The increased hormone production in the puberty stimulates to increased sebum production; while male testosterone appears to contribute the most. Girls begin to produces more testosterone by the age of puberty. Also altered hormone production may produce acne, for example by women in the menopause.

Not all teens get acne, the increased hormone level cannot be the whole cause of the increased sebum production. The follicles of affected people react stronger upon higher hormone levels.

Dietary factors, like eating too much fat, sugar or the wrong kind of fat may aggravate acne for some individuals. Lack of vitamins, minerals and essential fatty acids also contributes to the development of acne.

Poor digestion, lazy colon and constipation aggravate acne in some individuals; this is due to productions of toxins in the intestines. The term lazy colon may be caused by dietary faults, like lack of fiber. Frequent washing and using strong soaps will also aggravate acne. Rubbing, scrubbing or squeezing the skin will also agitate acne.

Here are other factors that may contribute or aggravate your acne:
- Testosterone and anabolic steroids used for treatment or by body-building.
- Stress
- Some contraceptive agents
- Environmental or domestic pollution.
- Humid environments.
- Some antidepressants.
- Steroids used for treatment or by body-building.
- Use of greasy cosmetic products.
- Some antiperspirants
- Exposing the skin for chlorine or other halogens, or medicines containing halogens.
- Some Women may get acne 2-7 days before menstruation.