Everyone tells us that acne is supposed to go away after puberty is over. In an ideal world, this would be true.
In our world, acne breakouts can and do happen well into adulthood. If you've noticed your acne flaring up around the same time each month (and all your best self-care practices don't seem to help), you may be experiencing hormonal acne.
Read on for a breakdown of what hormonal acne is, why it happens, and what you can do to get rid of it and get back to your life.
Hormonal acne happens when hormone fluctuations create the perfect storm for clogged pores.
The good news is hormonal acne is usually manageable with the right treatment regimen.
Hormonal acne treatments range from over-the-counter cleansers to prescription medicine to topical creams.
There are things you can do at home to help prevent breakouts.
What is hormonal acne?
Hormonal acne is a common skin disorder that causes outbreaks of skin lesions, aka pimples or zits, on the face and body.
It happens when hormone fluctuations create the perfect storm for your pores (skin surface openings) to get clogged.
Hormone fluctuations create the "perfect storm" for your pores:
Oil builds up on your face
Skin cells start clogging the hair follicles in your pores
Bacteria get trapped in pores
As you know, hormonal changes during puberty can lead to acne. What you may not know is that aging out of your teen years doesn't necessarily mean you're in the clear when it comes to your skin. Your hormones keep fluctuating even when you're an adult (thanks to, among other things, your menstrual cycle). These fluctuations can lead to adult acne.
Note: Hormonal acne isn't technically a type of acne, and your healthcare provider probably won't use that term when talking about it. (In case you were wondering, the actual term for acne is acne vulgaris.)
Cystic acne, a more severe type of acne, is often grouped into the category of hormonal acne. The phrase "hormonal acne" is mostly used by people outside of the medical profession to talk about the potential causes of their acne.
What causes hormonal acne?
In a nutshell, acne is caused by clogged pores or hair follicles. (Note: A pore is where the hair follicle opens up on the surface of your skin). Hormonal fluctuations can lead to excess sebum, or oil, and contribute to clogged pores. This leads to hormonal acne breakouts.
Acne can happen anywhere, but it's most common on the face, back, chest, and shoulders. We typically think of acne as a not-so-fun part of being a teenager, but unfortunately, some adults can continue getting acne into their 30s, 40s, 50s, and beyond.
Oil buildup = clogged pores
These clogs are caused by a buildup of oil and dead skin cells. The oil we're talking about is called sebum, and it's a natural oil produced by your body to keep your skin from getting too dry.
Fun fact: What is sebum? Sebum is produced by sebaceous glands that are connected to your hair follicles. On a clear skin day, these glands make sebum at the perfect rate, keeping your skin moisturized without clogging your pores. Good job, sebaceous glands!
When you get an acne breakout, dead skin cells and sebum gather in your hair follicles and cling to each other. Unfortunately, your sebaceous glands don't get the message that your pores are clogged, so they keep making sebum like nothing's wrong. That excess oil keeps building up in the hair follicle, leading to pimples.
All that buildup inside the hair follicle provides a perfect environment for bacteria to gather and grow. This bacteria (and your body's reaction to it) is what causes the redness, swelling, and pain that go hand-in-hand with acne breakouts.
Hormonal acne develops when hormonal changes result in increased oil buildup, leading to clogged pores. Common sources of hormonal fluctuation include:
Hormone changes during puberty: When a young person goes through puberty, their body starts producing more male hormones called androgens that make sebaceous glands grow and increase their oil production.
Hormone fluctuations in adulthood: Any changes in hormone levels as an adult-such as estrogen and progesterone fluctuations during your menstrual cycle-may lead to acne. Hormone changes during pregnancy and menopause can also cause acne.
Polycystic ovary syndrome (PCOS): PCOS is a hormonal syndrome linked to increased androgen levels, specifically testosterone. These higher levels of male hormones can cause acne in some women and people who menstruate.
Stress: When you're stressed, your androgen and cortisol (stress hormone) levels go up. This may make your sebaceous glands start creating more oil and may make acne worse.
Other things that can cause acne breakouts include:
Mythbusters! You've probably heard that chocolate, greasy food, or dirty skin can cause acne. Yet, there's little evidence that certain foods have much effect on acne, and it's a myth that dirt causes blackheads or pimples.
What are the symptoms of hormonal acne?
Hormonal acne is caused by hormonal fluctuations or hormonal imbalances.
Because females go through significant hormonal changes on a monthly basis (thanks, menstrual cycles), it's more common for adult women and people who menstruate* to deal with acne breakouts than men.
*Editor's note: Researchers surveyed women and men, ages 20 and older, in a 2007 study to find how many continued to be "plagued by acne well beyond the teenage years." They found that after the teenage years, women and people who menstruate were significantly more likely to experience acne in all age groups.
There are several common signs that point to hormonal acne breakouts. In general, look for the following symptoms:
Your breakouts happen at the same time
A good sign that your acne is hormonal is that breakouts happen around the same time each month. A 2014 study found that 65% of women and people who menstruate with acne reported that it got worse around their period. If you notice your acne following a similar pattern, it may be caused by your hormones.
You're breaking out along your chin and jawline
The 2014 study found that acne was spread pretty evenly around the women's faces, meaning that hormonal acne didn't occur more often in one specific place. But that's not always the case. Other studies have found that hormonal acne is most common on the chin and jawline.
Don't worry-it's normal for studies to find different results like this. Basically, all it means is that if your breakouts are mostly around your jawline, it may be a sign of hormonal acne. However, if your acne is spread more evenly around your face, that doesn't necessarily rule out hormonal fluctuations as a possible cause.
You're dealing with acne that’s deeper and beneath the skin’s surface
Another sign of hormonal acne is its appearance. Other types of acne can take the form of those all-too-familiar whiteheads or blackheads that we have to sit on our hands to keep from popping, but hormonal acne is often deeper beneath the surface of your skin. It's similar to cystic acne and can look like a bunch of cysts under the skin that appear all around the same time. This type of acne is caused by the excess androgens we talked about earlier.
Does hormonal acne go away?
Most types of acne, including hormonal acne, can visibly improve over time. Acne affects everyone differently, and breakouts can last anywhere from a couple days to months.
The good news? Hormonal acne is usually treatable. There are many products available to help reduce the frequency and severity of acne breakouts, ranging from prescription acne treatments and topical creams to over-the-counter cleansers. Finding the right hormonal acne treatment-or combination of treatments-may take some experimentation. However, with a little patience and open communication with your healthcare provider, you should be able to find an option that works for you.
What's the best hormonal acne treatment?
The best hormonal acne treatment is different for everyone. Your best options will depend on your specific condition and how severe your outbreak is. Everyone's acne is unique, and everyone responds to treatment in different ways.
If your hormonal acne symptoms are moderate or severe (especially if it's painful), you may want to ask your healthcare provider for treatment recommendations. They'll either prescribe you a personalized acne treatment plan or recommend an over-the-counter option.
Over-the-counter skin cleansers and face washes may be able to help people with mild to moderate acne. A few common ingredients in skin cleansers are:
Salicylic acid, which works by targeting the top layer of skin and dissolving dead skin cells. This helps prevent them from building up and clogging pores.
Benzoyl peroxide, which helps remove acne-causing bacteria from the surface of the skin. This makes it less likely for bacteria to enter clogged pores and cause redness and inflammation.
Antibiotics, such as clindamycin and erythromycin. These are typically combined with benzoyl peroxide to help keep bacteria on the skin's surface under control.
These over-the-counter skin cleansers and lotions may cause dryness and skin irritation. Your healthcare provider may recommend that you should stop using any product that causes a bad reaction.
Prescription acne options
Retinoids are a topical medication derived from vitamin A. These creams are anti-inflammatory and can treat acne of any severity. Retinoid creams work by increasing the turn-over rate of your skin. Basically, this means that dead skin cells are shed quickly and have less time to build up near your pores. Retinol creams can be used alone or with other acne medications to treat acne and prevent future breakouts. Retinoids can cause sensitivity to the sun, and to reduce your risk of a reaction, the FDA recommends wearing a broad sunscreen regularly and as directed.
Isotretinoin is a pill that can treat more severe cases of acne. Like retinol, it's a derivative of vitamin A. This medication works by making sebaceous glands smaller and telling them to produce less oil. It's also anti-inflammatory and helps prevent the buildup of dead skin cells around the pores.
This medication may cause birth defects if taken while pregnant, so it's important to be on a reliable birth control method while you take it.
Spironolactone is another prescription medication that's used for more severe acne cases. It's not technically approved as an acne treatment, but it's been successfully prescribed off-label to treat acne since the 1980s.
The drug spironolactone can work against the hormones in your body that increase oil production. This action may help prevent clogged pores, because more oil = more clogged pores = acne!
Like isotretinoin, spironolactone may cause birth defects, so it's important to use a reliable birth control method when you're on this medication.
Antibiotic pills may be prescribed to help reduce the growth of bacteria on your skin, which may prevent some acne. However, research has found that antibiotics may not be the best option because they have a couple drawbacks:
Over-prescribing antibiotics may lead to antibiotic resistance, which is when bacteria develop resistance to drugs, threatening their effectiveness.
They can also disrupt your microbiome (the collection of microbes that naturally live within us) and mess with your gut health
Birth control pills (oral contraceptives)
Your healthcare provider may recommend hormonal birth control to help get your acne under control. There are two types of birth control pills, combination birth control pills (which have progestin and estrogen) and progestin-only birth control pills (mini-pills). Only combination birth control pills, which combine the 2 hormones, are used to treat acne.
Hormonal birth control pills help by lowering levels of male hormones that are causing excess oil production in the first place. Any combined oral contraceptive should have this effect.
There are only four types of birth control approved to treat acne by the Food and Drug Administration (FDA):
Natural remedies for hormonal acne
If you prefer a natural remedy for your acne, you may have a few options. However, we should note that there isn't a lot of research on how—or if—natural remedies work. Also, if they do work, they'll probably be best for mild cases of acne.
Let's go over some natural remedies for acne and see if there's science to back up their effectiveness:
Vitamin D supplements
A 2016 study found that people with acne were more likely to have a vitamin D deficiency, but the study's authors couldn't tell why. More research is needed before we can say if vitamin D supplements help with acne.
Tea tree oils
Multiple studies have found that tea tree oil is an effective way to reduce hormonal acne naturally. You should talk to your provider and follow the manufacturer's recommendations before putting tea tree oil on your skin.
Researchers are studying plant substances to see if they can help reduce an excess of male sex hormones in the body. Natural remedies like spearmint tea, licorice, or green tea seem promising, but scientists have to study them further.
The scientific community goes back and forth on how food can affect acne, but making some changes to your diet may help decrease how often and how badly you break out.
These diet changes could include:
Decreasing your dairy intake, specifically cow's milk (yogurt and cheese may be okay)
Sticking to a low-glycemic diet (think: avoiding simple carbohydrates like white bread, potato chips, pastries, and sugary drinks; instead, opt for complex carbs like fresh vegetables, some fruits, beans, and oats)
Drinking more green tea for its potential to reduce sebum production
What can you do at home to prevent acne?
In addition to treating your acne flare-ups as they happen, you also want to take care of your skin between breakouts. Wondering how to treat hormonal acne at home? A few things you can do include:
Keeping your hands off your face throughout the day (the oil and bacteria on your hands can contribute to hormonal breakouts)
Being gentle on your skin (this means no picking at or squeezing pimples, harsh scrubbing, or scratching)
Washing your face twice (and only twice) a day with a fragrance-free, gentle cleanser
Washing your skin immediately after working out or sweating for any other reason
Avoiding astringents, toners, and exfoliants that may irritate your skin (gentle cleansers are your friends!)
Staying out of the sun and using sunscreen to protect your skin when you go outside
Sticking to non-comedogenic makeup and moisturizers (these are products specially made to not clog pores)
At best, hormonal acne can be a minor annoyance. At worst, it can be a painful ordeal that brings up feelings of anxiety or embarrassment. Though acne is a natural process that you should never feel ashamed of, it is still understandable to want to make it go away.
Treating hormonal acne can be an ongoing process, but you and your healthcare provider can experiment until you find a solution that works for you.