BACKGROUND: Acne severity and its response to treatment may be influenced by internal and external factors: the exposome. OBJECTIVES: The aim of this international real-life survey was to assess the most involved exposome factors in acne. METHODS: 11000 individuals, aged between 15 and 39 years, with clinically confirmed acne or without acne, defined by age, gender and prevalence, were invited to participate in an internet survey of 63 questions in order to assess the frequency of identified acne exposome factors. RESULTS: Data from 6679 questionnaires were used for statistical analysis purposes: 2826 from the acne group and 3853 from the control group. Nibbling, consumption of dairy products, sweets, alcohol, or whey proteins, as well as exposure to pollution, stress, certain mechanical factors and humid or hot weather or sun exposure, were significantly (all P≤0.05) more frequently reported for the acne group than for the control group. This was not the case for tobacco consumption. Data regarding the impact of cannabis consumption were insufficient for drawing any conclusions. CONCLUSIONS: Data from this international, anonymized internet questionnaire conducted with more than almost 6700 participants add new arguments to assumptions made that certain exposome factors have an impact on acne. Nutrition, pollution, stress and harsh skin care, as well as climate and sun exposure may be considered the most frequent factors related to acne.