Hormonal acne may bring to mind the pimples you experienced during puberty. However, hormonal acne occurs due to changes in hormone levels, particularly androgens, that can continue well beyond your teenage years .
It is one of the most common types of acne to affect adults, particularly women, due to hormonal fluctuations from menstrual cycles, pregnancy, and menopause, as well as certain medical conditions such as polycystic ovary syndrome (PCOS). It often appears in adult women as persistent pimples on the chin or jawline.
If you are experiencing hormonal acne you are definitely not alone. While it can be undeniably difficult to manage, learning more about its causes and hormonal acne treatment options can put you on the path to gaining control over hormonal breakouts.
Hormonal Acne Causes
Hormonal acne occurs when androgens (male hormones that are present in both men and women) stimulate the sebaceous glands in the skin, causing them to produce more oil. The excess oil can clog the pores and lead to the development of acne.
Hormonal changes that can trigger acne include:
Periods
For many of us, a breakout is the first sign that we are about to get our period. Although women produce androgens in smaller amounts than men, during your cycle there is a rise in androgen levels, particularly in the week leading up to your period. This can cause an increase in oil production and lead to hormonal acne.
In addition to androgens, other hormones such as estrogen and progesterone can also contribute to the development of hormonal acne.
Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects up to 10 percent of women of reproductive age and is characterized by cysts on the ovaries, irregular menstrual cycles, and high levels of androgens.
If you suffer from hormonal acne caused by PCOS, your high levels of androgens can cause your skin’s oil glands to produce more sebum, leading to clogged pores and acne. Women with PCOS may experience acne on the face, chest, and back, and it can be more severe than typical acne.
Oral Birth Control
Some people experience hormonal acne from their birth control pills, while others enjoy clear skin on the pill and only notice that they are getting pimples when they go off of it. This is because the hormones in birth control pills can affect the levels of androgens in the body in different ways, which can impact oil production and contribute to both the development of acne and to clearer skin.
Some types of birth control pills that contain progestin, a synthetic form of progesterone, can have androgenic effects and lead to the development of acne in some women. On the other hand, some types of birth control pills that contain a combination of estrogen and progestin can actually improve acne by reducing androgen levels and decreasing oil production. When you quit hormonal birth control, it can upset your hormonal balance and may cause “post-pill acne.”
Hormonal IUDs
There are two main types of IUDs: hormonal and non-hormonal. The non-hormonal type of IUD (brand name Paraguard) uses copper to prevent pregnancy and does not affect your hormones. However if you switched from a combination birth control pill which was suppressing acne to a non-hormonal IUD, you may experience post pill acne.
The hormonal type of IUD (brand names Mirena and Skyla) releases a small amount of the hormone progestin to prevent pregnancy. Progestin is a type of hormone that can increase oil production in the skin, which can lead to acne breakouts. This is especially true in people who are already prone to acne.
Menopause
During menopause, there is a significant decline in estrogen levels, which can lead to an increase in androgens relative to estrogen levels. This hormonal imbalance can cause an increase in oil production, which can clog pores and lead to the development of acne.
Menopausal acne typically appears as deep, painful cysts that occur around the chin, jawline, and neck. It can be particularly frustrating for women who have never experienced acne before, or who have not had acne since adolescence.
Pregnancy
Acne during pregnancy is a common condition, affecting up to 50 percent of women. While not all acne during pregnancy is hormonal, hormones like estrogen, progesterone, and androgens can fluctuate significantly during pregnancy, leading to changes in the skin.
When estrogen levels rise during pregnancy, it can improve the appearance of the skin, including reducing acne. However progesterone levels can also increase during pregnancy, leading to an increase in oil production and potentially causing acne. The treatments for acne during pregnancy are limited due to the risk of birth defects, but you can consult with your doctor to find some options that may be safe for you. Fortunately, hormonal acne during pregnancy should resolve once your hormone levels go back to normal after delivery.
Testosterone Treatments
Testosterone treatments are sometimes prescribed to men who have low levels of the hormone, and in some cases, to women with certain medical conditions.
When testosterone levels are increased through treatments, it can lead to an increase in oil production in the skin, which can clog pores and cause acne.
Genetic Causes
There may be a genetic component to hormonal acne. As hormonal acne is typically caused by an increase in androgen hormones, such as testosterone, some individuals may have a genetic predisposition to producing higher levels of androgens, which could increase their likelihood of developing hormonal acne.
Lifestyle Causes
Stress can trigger the release of hormones that can cause the skin to produce more oil. Diet can also play a role in acne development, particularly diets that are high in sugar and refined carbohydrates which can raise insulin levels.
A hormone that helps regulate blood sugar levels, high levels of insulin can cause an increase in androgen hormones, such as testosterone. This hormonal imbalance can lead to an increase in oil production, which can clog pores and cause acne. In addition to increasing androgen levels, high insulin levels can also lead to inflammation in the body, which can further exacerbate acne.
What Does Hormonal Acne Look Like?
Hormonal acne typically appears as deep, painful cysts and nodules. These types of lesions can be difficult to treat and can cause scarring. Hormonal acne can also cause blackheads and whiteheads, as well as small, inflamed bumps on the skin.
Hormonal acne breakouts tend to occur in the same place of your face over and over again. While hormonal acne during puberty is often concentrated in the T-zone of the face (your forehead, nose, and chin) hormonal adult acne is usually located in the lower half of the face including your:
- Chin
- Jawline
- Cheeks
- Neck
If you are often getting pimples on your chin and jawline, that could be an indication that you might have hormonal acne. Hormonal acne can also sometimes appear on your back, shoulders, and chest.
Hormonal Acne Treatments
Hormonal acne is notoriously challenging to treat, but fortunately there are many different treatment options to try.
Stay patient as you may have to try a few different treatments or mix and match to find a hormonal acne treatment combination that works for you. If your acne is severe or persistent, be sure to consult with a dermatologist to get medical advice and treatment.
Over-the-Counter Topical Treatments for Hormonal Acne
There are many over-the-counter topical products to treat hormonal acne at your local drug store or online. These include, but are not limited to:
Salicylic Acid
Face washes and leave-on products that contain salicylic acid are widely available. Salicylic acid is a type of beta-hydroxy acid (BHA) that works as an exfoliant to unclog pores, reduce inflammation, and prevent acne breakouts. When applied to the skin, salicylic acid penetrates into the pores and dissolves the sebum, dead skin cells, and other debris that can clog the hair follicles and lead to acne. However, it may not work for everyone, and some people may experience irritation or dryness when using salicylic acid products.
Benzoyl Peroxide
Benzoyl peroxide can also be commonly found in face washes and leave-on acne treatments. It works by killing the bacteria that cause acne, reducing inflammation, and helping to unclog pores. When benzoyl peroxide is applied to the skin, it penetrates into the hair follicles and pores, where it releases oxygen. This oxygen creates an environment that is toxic to the bacteria that cause acne, such as Cutibacterium acnes.
Benzoyl peroxide can be irritating and is known to bleach fabrics. If you are using it as a face wash, you should rinse thoroughly to keep it from bleaching your towels and pillowcases. If using it as a leave-on treatment, you might want to switch to all white bedding and towels.
Retinoids
You can find retinoids in the form of retinol and adapalene at 0.1 percent strength over-the-counter as a leave-on treatment. They work by regulating the skin cell turnover rate, reducing inflammation, and preventing the formation of new acne lesions.
When retinoids are applied to the skin, they stimulate the production of new skin cells and promote the shedding of dead skin cells. This process helps to unclog pores and prevent the formation of new acne lesions. Retinoids such as tretinoin (Retin-A) and adapalene are available at prescription strength from your doctor.
Azelaic Acid
Although less common in drugstore acne products, azelaic acid is a medication that can be used to reduce inflammation and unclog pores. It also has antibacterial properties that can help to kill acne-causing bacteria. It may be particularly effective for treating post-inflammatory hyperpigmentation, which is a common complication of hormonal acne.
With any topical treatment, try to start slowly before building up strength and frequency. For example, you can see how your skin reacts to salicylic acid or benzoyl peroxide as a face wash first before using it as a leave-on treatment which would have a stronger effect. You should also add only one new treatment at a time so that you can see how your skin tolerates it on its own before combining it with others. It is easy to get so enthusiastic about treating acne with many strong products that we end up irritating and drying out our skin, which can be uncomfortable and even worsen your acne.
Medical Treatments for Hormonal Acne
If it is at all available to you, consult with a doctor to receive medical treatment for hormonal acne. Hormonal acne is difficult to treat and usually needs more than topical treatment to have an effect. A medical provider can help diagnose the root causes of your hormonal acne and prescribe the appropriate treatment.
Multiple treatments might be prescribed to effectively target the hormonal imbalance and clear the skin and can include the following:
Combined Oral Contraceptives
Birth control pills that contain both estrogen and progestin can help to regulate hormonal fluctuations that contribute to hormonal acne. They work by suppressing the production of androgens, which can reduce sebum production and acne. However, they may not be suitable for all women and can have potential side effects.
Spironolactone
Spironolactone is a diuretic that is often used off-label to treat hormonal acne in women. It works by reducing the effects of androgens on the skin, which can lead to a decrease in sebum production and acne. It can have some side effects, such as dizziness, fatigue, needing to pee more often, and breast tenderness. As long as you don’t get pregnant, you can stay on spironolactone long term.
Oral Antibiotics
Antibiotics can be used to reduce inflammation and kill bacteria that contribute to acne. They are typically used in combination with other treatments, such as topical retinoids or benzoyl peroxide, and are typically prescribed for a limited period of time to avoid the development of antibiotic resistance.
Isotretinoin
Also known as Accutane, this medication is a powerful oral retinoid that is used to treat severe acne that has not responded to other treatments. It works by reducing sebum production, shrinking sebaceous glands, and preventing the formation of new acne lesions. However, it can have potential side effects, such as dry skin, chapped lips, and depression, and hormonal acne can sometimes reoccur after treatment.
Topical Prescription Treatments
In addition to the over the counter topical acne treatments listed above, a doctor can also prescribe stronger topical treatments tailored to help clear your specific skin issues. Prescription strength retinoids like tretinoin (Retin-A), adapalene at 0.3 percent (Differin), and tazarotene (Tazorac) can help unclog pores and reduce inflammation and are commonly prescribed. Topical antibiotics, prescription strength azelaic acid, and combination treatments are also available from medical providers.
A new type of prescription topical medication to treat acne was approved by the Food and Drug Administration (FDA) in 2020. Clascoterone (Winlevi) is a topical androgen receptor inhibitor that works by blocking the effects of androgens on the sebaceous glands in the skin to help to reduce the production of oil and improve acne. Unlike other spironolactone and birth control that target hormonal acne for women, topical clascoterone is also approved for men.
Skin Care Routine for Hormonal Acne
In addition to finding a treatment that helps clear your hormonal acne, you should make sure that any other skin care products you are using help support your skin and don’t clog your pores. Avoid using acne treatments in too many products as this can be irritating. If you are using a prescription treatment, use a gentle cleanser to fully remove makeup and sunscreen, and a moisturizer that is non-comedogenic. Harsh products can irritate the skin and worsen your acne by damaging the skin barrier.
Finding a broad spectrum sunscreen that works for your skin is important for hormonal acne because many acne treatments make skin more sensitive to sun exposure. Hormonal acne can also cause hyperpigmentation spots as it heals, and sun protection can help lighten these spots over time.
Take a look at other aspects of your daily routine to see if there is anything that might be exacerbating your acne. Try changing your pillowcases more often as clean pillowcases can help prevent acne by reducing the amount of oil, dirt, and bacteria that can accumulate on your skin while you sleep. Hair care products can contain ingredients that clog your pores, so keep them away from your skin and use a different towel to dry your face than the one you use on your hair.
Work on keeping your hands off your face, as this can spread dirt and bacteria to your skin. And, as tempting as it may be, don’t pop your pimples! Popping your pimples can delay healing and cause scarring. Instead, use a hydrocolloid pimple patch to create a protective environment that helps to draw out the fluid and pus from the pimple while preventing further infection and inflammation.
Diet and Lifestyle for Hormonal Acne
While many factors can play a role in the development of hormonal acne, diet and lifestyle changes can help manage the condition in addition to treatment:
- Eat a balanced diet: Eating a balanced diet that is rich in whole foods such as fruits, vegetables, whole grains, protein, and healthy fats can help support overall skin health and reduce inflammation.
- Avoid sugary and processed foods: High-sugar and processed foods can cause spikes in insulin levels, which can lead to increased sebum production and inflammation, contributing to acne. Try eating more foods lower on the glycemic index.
- Incorporate anti-inflammatory foods: Eating foods that are high in antioxidants and anti-inflammatory compounds such as omega-3 fatty acids, vitamin C, and zinc can help reduce inflammation and support skin health. Examples include fatty fish, nuts and seeds, berries, and leafy greens.
- Manage stress: Stress can trigger hormonal changes that contribute to acne, so finding ways to manage stress such as therapy, meditation, yoga, or exercise can be helpful.
- Get enough sleep: Adequate sleep is important for hormone regulation and overall health, so aim for 7-8 hours of quality sleep each night. Try to create a relaxing bedtime routine and stick to the same schedule every night.
Scarring from Hormonal Acne
Hormonal acne can often create deep cysts under the skin that can put you at risk for scarring. Unlike post-inflammatory hyperpigmentation, which will slowly fade over time, acne scars are permanent marks or indentations on the skin that are left behind after acne has healed. Acne scars are usually caused by the inflammation that occurs when acne lesions penetrate deep into the skin and damage the tissues beneath. The body’s natural healing response to this damage can lead to the formation of scars.
It is first important to prevent scarring by seeing a dermatologist for medical advice and treatment for acne. Once scarring has happened, there are several treatment options available from dermatologists to help reduce the appearance of acne scars if they bother you, including laser therapy, chemical peels, and microneedling.
Hormonal acne can be frustrating to manage, but with the right treatment and lifestyle changes, it can be controlled.
If you suspect that you may have hormonal acne, it is important to seek medical advice and work with a dermatologist to develop an acne treatment plan that is tailored to your specific needs. By taking a proactive approach to handling hormonal acne, you can develop a better understanding of what your skin and body needs, and minimize its impact on your life. Remember to be gentle with your skin and stay patient by giving your treatment a chance to work. Good luck!
