• Hormonal
o Signs of androgen excess would include precocious puberty
and hirsutism
o Possible causes of androgen excess would include polycystic
ovary disease, adrenal tumor, ovarian tumor and pituitary
tumor
• Mechanical
o Physical pressure from headbands, violins, chin straps, sports
helmets, guitar straps and orthopedic braces have induced
localized acne; wool and other rough textured fabrics and
occlusive clothing may also be irritants
• Contact
o Oil-based cosmetics, oil-based scalp lubricants, topical tar
products, and hairspray
o Occupational materials such as coal tar, pitch, mineral oil and
petroleum oil
o Ingestion, inhalation or transcutaneous penetration of
halogenated aromatic hydrocarbons, including components in
paint, varnishes, lacquers, fungicides, insecticides, herbicides,
wood preservatives and oils
• Environmental
o Heat and humidity may induce comedones
o Pressure, friction, and excessive scrubbing or washing can
exacerbate existing acne by causing microcomedones to
rupture
o Hair styles low on the forehead/neck may cause excess
sweating, occlusion and make acne worse
• Emotions
o Intense anger or stress can exacerbate acne, causing flares or
increasing mechanical manipulation.
• Drugs (see also Acne Comparison Chart)
o Hormones: androgenic hormones in women, corticosteroids,
corticotrophin (ACTH), oral contraceptives high in progestin
o Topical steroid induced perioral acne
o Bromides, chlorides, halothane, iodides (e.g., Kelp)
o Antiepileptic drugs: gabapentin, phenytoin, phenobarbital & trimethadione
o Tuberculostatic drugs: ethambutol, isoniazid & thionamide
o Miscellaneous: cyclosporine, cyanocobalamin, dantrolene, gold
salts, lithium salts, maprotiline, psoralens, quinidine, quinine &
topical coal tar
o Select cancer drugs: cetuximab, erlotinib & gefitinib
• Family history (genetics) often provides prognostic clues
