Everything You Need to Know About Hormonal Acne—and How to Clear It for Good

For many women, pimples continue to sprout up way beyond puberty, thanks to fluctuating hormones. The good news: Hormonal acne can be treated.

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Hormonal acne is unique

You might be thinking “isn’t all acne caused by hormones?” And you’d be correct. “All types of acne originate from hormones,” explains Miami dermatologist, Jill Waibel, MD. “Testosterone, a hormone that is present in males and females, increases during adolescence. Testosterone stimulates the sebaceous glands of the skin to enlarge, produce oil, and plug pores. But even when you’re done going through puberty, that doesn’t mean you’ll never get another pimple. “The term hormonal acne typically refers to breakouts that occur in adult women,” says Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York. “These pimples tend to be red, angry bombs that typically occur along the lower one third of the face, jawline, and neck.” Find out what your acne breakout is trying to tell you.

Know the causes

“Flares of hormonal acne are caused by overstimulating the oil glands and altering the development of the skin cells that line the hair follicles, which causes clogged pores where the acne bacteria grows, leading to inflammation, redness and acne,” explains Debra Jaliman, MD, dermatologist and assistant professor of dermatology at Mount Sinai School of Medicine, New York. “It can present as blackheads, whiteheads, pustules, and cysts. It usually occurs before your period, during perimenopause, or after starting or discontinuing birth control pills.” It can also happen in times of great stress. Check out these other sneaky causes of adult acne.

How to ID hormonal spots

Even if you’ve had clear, smooth skin for a decade, you might wake up in your late 20s with a big red honker and wonder what’s going on. Look for where the pimples are forming. “Common symptoms of hormonal acne are plugged pores and inflammatory pimples in the T-zone area,” Waibel says. This means noticing bulging, and sometimes painful spots underneath your skin that are more common on the most shine-prone parts of your face, including your forehead and jawline. The build-up of oil  is what’s forcing zits to form. As Dr. Zeichner explains: “Androgens, such as testosterone, stimulate oil glands to rev up oil production. This both clogs pores and helps feed acne-causing bacteria on the skin, which promotes inflammation.”

Can you blame your period?

In short, you sure can. In fact, most women who suffer from hormonal acne report more frequent breakouts in the week or so before their periods. “Women tend to break out around their period because of cyclical fluctuations in hormones along with the menstrual cycle,” Dr. Zeichner says. While some birth control might help regulate traditional acne, other types of hormonally based birth control can actually worsen your conditions. Dr. Zeichner notes that all of the big life moments that most women go through—from trying an IUD to getting pregnant and having children to undergoing menopause—can trigger some unwelcome breakouts. Did you know that certain foods can improve your acne (and some make it worse)?

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Hormonal acne is super common

You might envy the friend who proudly proclaims that she’s never had a pimple (and we don’t blame you)—but you should also know that if you suffer from pesky, unpredictable skin, you’re definitely not alone. According to the American Academy of Dermatology, about half of women in the United States experience acne between the ages of 20 and 29. That number goes down to 25 percent by the time you’re in your 40s.

Myths about hormonal acne

Dr. Waibel says the biggest misconception about hormonal acne is that birth control will help solve the issue, and you should pop a pill and forget about it. “About 10 percent of women’s acne improve with birth control pills, but many worsen with the adding of any external hormones,” she explains. Another falsehood is the belief that you must not be taking good care of your skin. Since genetics play such a big role in our tendency toward breakouts, you could be religious about cleansing and treating your skin and still suffer from hormonal acne. “While some cleansers can help treat acne, breakouts are actually determined by genetics and hormones not because your face is dirty,” Dr. Zeichner says. “There are some people who do not wash their face much, yet do not break out. There are others who wash their faces much more frequently but do suffer from acne.” Read more about the myths and facts about adult acne that will help you on your way to clearer skin.

The best ways to treat hormonal acne

Luckily, with the right cocktail of topical treatments and, for more severe cases, oral medication, you can help manage and treat breakouts. Start with over-the-counter formulas that focus on specific ingredients, known to lessen your symptoms and inflammation. “Options include benzoyl peroxide, salicylic acid, and topical retinoids,” Dr. Zeichner says. One powerful retinoid, Differin, has FDA approval for sale over the counter, after decades of being available by prescription only. “Leave-on treatments are effective because they have time to exert their effect,” Dr. Zeichner adds. Cleansers are not as effective at combatting acne because they don’t stay on very long, though Dr. Zeichner suggests leaving them on for the length of time it takes you to sing the alphabet; then rinse off. “They can be used alongside leave-on products or in place of them if you have sensitive skin,” he adds.

In addition to what you put on your skin, you can also consider light therapies, often used in derm offices, and now available at drugstores. Dr. Zeichner says blue light helps kill acne-causing bacteria (try Tria Beauty Acne Clearing Blue Light), while red light can reduce the puffiness or redness of your skin (try RejuvaliteMD by Trophy Skin).

If you’re able to visit your dermatologist, there are also oral prescriptions that over time, can help clear hormonal acne. “We have effective medications to help treat acne, so please visit a dermatologist if you are suffering. Early, effective treatment can help prevent permanent scarring,” Dr. Zeichner says. Prescription medications include oral and topical retinoids and antibiotics, topical prescription dapsone (Aczone gel), prescription strength benzoyl peroxide (in some brand-name drugs such as Epiduo Forte), and hormonal treatments such as spironolactone and even some birth control pills which are FDA-approved to treat acne.”

Sources
  • Jill Waibel, MD, dermatologist, Miami
  • Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York
  • American Academy of Dermatology: "Stubborn acne? Hormonal therapy may help"
  • Debra Jaliman, MD, dermatologist and assistant professor of dermatology at Mount Sinai School of Medicine, New York City
  • American Academy of Dermatology: "Hormonal factors key to understanding acne in women"
 
Medically reviewed by Jessica Wu, MD, on October 27, 2019