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WHAT ARE THE FACTORS THAT PRECIPITATE OR AGGRAVATE ACNE? Stress – Stress is frequently implicated in aggravation of acne while acne itself induces stress. Sweat – sweating in a hot and humid environment causes deterioration in 15% of acne patients. Menstruation – Pre menstrual flare of acne occurs in 70% of female acne patients. Friction and pressure – Friction and pressure from helmets, backpacks and tight collars can induce blackheads and papules. Pressure from face massages or facials can aggravate acne. Pregnancy – Pregnancy has an unpredictable effect on acne. Pre-existing acne may aggravate or remit during pregnancy. Diet – High glycemic load foods (sugar loaded and starchy foods), oily foods may aggravate acne. Drugs – Oral contraceptives, anti tuberculosis medication, oral steroids, anti depressants may aggravate acne.