Hormones happen. And that’s a good thing. These chemical messengers, produced by various glands, are constantly working overtime to coordinate the most important functions in the body.

Metabolism. Sleep. Digestion. Fertility. Growth and development. Blood pressure. Sex drive.

It’s safe to say, hormones influence every aspect of human life. Unfortunately, these chemicals are exquisitely sensitive things, and just as hormones impact our lives, our lives can have a big impact on hormones too.

Hormonal acne is one condition that can develop when certain hormones fluctuate and throw off the delicate balance required to keep the body’s internal dance regulated and in rhythm.

What is hormonal acne?

As the name suggests (sometimes medical terminology makes so much sense), hormonal acne refers to breakouts that are influenced by changes in hormone levels. While any gender can have hormonal acne, regardless of age or skincare routine, it typically affects people assigned female at birth more than men. That’s because, you guessed it, women tend to experience more hormone fluctuations than men due to puberty, menstruation, pregnancy, and menopause.

Unlike the occasional pimple that pops up, hormonal acne can be persistent and can appear in the form of cysts and nodules (usually around the jawline, chin and lower face), which are deeper, more painful, and more likely to leave scars. This type of acne is most prevalent among women in their 20s and 30s, but it can affect teenagers and older women as well. In fact, according to the International Journal of Women's Health, up to 25% of women in their 40s develop hormonal acne.

What causes hormonal acne?

The short answer: Excess sebum in oil glands. 

Hormonal acne is generally driven by fluctuations in estrogen, progesterone, and (especially) by androgens, which are a group of sex hormones (think testosterone) that play a key role in reproductive health and body development. During times of increased hormone production, the body makes more sebum, an oil/waxy substance that can clog pores and lead to inflammation, changes in skin cell activity, and bacteria colonization.

During certain life phases, like menstruation and menopause, estrogen decreases. This fluctuation can cause acne. During pregnancy and ovulation, progesterone increases, which triggers the release of sebum. This can also lead to skin problems.

Many women have excess androgens, particularly testosterone, and these hormones can stimulate oil glands and cause hormonal acne too. This explains why people with PCOS often experience breakouts of hormonal acne.

Of course, hormones are complicated, so it’s not always that simple. Medications, certain foods, anxiety, depression, and stress can also cause hormonal acne.

Preventing and Treating Hormonal Acne

Treating hormonal acne often requires a multi-faceted and flexible approach. There are some strategies to consider when planning your course of action to control hormonal acne, keeping in mind that trial and error, time, and patience are likely the most important factors when seeking a strategy that works for you and your unique situation:

• Skincare: Gently wash your face with a mild soap or cleanser that contains alpha hydroxy acid, like glycolic acid, or beta hydroxy acid, like benzoyl peroxide. These exfoliants help loosen dead skin cells, reduce inflammation, and prevent clogged pores.
• Diet: Some studies suggest that diet can influence acne. Foods with a high glycemic index (sugary, refined foods) and dairy products might exacerbate acne for some people. Adding more fruits, vegetables, and whole grains can be beneficial for your skin and overall health.
• Stress Management: Since stress can worsen acne, finding effective stress management techniques, such as exercise, meditation, or yoga might help reduce breakouts.
• Medical Treatments: If improved skincare and lifestyle changes aren't enough, it might be time to consult your healthcare provider for guidance about over-the-counter and prescription treatment options.
• Topical Retinoids: Most dermatologists consider this vitamin A derivative to be the mainstay of hormonal acne treatment. Retinoids can be harsh, so start slowly and wear sunscreen.
• Birth Control Pills: Oral contraceptives, which help regulate hormones at the root of hormonal acne, can work wonders for people with this condition.
• Anti-androgen Medications: Medications, like spironolactone, block androgen receptors and decrease overall oil production. Despite its well-documented effectiveness, spironolactone can come with side effects, including irregular periods, headaches, and breast tenderness.
• Isotretinoin (Accutane): A form of vitamin A, isotretinoin is usually reserved for severe forms of acne. It’s a strong medication and requires close supervision to monitor for unwanted side effects.
• Procedural Treatments: In-office treatments, like laser and light therapies, can play a role in hormonal acne, but these options require a skilled dermatologist with experience with these methods.

Keep your breakouts at bay

Hormonal acne can be a challenge, but with the right mindset and approach, many people find success keeping breakouts at bay. If simple steps aren’t getting you there, talk to your healthcare provider about possible treatment options. Since other health conditions, like PCOS, can play a role in hormonal acne, your provider can also rule out any underlying issues that might be causing skin problems and hijacking your overall health and wellness. 

It’s important to remember: A diagnosis of hormonal acne (or any condition) doesn’t define you and sometimes getting support and being seen is the most powerful medicine of all.