Considered by dermatologists to be the most severe type of acne, hormonal acne is characterized by the development of tender, inflamed nodules underneath the skin. Hormonal acne can be difficult to treat, and just as traumatic to your ego as it is to your skin, but it is treatable. Consider this your comprehensive guide to treating and preventing hormonal acne breakouts.
What is hormonal acne?
Acne is the most common skin condition in the United States, with roughly 40 to 50 million Americans suffering from it at any given time. For many people, the blackheads, whiteheads, and pimples associated with breakouts stop at puberty. But for lots of others, women, in particular, hormonal acne can be a stubborn problem that occurs well beyond their teenage years. Hormonal acne can be attributed to hormonal changes that take place during the course of a lifetime, specifically during puberty, pregnancy, and menopause. These hormonal changes increase sebum and oil production, and thicken the skin, resulting in bacteria, excess sebum and dead skin cells blocking pores and triggering breakouts.
What are the causes of hormonal acne?
Any hormonal changes can trigger a hormonal acne breakout, but it’s most typically related to a woman’s menstrual cycle and the fluctuations of estrogen and progesterone that come along with it. These hormonal fluctuations cause increased oil production in the pores, resulting in breakouts. Additionally, the ratio of progesterone to estrogen can also have an effect on a woman’s testosterone levels, which can contribute to acne. Hormonal acne tends to worsen in cyclic flares along with monthly menstrual cycles. It’s typically worse during the week right before your period starts, when progesterone is at its peak. Women may experience hormonal breakouts during pregnancy or menopause as well when hormone levels drop. Stress can also wreak havoc on your hormones, particularly cortisol (known as the stress hormone) and is a common trigger for hormonal acne. Hormonal acne is also more common in patients with polycystic ovary syndrome, a hormonal imbalance common among women of reproductive age. Hormonal acne is genetic, so if it runs in your family then you're more likely to suffer from it.
Who can get hormonal acne?
Hormonal acne is common and can occur in anyone, but it's much more prevalent in adults than teens. Women tend to get hormonal acne more often than men do, with fifty percent of women ages 20 to 40 affected by it. It's even possible for someone who has never experienced acne before to experience hormonal acne for the first time as an adult.
How do you know if you have hormonal acne?
So how do you know if you have hormonal acne or just suffer from regular breakouts? If your flare-ups tend to crop up regularly at the same time of the month, that’s an indication that it’s hormonal. Hormonal acne is also specific in its location; it shows up on the jawline, chin, neck, and upper back. The cystic-like bumps of hormonal acne linger painfully under the surface of the skin without ever coming to a head. The inflammation can last weeks and the marks left behind by the large, painful bumps take months to fade away. Hormonal acne is much more difficult to treat than regular pimples, whiteheads or blackheads. Most times traditional acne treatments just won’t cut it on these stubborn breakouts.
How to treat hormonal acne
Hormonal acne is big, painful and harder to treat than regular breakouts, but it is treatable. Here’s how.
Do not try to pop the pimples
This one might seem like a given, but if you’ve ever tried to pop one of those stubborn bumps, you know that not only do they never come to a head, but trying to pop it will only exacerbate the inflammation and make it worse (meaning bigger and more painful). Hormonal acne is made up mostly of deep pockets of white blood cells that can't be popped, the way a pus-filled whitehead can.
Ice the affected area
Hormonal acne is rooted so deep underneath the skin, you’ll be able to feel it coming. When you do, grab an ice cube and apply it directly to the area for several seconds. This constricts the small blood vessels, feeding the cyst, and will immediately decrease redness and size.
Oral contraceptive pills
Many women find success with oral contraceptive pills because the estrogen in the pill reduces the production of sebum and androgen. Oral contraceptive pills can be especially helpful during hormonal peaks like during ovulation. However, oral contraceptive pills may not be an option for you if you have a history of blood clots, high blood pressure, or breast cancer. You also shouldn’t take these if you smoke cigarettes. Your doctor can help you decide if this is the right treatment for your hormonal acne.
Spironolactone is another oral drug sometimes prescribed by a doctor to treat hormonal acne in women. When other acne treatments don’t work, spironolactone works to eliminate deep, cystic, acne on the lower face, jawline, or neck. Spironolactone is an androgen-blocker, which means it slows down the production of male hormones, which are responsible for excess oil and breakouts. Make an appointment with a dermatologist to discuss whether spironolactone is an option for treating your hormonal acne.
Isotretinoin is a vitamin A‑based drug that is highly effective in treating severe acne with signs of scarring. Isotretinoin stops the oil glands from producing too much sebum and speeds up the shedding process of dead skin cells; both of which work to prevent blocked pores, leading to breakouts. Dry, cracked skin is a common side effect of isotretinoin so close supervision by your doctor is recommended once it has been prescribed to treat hormonal acne.
Retinoids are a huge family of compounds derived from vitamin A and they play a significant role in reducing hormonal acne. Retinoids reduce the blockage of pores and prevent things like blackheads and comedones from forming. But it’s very common for skin irritation and redness to occur if you’ve never used a retinoid before, so treatment should be built up gradually. Start by adding a natural retinol serum into your skincare routine two to three times a week, taking a break in-between days. Use retinol in the evening, rather than during the day, when sunlight can break it down, making it less effective. In addition to treating acne, retinol benefits your skin in so many more ways, it really is a superstar ingredient.
Tea Tree Oil
Tea tree oil works by fighting the inflammation associated with hormonal acne breakouts. One study found that a 5 percent topical tea tree oil relieved symptoms in participants with mild to moderate acne. You can also use tea tree essential oil as a spot treatment. If you’re suffering with hormonal acne, apply a few pumps of tea tree oil face serum after washing your face, or apply it directly on the affected areas as a spot treatment.
Glycolic acid treats hormonal acne by dissolving the upper layer of skin cells and can prevent flare-ups from cropping up when used consistently as a part of your skin care routine. Another helpful acne fighter is salicylic acid. Like glycolic acid, it dissolves the top layer of skin cells, but it penetrates deeper into the pores, dissolving sebum and wiping out blackheads.
Hydrocortisone cream contains a low dose of topical steroids that can help reduce redness and calm inflammation from hormonal acne. A one-percent cortisone cream can be effective when applied two to three times a day over the breakout for seven to ten days.
Studies show a link between dairy and acne and blood sugar spikes are known to cause inflammation and hormonal fluctuations so try to eliminate simple sugars like white rice, candy, soda, and processed foods in general. If you’re dealing with hormonal acne, try a gluten-free, dairy-free diet, free of processed carbs for 30 days to see if it helps.
Everyone’s skin is different so finding the treatment for hormonal acne that works best for you might take some trial and error. Cleansing, treating and moisturizing is an effective skincare routine for every skin type, including those with hormonal acne.
Just be sure that the products you’re using are specifically designed for oily skin with active ingredients. And be sure to finish up every morning skincare routine by applying an anti-aging sunscreen.
If you’re suffering from deep cystic pimples, it's important to visit a board-certified dermatologist to discuss the best treatment options for you, especially if you haven't found results after adjusting your skincare routine and lifestyle. Some serious cases of hormonal acne can sometimes be an indication of something more serious going on beneath the surface.
By Jaclyn LaBadia, staff contributor