Patterns, Pores, and the Science Behind “Repeat Breakouts”

Merry Christmas and happy holidays, DERM Community!🎄✨

We hope this season finds you slowing down, enjoying time with the people you love, and taking a well-deserved break (even if your skin didn’t get the memo). Whether you’re celebrating Christmas, wrapping up the year, or simply enjoying a few quieter days, this is a perfect moment to reset, reflect, and show yourself a little extra care.

And speaking of care… if you’ve ever wondered why that one pimple seems to have a favorite place to visit (your chin, jawline, or forehead), you’re not imagining things.

Acne really does have patterns.

And understanding those patterns can tell you far more about your skin (and your habits) than you think.

Each pore has its own environment, its own density of oil glands, hormonal sensitivity, and exposure to friction or bacteria. When breakouts recur in the same place, it’s usually because one or more of those factors hasn’t changed.

Here’s what dermatologists often see:

• Chin and jawline: Hormonal fluctuations. Elevated androgens increase oil production, often worsened by menstrual cycles, stress, or certain contraceptives.

• Forehead: Occlusion or product buildup, think heavy hair products, hats, or sweat.

• Cheeks: Friction acne from phones, pillowcases, or mask use.

• Back or shoulders: Heat, tight clothing, and pressure (“acne mechanica”).
  

But here’s the deeper truth: acne recurring in the same place usually means the microenvironment of that area is persistently inflamed. 

Once a follicle’s wall has ruptured, the skin tends to repair with scar tissue and altered oil flow, making it more vulnerable to future blockages.

That’s why spot-treating the same blemish every month doesn’t work, it addresses the symptom, not the setup.

Dermatologists approach these patterns with two goals: calm the inflammation, then prevent recurrence. This often means using consistent, low-grade treatments (like retinoids or azelaic acid) rather than waiting for flares. 

For hormonal acne, regulating internal triggers through medication, stress control, or cycle tracking can make all the difference.

So next time you recognize that familiar spot, don’t ask, “Why is this back again?”
Ask, “What about this area hasn’t healed yet?”

We’ve Put Together a Free Guide Just for You!

A practical diagnostic checklist for recurring acne

If a breakout keeps showing up in the exact same place, it’s rarely random…and it’s usually not “just hormones.”

Recurring lesions often point to a local trigger, a repetitive habit, or a specific physiologic pathway being activated over and over again.

That’s why we created this guide: a clear, clinical-style diagnostic checklist to help you identify why that spot keeps returning, what’s sustaining it, and how to interrupt the cycle, whether you’re evaluating a patient or your own skin.

We’ll walk through:

• What location-specific acne can reveal

• The most common hidden triggers behind repeat lesions

• How to connect anatomy, habits, and inflammation

• Practical questions that lead to actionable changes

🎁 Holiday Gift for You: 2 FREE PDFs!

To celebrate the holidays with our DERM Community, today’s issue comes with two free PDFs as our gift to you:

• A book many dermatologists love and use daily (from their student years all the way through clinical practice):

• A practical habit audit you can use with your patients (or yourself) to identify and stop everyday behaviors that trigger unnecessary breakouts:

Because learning, reflection, and better skin habits make the best holiday gifts.

Looking for a Job?

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Here are some job postings you may find interesting:

• Physician Assistant or Nurse Practitioner | Full time | On-site | WellNow Urgent Care • Swansea, IL | Apply Here

• Physical Medicine NP/PA | Full time | On-site | Nuvance Health • Danbury, CT | Apply Here

• Surgical Physician Assistant | Full time | On-site | Nuvance Health • Danbury, CT | Apply Here

• Physician Assistant or Nurse Practitioner | Full time | On-site | WellNow Urgent Care • Fort Wayne, IN | Apply Here

• Nurse Practitioner/Physician Assistant | Full time | On-site | Health Care Resource Centers • Northampton, MA | Apply Here

• Physician Assistant or Nurse Practitioner - $60,000 Sign On Bonus | Full time | On-site | WellNow Urgent Care • Mishawaka, IN | Apply Here

• Physician Assistant or Nurse Practitioner | Part time | On-site | WellNow Urgent Care • South Bend, IN | Apply Here

Want to Go Deeper?

Take one of our modules

Here are our three featured courses for today!

Book Recommendation of the Week

“The Beauty of Dirty Skin: The Surprising Science of Looking and Feeling Radiant from the Inside Out” by Whitney Bowe.

A fascinating look into how the skin microbiome, hormones, and inflammation interact and how to manage breakouts from the inside out.

Inspiration of the Week

👋🏻 See you next Thursday, DERM community!

Thanks for joining us on Beneath the Surface.

Acne isn’t random, it’s repetitive because the skin remembers. The key is not to fight it harder, but to understand it better.

Until next week, stay curious and keep looking beneath the surface.

— The Derm for Primary Care Team