What worsens acne the most?

Hormonal changes. These can occur due to puberty, pregnancy, or menopause, and can cause the skin to produce more oil, which can lead to acne breakouts.

Certain medications. Some medications, such as corticosteroids, birth control pills, and antidepressants, can cause acne as a side effect.

Stress. Stress can trigger the release of hormones that can lead to acne breakouts.

Diet. Eating a diet high in processed foods, sugary drinks, and dairy products can worsen acne.

Skin care products. Some skin care products, such as those that are too harsh or contain certain ingredients, can irritate the skin and worsen acne.

Environmental factors. Exposure to pollution, dirt, and other environmental factors can clog the skin's pores and lead to acne breakouts.