When it comes to acne, most people focus on what they're putting on their skin. And while skincare plays a critical role in achieving clear, healthy skin, it's not the only factor that influences breakouts. Over the years, I've worked with countless clients who are using excellent products and following a consistent routine, yet still struggle with persistent acne. In many cases, the missing piece isn't a new product—it's identifying the hidden triggers that may be working against their progress.
From dirty pillowcases, hair products, stress, lack of sleep, workout habits, and even dietary factors some acne triggers are surprisingly easy to overlook. The challenge is that many of these influences are so common that people never think to connect them to their skin. Understanding these hidden triggers can help you get more out of your skincare routine and make it easier to achieve the healthy, balanced skin you're working toward.
THE UNEXPECTED TRIGGERS
One of the first things I look at when evaluating breakouts is pattern and location. Different areas of the face often provide clues about what may be contributing to congestion and inflammation.
Photo Credit: Dianne Marchevsky
Where do you typically start when a client is breaking out but can't figure out why?
"The first thing I do is look at patterns. Where on a face are the breakouts happening? Because the location tells you a lot. Breakouts along the cheeks and jawline often point to the phone—people don't realize how much bacteria, oil, and product residue accumulates on a screen throughout the day and transfers directly to the skin every time they take a call.
Breakouts along the hairline and forehead frequently trace back to hair products: shampoos, conditioners, leave-in treatments, and styling products. They migrate onto the skin and sit in the pores. I've had clients completely transform their skin just by rinsing their hairline more thoroughly after washing or switching to a different conditioner."
The phone and the hairline are two of the most common culprits, but they are far from the only ones. Pillowcases, I find, are another frequently underestimated source of recurring breakouts.
"Your pillowcase collects oil, sweat, skincare residue, dead skin cells, and hair products night after night. For acne-prone individuals, changing pillowcases several times per week can make a noticeable difference."
It is the kind of advice that sounds almost too simple—until it works.
THE BODY'S ROLE IN YOUR SKIN
Beyond surface-level habits, I pay close attention to what is happening inside the body because skin does not exist in isolation. Like every other organ, it responds to the conditions of the whole system.
How much do internal factors like stress and sleep actually affect the skin?
"Enormously. Stress doesn't directly cause acne, but it can absolutely worsen it. Elevated stress levels increase cortisol production, which stimulates the oil glands and promotes inflammation throughout the body. I see clients whose skin flares every time they have a big deadline, go through a major life change, or travel extensively. And sleep is just as important. Sleep is when the body focuses on repair and recovery. Chronic sleep deprivation contributes to increased inflammation. Impaired skin barrier function, and slower healing of existing breakouts. Beauty sleep isn't just a cliché. It's genuinely one of the most powerful skincare tools available, and it's completely free."
What's the most unexpected dietary trigger you see regularly?
"Whey protein is one potential trigger that people often overlook. It doesn't affect everyone, but I've seen some acne-prone clients notice positive changes in their skin after reducing or eliminating it. Certain dairy products, excess sugar, and high-glycemic foods can also contribute in susceptible individuals. If someone is doing everything right with their skincare but still struggling with breakouts, it's worth taking a closer look at dietary factors as part of the bigger picture."
"The products you use matter—but sometimes the reason they aren't working is because a hidden trigger is constantly working against them."
—Marissa Dalla Rizza, Master Aesthetician & Founder, MDR Skin Studio
THE DETAILS THAT DERAIL YOU
Some of the most actionable insights come from the smallest details— the things that are easy to overlook precisely because they seem so inconsequential. Makeup brushes. Sunglasses. The headband worn during a workout. The gym clothes that stay on too long after a session.
What are some of the smaller habits that people consistently overlook?
"Dirty makeup brushes are a huge one. Even high-quality makeup becomes problematic when applied with tools that haven't been cleaned. Brushes and sponges collect oil, bacteria, dead skins cells, and product buildup— and then spread all of that across the face with every application. Sunglasses are another one people never think about. They sit directly against skin for hours and pick up everything. Same with reusable face masks. And then there's the gym. Exercise itself is not the problem, but allowing sweat and bacteria to sit on the skin afterward, or wearing tight athletic clothing that creates heat and friction, absolutely contributes to breakouts. The habit of constantly touching your face is another. Most people do it dozens of times a day without realizing it, and every touch transfers oil, bacteria, and environmental debris onto the skin."
The common thread running through all these triggers is contact—the repeated, often unconscious ways that bacteria, oil, and debris find their way onto the skin throughout the course of a normal day.
THE BIGGER PICTURE
What do you want clients to take away from understanding these hidden triggers?
"Great skincare is incredibly important, but products can only do so much if hidden triggers are constantly fueling inflammation and breakouts. The goal isn't to replace skincare—it's to make it work better. When we identify things like stress, sleep, diet, hair products, dirty makeup brushes, or other lifestyle factors that may be contributing, clients often start seeing results much faster. Sometimes the missing piece isn't another product—it's understanding what's happening outside of your skincare routine."
Photo Credit: Dianne Marchevsky
Clear skin isn't just about the right products— it's about understanding the habits, routines, and everyday triggers that influence skin health. When great skincare is paired with awareness of those hidden factors, results often come faster and are easier to maintain. Sometimes the breakthrough isn't changing your entire routine— it's identifying the small, overlooked habits that may be standing in the way of your skin reaching its full potential.
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