A Skin Expert Just Broke Down the Real Reasons You’re Breaking Out—And It’s Not Your Pillowcase

Acne in 2026 is exhausting. One minute, you’re convinced it’s your moisturizer. The next, you’re ordering a silk pillowcase, cutting out dairy, drinking chlorophyll water, and wondering if a single tortilla chip ruined your skin.

According to acne nutritionist Sisley Fraser, most people are looking in the wrong place.

On The Art of Being Well, Fraser explains why breakouts are often less about what you’re putting on your skin and more about what your body is trying to tell you. From hormones and gut health to skincare mistakes and food myths, here’s what she says could be hiding behind stubborn acne.

What Your Breakouts Might Be Trying to Tell You

Your acne is a symptom, not a condition

“It really is just your body’s way of communicating with you,” Fraser says. “It’s just a symptom. We’re treating it as a condition, but really we need to look at it as a symptom.” Rather than asking how to make a pimple disappear, she asks what it’s pointing to, which in her experience is almost always inflammation somewhere deeper. She’s even grateful for her own acne-prone skin: “It’s taught me so much about my health, my toxic exposures, my fertility, all these things I would have never been able to dive deep into if my skin wasn’t communicating with me.”

Your ‘hormonal acne’ is probably a symptom too

“Yes, it’s your hormones running the show, but why is that happening?” Fraser says. She doesn’t accept hormonal acne as a dead end, and in her practice, she often traces it back to hidden triggers like strep, staph, H. pylori, or mold exposure, all of which can throw your hormones off and set off a breakout. She also reads breakout timing and placement like a map:

• Chronic, everyday breakouts often point to a deeper toxic burden or gut issue
• Breakouts around ovulation tend to be androgen-related
• Breakouts right before your period often signal an estrogen clearance problem

For that premenstrual flare specifically, she leans on cruciferous veggies to help the body metabolize estrogen. “I think one of the most underrated foods for hormonal acne is broccoli sprouts,” she says, crediting a compound called sulforaphane.

It usually starts in your gut

The gut-skin connection has officially gone from wellness-girlie theory to something increasingly backed by research, and Fraser sees it constantly in her clients’ lab work. “Almost every single person I’ve tested for has basically no akkermansia bacteria,” she says, referring to a keystone gut bacteria that helps keep inflammation in check. The frustrating part is that it’s notoriously hard to rebuild. A few foods she points to for support:

• Pomegranates, cranberries, and blueberries (all polyphenol-rich)
• Resistant starch, like cooled white rice (a little goes a long way)
• A wide diversity of plants over any single miracle food

She’s also blunt about the timeline. “We can’t just take a supplement for 30 days and expect things to completely change. It is possible, but we do have to stick in there for the long run.”

You’re probably over-restricting your food

“They’re just eating air and ice cubes and literally cardboard,” Fraser says of the everything-elimination trend social media has fueled. Her approach is quality over cutting things out entirely. A few swaps she swears by:

• A2 dairy instead of A1 (buffalo, goat, and sheep dairy are naturally A2, and she says about 99 percent of her clients tolerate it)
• Organic Valencia peanut butter, which is less prone to the mold-related toxins found in regular peanuts
• Tahini with honey and a pinch of sea salt as a peanut butter alternative
• Acne-safe nuts like macadamia, walnuts, and almonds, organic when you can swing it

And she is genuinely begging you to stop fearing fruit. “If your diet makes you avoid any sort of fruit for long periods of time…get a new diet,” she says, only half joking, noting that fruit’s fiber helps regulate blood sugar while delivering skin-loving nutrients like vitamin C. Carbs get the same defense. Under-eating them can spike cortisol and disrupt your cycle, which loops right back around to your skin.

Your skincare routine might be working against you

“Most people who come to me right away, their skin is really red, the breakouts aren’t clearing…their skin is actually usually very dry from these products,” Fraser says. If you’re throwing every acid and exfoliant at irritated skin and nothing’s improving, she says you’re likely over-stripping. Her fix is to scale way back and protect the barrier. Her go-to 30-day reset:

• A gentle double cleanse (an oil cleanser, then a gentle gel cleanser)
• A simple rose water mist
• A barrier-supporting serum
• A moisturizer plus an acne-safe facial oil like squalane, rosehip, or jojoba
• A Manuka honey mask in the morning for gentle, calming exfoliation

“Just give yourself 30 days in that routine,” she says, “and it’s actually shocking what happens for people.”

At the end of the day, your skin isn’t out to get you, it’s trying to tell you something. Once you start listening, and stop stripping, restricting, and spiraling, it tends to settle down. As Fraser puts it, getting your body back to balance “shouldn’t be as complicated as we make it.”

Listen to the full episode on The Art of Being Well, available wherever you listen to podcasts.

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