Everything You Need To Know About Hormonal Acne According to Dermatologists
If you deal with painful under-the-skin cysts, monthly jawline breakouts or treatment-resistant pimples, hormonal fluctuations likely play a driving role behind your acne struggle. In this BDA article, we will go over why hormonal acne happens, typical patterns to spot it, and what dermatologists want you to know regarding best treatments for clearing bumps tied to internal chemistry.
What is hormonal acne, and how is it different from other types of acne like cystic acne or acne vulgaris?
Categorized under the umbrella of adult acne, hormonal acne surfaces in response to normal hormone level changes in contrast to the excess oil production causing blackheads or whiteheads in youth. Monthly surges and declines around your cycle or with major events like pregnancy, perimenopause or starting/stopping birth control can trigger inflammation and visible bumps. The red, sore papules and pustules concentrate around the lower face/jaw/neck region typically. Hormonal acne is a type of acne that is primarily driven by hormonal fluctuations in the body. It is typically characterized by deep, cystic lesions and often differs from other types of acne, such as cystic acne or acne vulgaris, in terms of its severity and root cause.
What Causes Hormonal Acne?
The androgen hormones causing excess oil and altered skin cell development reside naturally in all genders. But rising amounts can overstimulate oil glands and hair follicles. In those prone to acne, the extra sebum, sticky cells and bacteria drive congestion plus inflammation forming hormonal acne lesions.
Specific causes include:
Cycle fluctuations with menstruation
Perimenopause/menopause dropping estrogen
PCOS raising androgens
Conditions like polycystic ovary syndrome (PCOS) can lead to hormonal imbalances and contribute to hormonal acne. PCOS is often associated with elevated androgen levels and can worsen acne in affected individuals.
Coming off birth control
Pregnancy shifts
Skin can remain clear for years before hormonal changes suddenly awaken breakouts. Acne often hits adult women but men experience these triggers too.
Typical Signs of Hormonal Acne
Look for these distinguishing characteristics signalling hormonal hyperactivity driving your bumps:
Breakouts circling the chin, jawline and lower cheeks rather than random areas
Deep painful nodules/cysts without whiteheads
Monthly worsening prior to your period
Resists normal acne treatments
Starts or worsens with life events impacting hormones like perimenopause, stopping birth control pills, pregnancy
When To See A Dermatologist
Make an appointment with a board-certified dermatologist if you notice acne is:
Persisting over age 25 especially with painful nodules
Getting worse/not fully clearing monthly
Scarring without controlled healing
Not improving after 3 months of over-the-counter washes/creams
Significantly impacting your self-esteem
Customized prescription therapies target hormonal acne at the root level in a way store products can’t. Your dermatologist will uncover why breakouts are happening and how to get them under control.
Hormonal Acne Treatment Options
Both systemic and topical therapies combat the internal process producing hormonal acne for clearer skin long-term. The classic acne treatments such as topical antibiotics, oral antibiotics, and chemical peels may not be too helpful in hormonal acne as the trigger and pathophysiology is entirely separate.
Hormonal Birth Control Pills
Contraceptive pills containing estrogen and progesterone block hormonal fluctuations. Estrogen lowers testosterone’s acne provoking effects while progestin stabilizes the uterine lining stopping period-related monthly worsening.
Anti-androgen medications: Spironolactone
Spironolactone is an oral medication blocking androgen hormone receptors thereby reducing acne provoking inflammation. It also decreases oil gland production. Dermatologists frequently prescribe spironolactone long term treating hormonal adult acne in females. Requires contraception use concurrently given risk of feminizing male fetuses if pregnant.
Potassium levels, kidney function and blood pressure should be counseled by your dermatologist while taking spironolactone. Contrary to dogma, routine monitoring of labs may not be routinely recommended and should be determined on a case-by-case basis.
Pros:
Truly one of the most effective medications for hormonal acne
Simple pill taken once daily
Does not require lab monitoring for most patients or lifestyle modifications
Cons:
Unclear treatment end date (other than for pregnancy, of course)
Lightheadedness can be a common side effect
Irregular periods and breast tenderness
Clascoterone Cream
Clascoterone 1% topical cream is a novel anti-androgen FDA approved in 2021 for treating hormonal acne. It works locally at the skin follicle level similarly to spironolactone without systemic absorption or bloodwork requirements. Safe to use alone or combined with birth control pills or oral spironolactone. Minimal side effects given the localized action directly where breakouts originate.
Pros:
Similar mechanism of action to spironolactone
Topical delivery mechanism, no pills needed
Cons:
Rarely covered by insurance
Frequently ineffective as a solo treatment
Isotretinoin (Accutane)
The heavy hitter vitamin A derivative isotretinoin indirectly reduces acne by shrinking oil glands long term. Best for severe scarring acne unresponsive to other treatments. Causes birth defects requiring two forms contraception during and one month after treatment.
Accutane is one of the best options for any type of acne in terms of being a definitive cure. See our comprehensive guide on everything you should know before starting Accutane.
Topical Retinoids
Creams containing tretinoin or adapalene applied to breakout zones help unplug clogged pores, prevent new blackheads/whiteheads and calm inflammation short circuiting future lesions. Use consistently for optimal results.
Pros:
Anti-aging
Prevents acne
Cons:
Can cause dryness with overuse
May not be great for patients with underlying rosacea or skin sensitivity
Benzoyl Peroxide
Benzoyl peroxide is a topical over-the-counter ingredient that treats acne in two ways - by killing bacteria nesting within clogged follicles and reducing inflammation. It comes in various concentrations in gels, creams and cleansing washes. When combined with topical retinoids, benzoyl peroxide works synergistically providing enhanced acne reduction compared to either therapy alone.
Pros:
Bacteriocidal and kills p. acnes
Great in combination with clindamycin topical to prevent bacterial resistance
Cons:
Can bleach clothing
May be too drying for some patients
Dapsone Gel
The topical antibiotic Dapsone gel combats acne through dual antimicrobial and anti-inflammatory properties without bacterial resistance seen with other antibiotic spot treatments. Particularly beneficial in adult female hormonal acne. Requires about 12 weeks for full clearance but prevents new lesion formation with continued use.
Pros:
Great for patients who do not respond well to clindamycin gel or lotion
Cons:
Frequently denied by insurance
Skincare Routine for Those with Hormonal Acne
Patients with hormonal acne should keep a minimal yet effective skincare routine.
Hydrating and inert cleanser (AM, PM)
Use non-comedogenic moisturizers (AM, PM)
Apply retinoid creams like retinol nightly (PM)
Spot treat emerging breakouts with acne patches and medications such as clindamycin or topical dapsone (AM, PM)
Moisturizing Sunscreen daily (AM)
Summary of Things To Remember About Hormonal Acne
Consistent skin care, avoiding triggers that worsen hormone fluctuations and determining the optimal acne prescription formula with your dermatologist prevents most hormonal acne breakouts from controlling your life.
Pay attention to lesion patterns and life stage timing for clues guiding suitable treatment before permanent scarring develops.
Occurs due to hormonal shifts causing oil gland/follicle changes
Look for signs like lower face clustering, monthly cyclic worsening, cystic lesions
See a dermatologist for persistent bumps not resolving with over-the-counter routines
Hormonal birth control pills, spironolactone, isotretinoin, topical retinoids treatment options
Blue/red light therapies, peels and extractions address current breakouts
Controlling hormones stops new acne formation over time
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What role does testosterone play in the development of hormonal acne in women?
Testosterone, a male sex hormone present in both men and women, can contribute to hormonal acne in women when its levels become imbalanced. An excess of testosterone can lead to increased oil production in the sebaceous glands, which can trigger acne outbreaks.
Can hormonal imbalances contribute to the development of hormonal acne, and what are some common hormonal imbalances associated with it?
Yes, hormonal imbalances can play a significant role in hormonal acne. Common hormonal imbalances that contribute to acne include elevated androgens (like testosterone) and fluctuations in estrogen levels, particularly during the menstrual cycle.
How does hormonal acne typically appear, and who is more likely to experience hormonal acne, specifically adult females?
Hormonal acne is typically characterized by deep, painful cystic lesions on the face, neck, chest, or back. Adult females are more likely to experience hormonal acne, especially during times of hormonal fluctuations, such as menstruation, pregnancy, or menopause.
What are some treatment options available for hormonal acne, including both medical and non-medical approaches?
Treatment options for hormonal acne include topical treatments (e.g., benzoyl peroxide, salicylic acid), oral antibiotics, hormonal therapy (such as birth control pills or anti-androgen medications), lifestyle modifications, and dietary changes. Consultation with a dermatologist can help determine the most suitable approach.
Can oral contraceptives be used as a treatment for hormonal acne, and how do they work to address the hormonal component of acne?
Yes, oral contraceptives are often prescribed as a treatment for hormonal acne. They work by regulating hormone levels, particularly reducing androgens, and thus can help manage acne by addressing the hormonal component.
How can people with persistent hormonal acne create an effective acne treatment plan?
An effective acne treatment plan for persistent hormonal acne typically involves a combination of medical treatments, proper skincare, and lifestyle modifications. Consulting with a dermatologist can help tailor a personalized plan.
What lifestyle factors and skincare routines can help prevent and clear up hormonal acne?
Maintaining a healthy lifestyle, managing stress, using non-comedogenic skincare products, and adopting a consistent skincare routine can help prevent and clear up hormonal acne. Additionally, avoiding certain dietary triggers and maintaining a balanced diet can be beneficial.
Are there any specific dietary or hormonal cascade triggers that may worsen hormonal acne, and how can one modify their lifestyle to help with hormonal acne management?
High-glycemic diets, dairy consumption, and excessive stress can worsen hormonal acne. Modifying your diet to include more low-glycemic foods, reducing dairy intake, and practicing stress management techniques like exercise and meditation can help with hormonal acne management.
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We are a group of dermatology residents and attending physicians based in Boston, MA. Our team of Ivy League-trained dermatologists is demystifying the cosmeceutical industry by offering unbiased, scientifically supported reviews of skincare products. We are extremely passionate about skincare and making it accessible to all through education. We value integrity, practicality, and inclusivity. No sponsorships were received for the products prior to testing; we feel strongly about providing un-biased reviews. After blogs are published, following the links in this blog post may result in commission.
