Growing up, most of us battled with acne or something related to skin issues. Okay, maybe not everyone, but it sure felt like it, right? We couldn’t wait to grow up because it meant more freedom, no more being bossed around, and—most importantly—the disappearance of those dreaded pimples. So why, now that we’re adults, are we still struggling with breakouts and the occasional hormonal acne? It’s frustrating, exhausting, and honestly can make you want to scream. When you’re doing everything right but still waking up to new breakouts, it’s like running in circles.

The thing is, acne as an adult isn’t just about what’s happening on the surface of your skin, it’s about what’s going on underneath too. Most of us are told to try a variety of “fixes” when we start breaking out:

1.Take birth control pills

2.Try Retin-A

3.Do a liver cleanse

4.Get facials

5.Cut out dairy or gluten

6.Use benzoyl peroxide

But if you’re doing all these things and still seeing those unwelcome breakouts, it’s not just bad luck. There are deeper reasons your skin isn’t cooperating, and many of them have to do with how your body functions internally. Here are five reasons you might still be breaking out:

1. Hormonal Imbalances

If you’ve got a super-detailed skincare routine but nothing seems to work, it might be because your hormones are going crazy. Acne is heavily influenced by hormones like androgens, which increase oil production. This excess oil clogs pores, causing breakouts. Hormonal imbalances can be triggered by stress, certain medications, or even your menstrual cycle. If your acne is concentrated around your chin and jawline, or if it flares up during certain times of the month, hormonal imbalance might be the culprit.

2. Gut Health Issues

You might be getting regular facials and using the best skincare products, but if you’re not addressing your gut health, your skin will still suffer. The gut-skin axis is a real thing—your gut health is directly linked to your skin’s appearance. Poor gut health, often caused by an imbalance of bacteria (also known as dysbiosis), can trigger inflammation, which manifests as acne. If you’ve been struggling with bloating, digestive discomfort, or irregular bowel movements alongside your acne, it could be worth looking into probiotics and a healthier diet to balance your gut microbiome.

3. Blood Sugar Management

Cutting out gluten and dairy isn’t a magic solution for everyone, especially if blood sugar management is the root of your acne. When blood sugar spikes, it triggers a rise in insulin, which in turn increases androgen production. This causes your skin to produce more oil, leading to clogged pores and, you guessed it, more breakouts. Stabilizing your blood sugar with balanced meals and reducing processed sugars can help keep your skin clear.

4. Food Intolerances

You might have been to five dermatologists and still haven’t seen an improvement in your acne. If this sounds like you, consider food intolerances. These can trigger chronic inflammation in the body, and as we know, inflammation is a major player in acne. Even foods we think are “healthy” can trigger an immune response in people with intolerances. Keeping a food journal to track what you eat and how your skin reacts can help pinpoint these triggers.

5. Chronic Inflammation

If your “no eggs, no cheese, no gluten” diet isn’t yielding results, the issue might be inflammation. Inflammation doesn’t just occur from obvious things like an injury or illness. Chronic inflammation can be silent and caused by everything from stress to poor diet. This internal inflammation affects your skin’s barrier, leading to redness, breakouts, and other skin issues.

It’s not about trying every acne treatment and hoping for the best. It’s about figuring out what’s causing your acne. This is where we tend to go wrong. We see something that worked for someone else and try to apply it to our situation, but everyone’s acne triggers are different.

So, instead of piling on products, it’s important to understand your unique triggers. Are you managing your stress? Are your hormones balanced? Is your gut healthy? These underlying factors could be playing a much bigger role than you realize.