Why Acne Can Become Chronic
Acne starts when pores in your skin get clogged, but it turns chronic when this clogging keeps happening over months or years without clearing up. This ongoing problem affects many people beyond their teenage years, leading to repeated breakouts on the face, back, chest, or shoulders.
One main reason acne sticks around is too much oil, or sebum, from glands under your skin. Hormones like androgens make these glands produce more oil or become extra sensitive to normal hormone levels. This extra oil mixes with dead skin cells, blocking hair follicles and creating blackheads or whiteheads. Over time, if the oil keeps flowing heavily, pores stay blocked and acne worsens.
Another factor is unusual skin cell growth inside the follicles. Normally, skin cells shed gently, but in acne, they pile up too fast and stick together. This narrows the pore openings, trapping oil and bacteria. When this hyperkeratinization, as experts call it, continues unchecked, it sets up a cycle of clogs that does not break easily.
Bacteria play a big role too. Cutibacterium acnes, a common skin bacteria, thrives in these oily, blocked pores. It breaks down oil into irritating fatty acids and forms protective biofilms that shield it from treatments. Not everyone with this bacteria gets acne, but certain strains or changes in the skin’s microbiome make it more harmful in some people. Stress can make this worse by boosting oil production and skin cell shedding through hormone signals.
Inflammation keeps the cycle going. Once pores rupture, bacteria and debris leak into deeper skin layers, triggering immune cells like macrophages and neutrophils. This causes red bumps, pus-filled pimples, nodules, or cysts. Chronic low-level inflammation can linger, damaging skin and making healing slow.
Genetics add to the risk. If your family has a history of acne, you are more likely to have it last longer. Oily skin types and hormonal shifts in adolescence or adulthood fuel persistence. Lifestyle elements like diet, humidity, certain cosmetics, or even friction from clothing and sports gear can tip the balance, keeping pores imbalanced in the same spots.
In sensitive skin, environmental triggers or product reactions spark extra inflammation, making acne harder to shake off. Even after treatment, if root causes like hormone sensitivity or bacterial shifts remain, breakouts return.
Sources
https://pmc.ncbi.nlm.nih.gov/articles/PMC12735603/
https://www.mims.com/malaysia/disease/acne-vulgaris/disease-background
https://suganda.co/blogs/skin-journals/what-is-acne-and-what-causes-acne
https://consciouschemist.com/blogs/good-skin-blog/why-you-keep-getting-pimples-in-the-same-spot-and-how-to-stop-it
https://worldofasaya.com/blogs/acne/how-to-identify-which-skin-type-causes-pimples
https://pmc.ncbi.nlm.nih.gov/articles/PMC12732949/
https://www.dermatologytimes.com/view/balancing-pathophysiology-and-patient-lifestyle-in-acne-management-part-2
