The Cause of Acne

Acne has nothing to do with your dirty hands, greasy foods, or unwashed pillows. Total BS. I hypothesize that acne is caused primarily by the stretching or squeezing of the skin. Stretching the skin leads to the formation of whiteheads, or what I call "fluid pimples." Squeezing the skin leads to blackheads, or what I call “solid pimples.” So why hasn’t this simple explanation been suggested before? Because pimples typically appear ~24 hours after the triggering action and such small everyday actions are forgotten by then.

More specifically, whether a pimple forms or not depends on three factors:

1. Frequency of stretching or squeezing,
2. Amount of force applied, and
3. Elasticity of the individual's skin.

Mud as an Analogy

Think of skin like mud. If you stick your hand into mud and swipe across, a void forms and eventually it fills with water. This is a demonstration of a fluid pimple. If you press mud together, water seeps out and the mud solidifies. When it comes to skin, the force applied from a single finger is enough to cause a pimple.

Skin elasticity varies by person, however. Some people have tight skin, others have loose or flabby skin. This is determined by genetics and lifestyle. This human variation helps explain why a strong squeeze might trigger pimples in one person but not another. In my view, looser skin is more vulnerable to acne caused by physical manipulation.

By merely considering the location of a pimple, I believe I can determine the specific action from 24 hours earlier that caused it to form.

External Triggers: The Hands

One common spot for fluid pimples is the jawline. I propose this is frequently caused by resting your head in your hand. This action pushes the skin upward—repeatedly and forcefully—stretching that results in whiteheads. It is worth noting that the pimples don’t sprout where your hand touched the face, but where the skin was stretched the most.

A fluid pimple on the nose? This is due to repeated, forceful nose-picking. This stretches the skin on the outside of the nose, and the pimple appears on the same side that was picked.

Styes are fluid pimples on the eyelid margin. These are the result of continually dragging down the corners of the eye using the fingers. This action does not involve touching the upper eyelid but rather stretching, thus causing a pimple on the rim.

Recurring Acne

Popping pimples can lead to a vicious cycle of recurring acne. Because when a pimple is popped, the skin surrounding the pimple is stretched, thereby possibly causing more pimples to form. This is likely why the myth that acne spreads via germs is so popular. The age-old advice to avoid touching your face remains valid—not because of bacteria, but because touching stretches and squeezes the skin.

Internal Forces: Muscle Growth

In the majority of cases, acne is be triggered by internal forces—specifically, muscle hypertrophy. When a muscle grows suddenly, the skin on top of it is stretched suddenly. For example, eating something very tough, like sourdough bread, can cause a pimple to form on the side of the face 24 hours later. The act of chewing utilizes the masseter muscle, which—under a heavy load—can grow in size like any muscle of the body, which would expand and stretch the skin, producing a pimple.

The same applies to forehead acne. Raising your eyebrows activates the frontalis muscle. With enough vigor and frequency, hypertrophy occurs, skin stretches, and a pimple forms.

My theory also explains acne in people using anabolic steroids. It’s not the steroid itself that causes acne, but the rapid muscle growth. Similarly, teenagers experiencing hormone surges may begin using muscles more intensely—leading to growth, skin stretching, and pimples. Or, growth spurts at the bone can stretch the skin enough to induce pimples.

Over the past five years, I’ve backtracked more than 400 instances of pimples on my face and body. I’ve always been able to connect each one to a repeated action I performed the day before.

To prevent acne, I recommend being mindful of how you’re touching your face with your hands and how you’re using your face and body muscles. As for treatment, I’ve had success with good old-fashioned sun exposure. Today, there are effective, affordable creams like tretinoin and tazarotene.