Surprising Causes of Acne Breakouts! Hint: It’s not hormones or diet! As a board-certified Integrative Dermatologist, I’m always looking for how things are interrelated to the skin issue at hand. I look beyond the current skin condition for other interlacing factors that may be linked to the rash or breakout etc.

For acne, typically there are several things that can contribute to breakouts including hormones, nutrition, stress, skin care products etc. However, sometimes it’s not any of that!

I know!! What else could it be then….????

I have had several patients come into the office recently with these different type of acne breakouts. Thought I would challenge you a bit this week and see if you can be a good skin detective and figure out what is causing these breakouts.


Patient Number 1

Suzy* is a 42-year-old female that came into the office to see me to find solutions for acne breakouts she’s been struggling with for a several months and are getting worse. She had never really had any bad breakouts prior to this. She said at first the breakouts weren’t that bad and they seemed to come and go. But over time they seemed to be getting worse and staying longer. She said she had a really bad breakout last month and she saw another dermatologist and they prescribed her a low-dose oral antibiotic that helped her breakouts go away for some time, but they came back with a vengeance a week after she stopped taking the medication. She wanted to explore other options to treat her breakouts because she doesn’t want to rely on antibiotics to treat them. She also wonders why she only has a breakout on the left side of her face.

acne cartoon

When I examined her skin she had a large cluster of red pimples and pustules on just the left cheek and a little on the left chin…..the rest of her face was 100% clear!

Hmmmm….it’s quite unusual to have acne only on one side of the face….

I knew I could give her some guidance on how to dampen the pimples with different natural and prescription options, but we needed to dive a little deeper to find out what was triggering the one-sided breakouts.

I started asking some questions to see if we could figure out what was triggering such unique breakouts.

I asked her if she slept on her side or got a new pillow or sheets or changed her laundry products. I thought maybe she was triggering breakouts on one side of her face by sleeping on a new pillow or if her pillowcase was washed in new laundry products that maybe she was sensitive to. Acne-like allergic reactions can be confusing so I thought this would be a good possibility to explain her breakouts.

Well……she said no to all of these questions!

She sleeps on her back and has the same pillow and laundry products she’s had since before the breakouts started happening.

Next, I asked her if she leaned her head on her hand on that side of her face frequently and she said no to that question as well.

Suzy tried to think of any other things that may be triggers to her breakouts…..and then we figured it out…..

She has been talking on her phone more and holding it next to her face rather than using her earbuds. She lost her earbuds and just hasn’t had time to get new ones. She embarrassingly also admits that she always forgets to clean her phone.

BAM! That was it!

I gave her some topical prescription products to help heal her breakout faster, she was going to get some new earbuds, regularly clean her phone and stop holding the phone next to her face when she talks on the phone.

I just saw her back for a follow-up appointment in clinic and her breakouts are 100% resolved!


Patient Number 2

Braden* is a 14 year old that came in with his mom. He clearly did not want to be at the doctor’s appointment and was there because his mom made him come in.

Mom was very concerned because she’s been noticing that he’s been getting pimples in his ears and she read online that if you have acne in your ears that you may be prone to severe scarring acne on the face.

Braden’s dad had severe acne when he was a teenager and has a lot of acne scars from it that he’s self-conscious about. So naturally, Braden’s parents wanted to get a head start on treating his acne early and certainly before it started scarring.

Braden is a handsome boy and his face, chest, back and shoulders are 100% clear of acne. No signs of any teenage acne starting in the usual places! Hmm…

In his right ear, he had a large red pimple and in almost the same exact place in the left ear he had a pink flat spot where one had been there a week ago and was now healing.

Typically, when teenagers start with acne we see some evidence of it on the face. If we see acne in the ears, usually there are blackheads in the ears and maybe some of the red pimple bumps.

Braden just had red pimples in each ear, no blackheads in ear and no other evidence of teenage acne.

Any ideas???

Well….Braden was holding the culprit in his hands….


When he got into the room, his mom made him take out his earbuds and he was holding them in his hands. His earbuds were causing his ear pimples!

He said he’s never even thought of cleaning them. He carries them in his pocket or throws them into bottom of his backpack when he’s not using them. He tends to leave them around the house in random places too and mom finds them frequently on the bathroom counter.

Those earbuds get exposed to lots of bacteria, dirt, etc and then we use our unclean fingers to place them in the ear and they tend to sit tightly on the skin of the ear. The combination of various microbes and the dark, moist environment create the perfect set-up for the immune system to come and create a red, inflammatory pimple to attack the microbes that typically aren’t part of the microbiome of the ear.

The quick solution of this is just modifying the hygiene and care of earbuds and our hands.

We recommended that he is mindful that he washes his hands frequently and regularly clean his earbuds. When they are not being used, we advised placing them in a container that is also cleaned regularly.

We also went over some basic acne prevention and advised him to use a gentle cleanser to wash his face twice a day, eat healthy and to watch for clogged pores and pimples on the face and to come back if he starts breaking out there as we’d like to catch his acne early.


Patient Number 3

Claire* is a 20 year old female who is a full-time college student. She’s home for a break and her mom noticed that her back and face were breaking out.

Claire is a long-time patient of mine and her acne has been very well controlled for years with nutrition and topical prescription medications so it was quite unusual for her to have breakouts these days.

Claire said she’s only been breaking out for a few weeks and she’s been very good about her nutrition and using her topical medications and doesn’t feel like she’s more stressed than usual and she couldn’t figure out why she was breaking out again.

I took a close look at her skin and she had lots of little pimples all about the same size across her forehead, sides of her face, and on her upper back. The center part of her face, her chest and lower back were 100% clear. She said she’s putting the topical medications on her breakouts but it’s not helping and she feels it just keeps getting worse.

There had to be something triggering her breakouts in these very specific areas of her skin.

If you stood back and examined her, you could then see that the areas where she has the breakouts are the exact same areas where her hair was touching her face!

So I asked her if she started doing anything different to take care of her hair……

She paused for a minute and said she has the same shampoo and conditioner she’s always used and she doesn’t put any other products in her hair to style it.

Hmmm…..well there goes that theory.

And then she suddenly got really excited and said YES! There is something different I’ve been doing with my hair!

Her best friend had started using a hair mask on her hair to help with dry hair and her friend’s hair looks so good after she started doing the hair mask, Claire decided to try it too. She said she leaves it on overnight with wet hair and washes it out in the morning. The breakouts were exactly where her hair mask covered her skin on her back, forehead and sides of the face!

wet hair

Easy fix!

She was going to just change the time of day when she does the hair mask treatment to the daytime and not sleep with the conditioning mask on her hair. She was also going to wear her hair up when she does the treatment and make sure none of her hair touches her face or back….and if that didn’t help she was going to stop using that product.

Well, I hope you had fun trying to figure these out! Keep your phones and earbuds clean and watch for reactions from hair care products on your skin!