Hormonal Acne Explained: Causes, Symptoms, And Treatments
Many of us are under the impression that acne is something of the past once we enter adulthood, only to find out later that this pesky skin condition doesn't discriminate based on age. Roughly 80% of the U.S. population deals with acne sometime in their life, according to the Cleveland Clinic. In fact, 50% of women in their 20s develop this skin condition at some point (so much for leaving acne behind in our teenage years), and 25% of women in their 40s struggle with hormonal acne. Even though hormonal acne mostly affects women, men are not exempt from this skin condition.
When women experience changes in their hormone levels, acne tends to rear its ugly head, but it can also be genetic in some cases or even be a side effect of medication. Men who undergo testosterone treatment usually have to deal with acne as one of the side effects.
Acne can undermine people's dreams of flawless, glowing skin, and while a miraculous cure still doesn't exist (though we're holding out hope), there are some effective ways to treat acne and prevent flare-ups. Let's have a look at the causes, symptoms, and treatments for hormonal acne so you can get started on your journey to clearer skin.
What is hormonal acne?
We know what you're thinking: Aren't hormones usually the culprit when it comes to acne? Yes, they are, but the term "hormonal acne" is used to refer to acne that develops during adulthood and typically shows its ugly face in people aged between 20 and 50. "In fact, 54% of adult women and 40% of adult men suffer from acne, and many of them do not have a history of acne as a teenager," board-certified dermatologist Corey L. Hartman told Good Housekeeping.
Speaking to Marie Claire, dermatologist Dr. Andrea Tomizawa explained that hormonal acne is the result of inflamed pores caused by hormonal fluctuations, and often it is triggered by changes to the menstrual cycle or pregnancy. There are also instances where it's caused by underlying conditions. "Hormonal acne is more common in patients with polycystic ovarian syndrome (PCOS), a condition that can cause irregular periods, increased body hair, and important changes in the way your body responds to sugar," Tomizawa says. According to Healthline, some people who suffer from hormonal acne don't have any obvious hormonal irregularities. This can make treating the source of the problem more difficult.
Hormonal acne usually manifests as cysts, whiteheads, or blackheads, and you'll notice that most blemishes appear on the lower half of your face, like your chin, lower cheeks, and jawline. However, according to board-certified dermatologist Marisa Garshick, hormonal acne can look different for everyone (via Good Housekeeping).
Causes of hormonal acne
The main cause of hormonal acne is — you guessed it — fluctuating hormones. Board-certified dermatologist Marisa Garshick told Good Housekeeping that there are three hormones that are responsible for those acne flare-ups during adulthood: testosterone, estrogen, and progesterone. Whenever these hormones fluctuate, whether that be because a person is pregnant or going through menopause (or any other reason), the body responds by producing more sebum, which ends up clogging pores. According to Garshick, this "leads to inflammation, changes in skin cell activity and colonization of bacteria in hair follicles." This creates the perfect conditions for acne to thrive.
Menopause, pregnancy, and menstrual cycles aren't the only things that can cause hormones to fluctuate: Your lifestyle and certain chronic medications can also have an impact. If you're super stressed, don't sleep enough, and regularly indulge in junk food, your skin will likely start to retaliate. Acne can also appear when you first start using birth control or after you stop taking it. Some steroids can also have an impact, as well as certain supplements and testosterone therapy.
The role hormones play in acne breakouts
Our bodies can't function normally without hormones, but we can all agree that they can be a real pain in the butt sometimes. According to Medical News Today, testosterone is the main cause of acne, especially in teenagers. As young bodies develop, testosterone levels rise to aid development in males while building muscle and increasing bone density in girls. While these changes are necessary, it usually causes acne flare-ups. Oil glands are very sensitive to testosterone, and when this hormone fluctuates, the glands respond by producing more sebum, which result in clogged pores.
Another hormone associated with hormonal acne is estrogen. When this hormone's levels start to diminish during menopause, it can trigger breakouts. Cortisol, otherwise known as the stress hormone, is another culprit, board-certified dermatologist S. Manjula Jegasothy told Self. "Women who are prone to monthly hormonal fluctuations, which are quite steep, and have periods of acute stress, are setting up a 'perfect storm' for themselves to get a hormonal acne flare," she explains.
In short: Fluctuating hormones will almost always manifest as breakouts or acne, and doctors speculate that it's because altered hormonal ratios act as stimulants to sebaceous glands. In addition, if you suffer from medical conditions that cause constant hormonal fluctuations, like polycystic ovary syndrome (PCOS), you're more likely to experience hormonal acne during your lifetime.
Symptoms that indicate hormonal acne
We're all familiar with breakouts, but how do you know if what you're experiencing is actually hormonal acne? Speaking to Women's Health, board-certified dermatologist Sanusi Umar said it's best to make an appointment with a dermatologist to ensure you diagnose your skin's condition correctly. However, there are a few signs you can look out for that will indicate you have hormonal acne.
Board-certified dermatologist Michele Green tells Women's Health that having painful cysts popping up on your jawline or chin is usually a dead giveaway. You might also notice papules, pustules, whiteheads, and blackheads in this area, Umar adds. Hormonal acne also tends to follow a pattern. "It is common for hormonal acne to reappear in the same areas in a cyclic fashion," Umar explains. "Many adult patients struggling with hormonal acne indicate that their breakouts are more pronounced for a certain period each month or when they have endured significantly more stress." So, if your breakouts are in sync with your menstrual cycle, you're likely dealing with hormonal acne. You might also notice that the spots appear in the same area every month. Speaking to Self, dermatologist S. Manjula Jegasothy explained that some acne pimples actually enlarge pores, which makes them more prone to trapping oil again and forming another pimple.
Another telltale sign that you're dealing with hormonal acne is your age. If you're in your 20s or older and experiencing serious breakouts, you're likely dealing with acne, Jegasothy says.
Hormonal acne can vary in severity
Not all hormonal acne breakouts are the same. They're usually divided into three categories: mild, moderate, and severe (via Medical News Today). Treatment will depend on the severity.
If you struggle with whiteheads and blackheads that don't need any intervention from a doctor and only have about 20 acne papules on your face, you likely only have a mild case. Moderate acne is classified by 20 to 100 acne papules that include inflamed lesions. Moderate acne also tends to leave scars. If your entire face appears to be covered with inflamed lesions, you've likely reached a severe state of acne that can cause scarring and seriously affect your self-esteem. With that said, acne can affect our self-esteem no matter how severe it is. It's important to consult with a dermatologist when you notice acne-like breakouts so you can get the right treatment as soon as possible.
How long does hormonal acne last?
Most of us who struggle with hormonal acne have only one question: How long is it going to take for this to go away? Unfortunately, there isn't one answer to this question. If you have mild to moderate acne, you might have clear skin within six weeks of starting over-the-counter treatments, dermatologist Paradi Mirmirani told WebMD. But if your acne is more severe, you'll likely need prescription drugs to see results.
Speaking to Women's Health, dermatologist Michele Green explained that the pimples can disappear within a week once you start treatment, but they might return if you don't seek out professional help. "For patients who forgo evaluation and treatment with a dermatologist, their hormonal acne can last for years," she warns.
If you opt for treatments like Isotretinoin (Accutane), you will likely start to see an improvement in your acne symptoms two months after beginning treatment, according to Practical Dermatology. Usually your face will be clear of acne within four to five months. This is why it's imperative you see a dermatologist if you constantly struggle with hormonal acne flare-ups. They can prescribe treatment that will help you get your clear skin back in no time.
An effective, consistent skincare routine can help treat and prevent acne
If you don't already have a consistent skincare routine, hormonal acne will provide you with plenty of motivation to start one. Dermatologist Corey L. Hartman told Good Housekeeping that you should be washing your face twice a day with a cleanser specially formulated for acne-prone skin. Look for cleansers that contain acne-busting ingredients like lactic or salicylic acid — these chemical exfoliators will do away with dead skin cells and prevent your pores from clogging. If you struggle with very red, inflamed acne, opt for a cleanser that includes benzoyl peroxide. If your skin can handle it, go for a face wash that contains a concentration of 10%. Director of Cosmetic & Clinical Research in Dermatology at Mount Sinai Hospital Joshua Zeichner says that products with this concentration of benzoyl peroxide work great "because they sit on the skin for only a short period of time, [so] a higher concentration gives a better chance of penetration into the follicles before it is washed off of the skin."
As much as you'd like to scrub your face, Hartman says to avoid it and refrain from giving in to the urge to pick or pop pimples. If you have very sensitive skin and know that benzoyl peroxide is only going to make things worse, Hartman says you can opt for a gentle cleanser and then apply a topical acne treatment after.
Using retinoids can be a game-changer
If you've heard rumors about retinoids working miracles for acne-prone skin, you heard right. If you're struggling with hormonal acne and would like to see what retinoids can do for you before making an appointment with a dermatologist, you can opt for over-the-counter products like Differin or La-Roche Posay Effaclar. According to board-certified dermatologist Mona Gohara, speaking to Cosmopolitan, these products contain prescription-strength retinoids that can kick acne to the curb.
Retinoids should only be applied every other night, and it's imperative you follow them with a rich moisturizer to keep your skin hydrated. If you don't see any improvement after six weeks, Gohara says to make an appointment with a dermatologist, adding that "it's just not worth the scarring or inflammation."
Your dermatologist will be able to assess your skin and prescribe stronger retinoids if needed. "Retinoids speed up and regulate the shedding within your oil glands, so bacteria doesn't have anything to feed off of to create inflammation," Gohara explains. She adds that prescription retinoids will be much more effective in the war against acne. Dermatologists can also add additional treatments, like anti-inflammatory products as well as ointments containing antibiotics.
Using prescription medication can help get acne under control
If topical treatments alone don't do the trick, your dermatologist will likely suggest that you treat your acne from the inside out. One common medication prescribed for acne is oral contraceptives. This medication works to stabilize the hormones that cause flare-ups, according to WebMD.
Another option you can consider is antiandrogen drugs like spironolactone. "These oral therapies help reduce the amount of excess androgens (primarily male hormones) that can cause hormonal acne," cosmetic and board-certified dermatologist Marina Peredo told Self. Board-certified dermatologist Cherise M. Levi agrees, saying that spironolactone works great to reduce your skin's oil production.
If you've tried hundreds of treatments and medications without success, your dermatologist might recommend Isotretinoin. Better known as Accutane, this medication is vitamin A in pill form. This is a strong medication that keeps your oil glands from producing excessive amounts of oil while also working to encourage skin renewal, according to Peredo. This treatment is usually reserved for people with severe acne, but according to the American Academy of Dermatology (AAD), it is often prescribed to people with moderate acne who don't see any results from alternative treatments. Most medications have side effects, and Isotretinoin is no different. You should not get pregnant while you're taking it, since it's known for causing birth defects, according to the National Organization for Rare Disorders. However, this medication won't affect your ability to become pregnant later on, Peredo assures (via Self).
Some vitamins and supplements might make a difference
Some of us don't like taking prescription medication unless absolutely necessary, and if you'd like to try out other treatments for acne first, there are some vitamins and supplements that could help you out, like nicotinamide (vitamin B3) and zinc.
A 2017 study published in Dermatologic Therapy found that nicotinamide has anti-inflammatory properties that are effective at fighting acne when taken orally. The best part is that researchers didn't observe any major side effects in participants taking this supplement. Additionally, speaking to Good Housekeeping, dermatologist Marisa Garshick explained that zinc can be effective at treating hormonal acne as well, and there is research that supports this. A 2014 study published in Dermatology Research and Practice found that applying 5% zinc sulphate topically can help treat mild to moderate acne effectively. Those who suffer from more severe acne saw better results when taking zinc sulphate orally, but this group did experience side effects like diarrhea and nausea.
Garshick warns that it's important to check in with your doctor before taking supplements since taking too much can do more harm than good (via Good Housekeeping). She also recommends you don't start chugging several supplements at once. "[It's] best to only start one new supplement at a time to be able to identify what is helping or if any side effects occur," she explains.
You can try to treat hormonal acne naturally
Mother nature always has a few tricks up her sleeve, and if you want to try all-natural treatments for hormonal acne, there are plenty of options like tea tree oil, alpha hydroxy acids, and green tea.
You've probably heard some people rave about the positive effect tea tree oil has on their acne, and research has proven that it packs quite the punch, thanks to its anti-inflammatory properties. A study published in Advances in Experimental Medicine and Biology found that applying 5% tea tree oil on the skin can be beneficial to those who have acne that falls in the mild to moderate category (via Healthline). Similarly, green tea also has anti-inflammatory properties, and while you'll likely reap plenty of benefits by drinking it a few times a day, you can also shop for skincare that contains at least 2% green tea extract. This powerful natural compound might help you treat and prevent acne breakouts when used regularly.
Alpha hydroxy acids (AHAs) are natural acids usually found in citrus fruits. These are pretty powerful compounds, and they can serve as chemical exfoliators that clean out clogged pores while removing dead skin cells. As a bonus, these acids can also help you get rid of scars left behind by acne.
Eating right and stressing less may result in clearer skin
You've heard it before: Stress can really mess with your skin, and so can your diet. Speaking to Women's Health, dermatologist Michele Green explains that stress has a direct impact on your hormones, so reducing it can help you control those imbalances in a way. She suggests you incorporate some stress-relieving activities like meditation and exercise into your daily routine.
In addition to managing stress, cleaning up your diet a bit might prove to be helpful in preventing and reducing acne breakouts. Even though research hasn't shown a direct link between eating habits and acne, dermatologist Andrea Tomizawa told Marie Claire that some people do notice improvement when they eat less of certain food groups: "[In] certain people, they may find that a particular food group — especially those in high refined sugar — can exacerbate their acne. For these people, avoiding these foods can help to reduce their breakouts." However, Tomizawa warns that you shouldn't expect your skin to suddenly become acne-free when you improve your diet; additional treatments are usually required. Some people find that consuming less high-fat and dairy foods also helps their skin to clear up. "Foods that have been linked to increasing levels of acne-causing hormones include dairy, trans and saturated fats, and high-glycemic carbs," Green says.
When should you see your doctor about your acne?
Sometimes hormonal acne can be treated successfully with over-the-counter products, but often the best route is to go see your doctor or dermatologist. Speaking to WebMD, dermatologist Paradi Mirmirani says that people with mild to moderate acne will typically notice an improvement within six weeks after starting treatment with over-the-counter products. If your acne lasts longer than that and doesn't show any improvement, it's time to make an appointment with a dermatologist. Either you have a more severe form of acne, or you're using the wrong products, dermatologist Ranella Hirsch says (via WebMD).
Another telltale sign that you're dealing with more severe acne is when you experience scarring and inflamed pimples along with nodules. The latter usually presents as painful bumps under the skin and is a sign of cystic acne. Treating this can be challenging, and you definitely won't be able to take care of it on your own. "If you suffer with more serious forms of acne like cystic acne, over-the-counter treatments will never be enough, and waiting is just delaying the inevitable trip to the dermatologist," dermatologist Amy Derick tells WebMD.
Another sign you need to pay a visit to your dermatologist is when you notice that your acne is starting to take a toll on your self-esteem. If you're canceling plans with friends or feel anxious about your appearance when you're in public spaces, it's time to tackle the problem with the help of a professional.