Acne: Prevention, Diagnosis, and When to See a Doctor
Acne is the most common skin condition in the United States, and it does not stop at the teenage years. Gym-goers often notice flare-ups linked to sweat, friction, diet or, in some cases, hormones and performance-enhancing substances. Our editorial team explains what drives acne, what prevention actually works, how doctors assess it, and the warning signs that mean it is time to book an appointment.
How acne develops
Acne is a disease of the pilosebaceous unit, the combination of a hair follicle and its oil gland. Four processes work together: excess sebum production, abnormal shedding of skin cells that clogs the follicle, overgrowth of the bacterium Cutibacterium acnes, and inflammation.
Androgens are the main hormonal driver of sebum production. That is why acne typically begins at puberty, why it can flare around menstrual cycles, and why any situation that raises androgen activity, from polycystic ovary syndrome to anabolic steroid use, tends to worsen it.
Clinically, acne lesions are divided into non-inflammatory comedones (blackheads and whiteheads) and inflammatory lesions such as papules, pustules, nodules and cysts. Deep nodules and cysts carry the highest risk of permanent scarring.
According to the American Academy of Dermatology, acne affects up to 50 million Americans each year. While most cases are mild, the psychological impact can be significant regardless of severity, and that alone is a valid reason to seek care.
Triggers relevant to active people
Friction and occlusion from helmets, chin straps, tight synthetic clothing and backpacks can cause a form called acne mechanica. It often appears on the forehead, shoulders and back of athletes and improves when the source of pressure is reduced and sweat is removed promptly.
Diet has a modest but real role. Observational studies and some controlled trials link high-glycemic-load diets and, less consistently, dairy intake, particularly skim milk, to acne. Whey protein supplements have been associated with acne flares in case series, although controlled evidence remains limited.
Anabolic-androgenic steroids are a well-documented cause of severe acne, including the rare but serious acne fulminans. Testosterone and its derivatives sharply increase sebum output, and dermatologists often recognize steroid-related acne by its sudden onset on the chest and back of adult men.
- Sweaty gear left on for hours after training
- Helmets, straps and tight compression clothing
- High-glycemic diets and, for some people, dairy or whey
- Androgenic substances, including testosterone and other steroids
- Some medications such as corticosteroids, lithium and certain anticonvulsants
Stress and poor sleep can worsen existing acne, though they are rarely the sole cause.
Prevention and everyday care
Gentle cleansing twice daily and after sweating is the foundation. Harsh scrubs and frequent washing with strong soaps irritate the skin and can make inflammation worse. A mild, non-comedogenic cleanser and moisturizer are usually enough.
Over-the-counter options in the US include benzoyl peroxide, salicylic acid and adapalene, a retinoid the FDA approved for non-prescription use in 2016. Benzoyl peroxide reduces bacteria without promoting antibiotic resistance, while adapalene normalizes skin-cell turnover and helps prevent new comedones.
| OTC ingredient | Main action | Common side effects |
|---|---|---|
| Benzoyl peroxide | Antibacterial, mild peeling | Dryness, bleaching of fabrics |
| Salicylic acid | Unclogs pores | Mild irritation |
| Adapalene 0.1% | Normalizes follicle shedding | Dryness, redness in first weeks |
For athletes, practical steps include showering soon after training, washing gear regularly, placing a clean cotton layer between skin and equipment, and avoiding picking or squeezing lesions, which increases scarring risk.
Patience is essential. Topical treatments typically need eight to twelve weeks to show their full effect, and many people quit too early.
How doctors diagnose and grade acne
Acne is diagnosed clinically, by looking at the skin. A dermatologist will note the type and number of lesions, their location and any scarring, and will classify severity as mild, moderate or severe. The American Academy of Dermatology 2024 guidelines base treatment choices on this assessment.
The doctor will also consider conditions that mimic acne, such as rosacea, folliculitis, including fungal folliculitis common in athletes, and perioral dermatitis. Getting this distinction right matters because treatments differ.
When hormonal causes are suspected, for instance in women with irregular periods, excess hair growth or sudden adult-onset acne, blood tests for testosterone, DHEA-S and other hormones may be ordered. In men with abrupt, severe truncal acne, a doctor may ask directly about steroid or testosterone use.
Prescription treatments include topical retinoids and antibiotics, oral antibiotics such as doxycycline, hormonal therapy for women, and isotretinoin for severe or scarring acne. Isotretinoin is distributed in the US under the FDA iPLEDGE program because it causes serious birth defects.
When to see a doctor
Mild acne that responds to over-the-counter products within two to three months can usually be managed at home. If there is no improvement after that period, a primary care physician or dermatologist can offer stronger options.
Painful nodules or cysts, any scarring, or dark marks that persist should prompt an earlier visit, because the goal is to prevent permanent damage rather than repair it later.
Sudden, severe acne with fever, joint pain or ulcerated lesions may indicate acne fulminans and requires urgent medical attention. This picture has been reported in association with anabolic steroid use and isotretinoin initiation.
Finally, acne that significantly affects mood, confidence or social life is reason enough to seek care. Effective treatment exists, and there is no benefit in waiting.
Editorial team conclusions
Acne is driven by sebum, clogged follicles, bacteria and inflammation, with androgens acting as the main hormonal amplifier.
Simple measures, including gentle cleansing, prompt post-workout showers, clean gear and evidence-based OTC products, control most mild cases.
Sudden severe acne in adults, particularly on the chest and back, warrants an honest conversation with a doctor about hormones, supplements and any performance-enhancing substances.
Readers interested in this topic may also find our editorial articles on DHT testing, on hormonal side effects of anabolic steroids, and on whey protein and skin health useful.
References
- Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1–1006.e30.
- Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–973.e33.
- Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet. 2012;379(9813):361–372.
- Melnik B, Jansen T, Grabbe S. Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. J Dtsch Dermatol Ges. 2007;5(2):110–117.
- Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007;86(1):107–115.
- Adebamowo CA, Spiegelman D, Danby FW, et al. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005;52(2):207–214.
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