Having oily or unwashed skin is what causes acne, right? This seems like a universal beauty truth. It’s definitely the culprit in a lot of cases, but it’s also a gross oversimplification in many others.

While some are dermatologically predisposed to pimples, including those with oilier skin or a slower cell turnover, the fact is many breakouts result from internal factors—especially hormones.

Some skin and health pros speculate that the location of a pimple can help give an indication of what unholy evil spawned it. Enter the acne face map, which shows how different areas of the face correspond to different organs and systems throughout the body.

Acne face map key

1. Acne on the forehead is linked to the bladder and small intestines. Triggers: hair products, hats, fatty and processed foods, alcohol, sugar, lack of sleep.

2. Mid-brow pimples are linked to liver and digestion issues. Triggers: lack of sleep, possible food allergies or sensitivities.

3. A breakout on the temples can be linked to the kidneys. Triggers: alcohol, tobacco, poor lymphatic circulation, saturated fat consumption.

4. Nose acne is linked to the digestive and circulatory systems. Triggers: constipation, bloating, indigestion, gas, poor circulation, high blood pressure.

5. Blemishes plaguing the upper cheeks are linked to the lungs. Triggers: smoking, asthma, pollution, lack of movement or fresh air, spicy and fatty foods.

6. Those on the right and left cheeks are linked to the lungs and kidneys. Triggers: smoking, poor digestion, stomach issues, food allergies, sugar, poor diet, stress.

7. A bout of jawline acne is linked to the large intestines and hormones. Triggers: ovulation or hormonal shifts, the body fighting off bacteria, stress.

8. Chin acne can be linked to the kidneys, stomach, genitals, and endocrine system. Triggers: diet rich in fat, sugar, caffeine, or alcohol, staying up late or lack of sleep, menstruation, pregnancy, stress.

“It all boils down to hormones.”

That’s how Amy Halman, aesthetician and president of Acure Organics, answers the question of what causes acne.

“Not just the biological shift that happens during a monthly menstrual cycle or pre- or post-menopause, but also the hormonal responses in the body that relate to cortisol production, which tend to be related to any kind of stress put on the body,” she said. “Lack of sleep, poor diet, mental or emotional stress. These are all situations that cause a higher percentage of androgen in the system, which leads to increased oil production.”

... and not just human hormones.

Melanie Betz, a dietitian at Chicago’s Rush University Medical Center, seconded Amy’s take on hormones. From a nutritional standpoint, downing too much dairy can potentially impact your body’s hormonal composition.

“Even if a cow wasn’t treated with hormones and antibiotics and all that business, milk from a cow is going to have cow hormones in it,” Melanie said. “And those hormones could potentially be precursors to exacerbating acne.”

Sugar isn’t exactly your friend, either.

A food’s glycemic index—which measures how much insulin your body produces after you eat that food—is something to watch out for as well.

“If you’re eating a lot of sugar and simple carbs all the time, your body is going to produce insulin all the time, and insulin is a precursor to a whole bunch of hormones that are known to be linked to acne,” said Melanie.

So how do you prevent pimples?

“It’s not as simple as, ‘Oh, you have acne, you should stop eating carbs or cut back on sugar,’” Melanie noted. But it may be worth experimenting with your food intake. She recommends trying a low-sugar, “normal-carb diet” for two weeks, one that focuses on non-starchy vegetables, whole grains, and proteins.

Then go back on your normal diet for two weeks. If your acne ebbs and flows with your carb and sugar intake, that’s probably not a coincidence.

Of course, great skincare helps, too.

But just as oily skin is not the only thing that causes breakouts, cleansing skin is not always enough to combat breakouts. (Not that we are giving you a pass on washing your face at night. ALWAYS WASH YOUR FACE AT NIGHT.)

Use the acne face map as a detective tool, not a set-in-stone decree.

“If anything, [acne mapping] simply gives you a bit more awareness as to what issue may be causing stress internally,” Amy said. “It’s super helpful to know when your breakout is just related to your period or if you have a digestive issue that could be [inflaming] the system. Initially, that kind of internal issue could simply be a pimple or two, but long-term inflammation can result in much bigger health issues down the road. Your skin is your best ally for overall health.”