The causes of acne could be more than skin deep—maybe gut deep, according a new investigative study performed in China.

The recent study detailed in the Journal of Investigative Dermatology reports that patients afflicted with acne have distinct differences in the ratios of their gut microbiome compared to patients without acne. These differences may be reflected in the skin microbiome.

Both Staphylococcus and P. acnes have the ability to inhibit the growth of the other, leading to a sort of tug of war that can contain or cause acne breakouts.