your first step to understanding the source of your breakouts and how best to treat them.

In this article, we’ll explore the key differences between various types of acne, how common sources of bacteria can contribute and help you understand how to identify, manage and treat these skin conditions properly.

Common causes of acne and skin infections

There are many causes of acne, including hormonal changes, skin hygiene, hereditary factors and skin infections. Acne forms when pores in the skin are exposed to bacteria, like Propionibacterium acnes, and/or become clogged with excess oil and dead skin cells. Since acne-causing bacteria can be found on everyday surfaces, there are many reasons for acne to occur on the face or body. Determining if acne is hormonal, bacterial, fungal, or a combination depends on the symptoms.

​​Dr. Daniel Schlessinger, a board-certified dermatologist, as well as Mohs surgeon and cosmetic surgeon, explains, “Hormonal acne is caused by shifts in hormone levels, often triggered by puberty, menstruation, pregnancy or certain medications. Bacterial acne often occurs after contact sports like wrestling, working out in an unclean gym or even after a visit to a hospital or nursing home. Yeast (or fungal) acne is also very common and can occur in individuals who sweat more frequently. However, there are times when the source of the infection remains unknown.”

Dr. Joel Schlessinger highlights the prevalence of bacterial skin infections, saying, “These infections are very common and can happen to anyone, especially if you’ve been in contact with germs or your skin barrier has been injured or broken. Practicing good hygiene like frequent (but not too frequent) handwashing, disinfecting and covering wounds and being mindful of what you touch throughout the day can help reduce the risk of infection.”

Understanding your acne

The symptoms of acne can vary from mild to more severe, depending on the type. Most people are familiar with pimples, which are small, red, inflamed bumps on the skin. You may also experience blackheads, which occur when pores are clogged with oil and dead skin cells but remain open, giving them a dark appearance. In contrast, whiteheads form when these clogged pores are sealed, creating small white bumps. 

Nodules or cystic acne are deep, often painful, bumps that can lead to scarring if not properly treated. It’s important to remember that acne can appear on many different parts of the body, not just the face. Body acne may occur on the back, chest or shoulders.

Hormonal acne often presents as painful, red cysts and often appears on the lower half of the face, including the jawline and chin. Bacterial acne tends to appear on the surface of the skin in the form of pimples or pustules and pops up in oilier regions of the face like the forehead or cheeks. Yeast acne usually looks like numerous tiny, whitish bumps on the face, chest and/or back.

More seriously, a skin infection might exhibit similar symptoms to acne initially, but an infection may feel warm, itchy or painful. Skin infections can occur alongside acne, especially if bacteria enter the skin through an open blemish, but they can also appear on healthy skin. If the infection spreads, you may notice additional symptoms like fever or chills. Acne that appears suddenly in people who are well past the typical age of acne likely have an infection and obtaining a bacterial culture may be something your dermatologist does when you visit their office.

Dr. Daniel Schlessinger explains, “Under rare circumstances, bacterial infections can impact deeper layers of skin and even enter the bloodstream if left untreated. If you notice any of these signs, especially fever, a streak emanating from a cyst or more widespread redness, it’s important to seek medical advice to prevent complications.”

Everyday sources of acne-causing bacteria

It’s easy to overlook some of the daily tasks that may contribute to breakouts. In fact, many common activities and environments can expose your skin to harmful bacteria or irritants that exacerbate breakouts.

Hitting the gym is great for your health, but it can also pose unexpected risks to your skin if you’re not careful and the gym isn’t cleaning equipment regularly. Avoid touching gym equipment and then touching your face or body, especially while sweating. This can transfer bacteria to the skin, contributing to acne. 

Dr. Daniel Schlessinger says, “Using a body wash with sodium hypochlorite, like the CLn Sportwash, can be very beneficial for reducing bacterial infections after playing sports or working out at the gym, as well as for anyone experiencing “bacne” or folliculitis.” 

Other common culprits include dirty makeup brushes, which are a breeding ground for bacteria if not cleaned often, unwashed pillowcases, and environmental factors, including pollution and humidity. Dietary choices, such as cow’s milk, which may contain hormones, can also contribute to acne. 

Also, protein shakes and muscle building supplements can cause acne due to the hormones these often contain. Testosterone, in both the injectable and topical forms, can cause significant acne, particularly on the back. Oftentimes, an adjustment of dosage on testosterone can greatly improve acne. Finally, picking at your blemishes not only makes acne worse but also introduces bacteria into the open skin, potentially leading to an infection or scarring.

Dr. Joel Schlessinger suggests, “Simple changes like regularly cleaning your makeup tools, avoiding touching your face during workouts and sports activities, and ensuring that gym equipment is cleaned regularly before use can greatly reduce the risk of exposure to acne-causing bacteria.”

Finding the right treatment

Effective treatments are available to help treat acne and eliminate bacteria on the skin. For mild acne, topical treatments formulated with salicylic acid or glycolic acid can provide exfoliation to help unclog pores. LovelySkin LUXE Acne Care Gel 9%, which contains a blend of amino-based filaggrin antioxidants, called afaLUXE, improves skin’s ability to retain moisture while gently exfoliating skin. Great for oily, acne-prone skin, it eliminates existing blemishes while working to prevent future breakouts from forming.

Looking for the best face wash for hormonal acne? We recommend LovelySkin LUXE Clarifying Gel Cleanser, which gently exfoliates the skin with acne-fighting salicylic acid, glycolic acid and afaLUXE. Vitamin C and Dead Sea minerals nourish and rebalance the skin.

Dr. Daniel Schlessinger explains, “There are many effective over-the-counter acne treatments that can help treat and prevent breakouts. It’s important to keep in mind that patience and consistency are key to achieving long-term results. However, if acne persists or becomes painful, it’s best to see a dermatologist for professional acne treatment as soon as possible.”

If bacteria is determined to be contributing to your acne, the treatment path is a little different. Dr Joel Schlessinger explains, “In some cases, antibiotics are necessary to treat the underlying source of bacteria that is contributing to your acne. Antibiotics can be very effective, but it’s important to know what is being treated and treat it for the full course.”

Achieving a healthy complexion

When you’re dealing with acne, it’s important to remember these conditions are very common and manageable, and you don’t have to face them alone. At Schlessinger MD, our providers will carefully examine your skin to determine the cause and recommend the best course of treatment for your specific needs.

Our board-certified dermatologists may suggest over-the-counter treatments, prescribe antibiotic pills or recommend prescription-strength options to address more severe skin infections or painful cystic acne.

If you’re struggling with acne or unsure if you have a bacterial skin infection, you can easily reserve an appointment with Drs. Joel and Daniel Schlessinger or one of our physician assistants by visiting our appointment page and booking online.

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