Hormonal acne: Signs, causes, and treatments

Many of us associate acne with being a teenager.  But those pesky, inflamed bumps can—and often do—persist well into adulthood, causing the concealer and pimple patches to stay in rotation for much longer than anticipated. If you’re in that (annoying) adult acne boat, you may be dealing with hormonal acne.

There are a few ways to spot hormonal acne—and, luckily, it doesn’t have to last through adulthood. Read on to learn more about hormonal acne, its causes, and how to treat it. 

What is hormonal acne?

Hormonal acne is acne that occurs in the adult years and is caused by hormone fluctuations. It typically appears on the lower parts of the face, around the chin, cheeks, and jawline. It often manifests as deep cysts and nodules, but may also form as blackheads, whiteheads, pustules, and/or papules. 

About 50% of women in their 20s and 25% of women in their 40s experience hormonal acne, according to Cleveland Clinic.

What causes hormonal acne?

Many (but not all) kinds of acne are caused by hormones. Most people start experiencing breakouts as teens or tweens, when puberty causes an increase in androgens, a sex hormone that plays a role in reproductive development. The increased levels of androgens act on sebaceous glands (oil glands in your face) and increase the production of sebum, an oil that clogs your pores and causes pimples. 

For some people, hormones level out as puberty ends and the acne goes away. People whose hormones don’t quite level out in adulthood often experience hormonal acne. For this reason, hormonal acne is especially common in people who have conditions that cause hormone imbalances, like polycystic ovary syndrome (PCOS). You don’t have to have PCOS to experience hormonal acne, but  a lot  people who have PCOS get hormonal acne.

Your hormones fluctuate throughout your life, too, so hormonal acne may also appear and disappear during adulthood. For example, pregnancy increases androgen production, which can often cause or worsen hormonal acne. Likewise, there is a relative increase of androgens in the menopausal female that leads to clinical hyperandrogenism manifesting as acne.  

How to know if you’re dealing with hormonal acne

The best way to find out whether or not you have hormonal acne is to visit a dermatologist. They’re the only ones who can provide an official diagnosis. However, hormonal acne often comes with a few telltale giveaways that you can investigate for yourself:

  • Acne located on the lower half of your face: Hormonal acne usually appears on the lower part of the face—along the jawline, chin, and lower cheeks. It can also appear on the chest, neck, back, and shoulders.
  • Breakouts come at the same time every month: Hormones fluctuate with your menstrual cycle, so pimple flare-ups that occur around the same time every month are often a sign of hormonal acne. They may even appear on the same exact spot every time. If you find that you often receive unwanted visitors (that is, acne) say, a week or two before your period, it may be helpful to start tracking your breakouts so you know exactly when they occur. This can be useful to present to a derm to get the best treatment plan.
  • Acne feels painful and lasts for a long time: Hormonal acne can come in the form of surface-level whiteheads and blackheads. But it often causes deeper nodules and cysts. These breakouts form under the skin and become painful and inflamed without coming to the surface. They may also last longer than other types of breakouts.
  • You’re really stressed: High levels of the stress hormone cortisol can increase oil production and clog pores. If you have a new source of stress in your life—school, a new job, family stress—that may be a source of your breakouts, too. 
  • You’re breaking out in your 20s or later: This one may feel like a “duh.” But if you’re consistently dealing with pimples beyond your teen years, that’s a sign of hormonal acne. Your hormones are especially active in your 20s, which can wreak a lot of havoc on your skin.
  • You’ve been told you have a hormone imbalance: If you know you have a condition that impacts your hormone levels, like PCOS, your breakouts could be caused by hormone fluctuations.

If you haven’t been diagnosed with a hormone imbalance, it’s still a good idea to let your doctor know if you’re dealing with consistent adult acne. It could be a sign of a hormone imbalance and may be used to reach a diagnosis.

How to treat hormonal acne

Because it’s caused by fluctuations happening inside your body, hormonal acne can sometimes be more stubborn than other forms of breakouts. However, it’s still possible to treat.

  • Try salicylic acid, retinoids, or benzoyl peroxide: A face wash or treatment with salicylic acid—a common ingredient in over-the-counter acne treatments—can help reduce sebum content in the skin and prevent hormonal breakouts. Retinoids (like retinol) or benzoyl peroxide have also been shown to reduce adult acne. Just be sure to start with one topical treatment (unless you’ve gotten direct instructions from a skincare pro to mix and match). Doing too much, too fast on your skin can cause irritation and further breakouts. 
  • Minimize stress: Yes, this one is easier said than done. But identifying stress triggers and managing them—whether that involves meditation, medication, exercise, therapy,  reduced screen time, or something else—may help clear up your skin.
  • Eat nutrient-dense foods: Your diet can have an impact on your hormonal health—and your skin. Foods rich in omega-3 fatty acids (like salmon and walnuts), antioxidants (like berries), and vitamin A (like leafy greens) are proven to benefit your skin. Plus, they’re just good for you.
  • Visit a dermatologist: If you can, it’s always best to visit a derm. They can confirm that you have hormonal acne and may prescribe you treatments you can’t get over the counter. This may include hormonal therapy, which involves taking spironolactone (a drug that helps clear hormonal acne by slowing the body’s production of androgens) alongside birth control pills. You can also take spironolactone or the pill individually. A dermatologist can also prescribe topical treatments like tretinoin, which speeds up skin cell turnover and minimizes breakouts and acne scarring. Finally, they may suggest laser treatment, which can provide long-lasting acne relief (and may help treat acne scars, too).

Allara Health provides personalized treatment for hormonal, metabolic & gynecological conditions that utilizes a holistic plan that merges nutrition, lifestyle, medication and supplementation, and ongoing, expert support to heal your body.