Hormonal Acne: What It Is, Causes, Treatments and Remedies

• Hormonal acne is triggered by hormonal fluctuations and is characterized by clogged and inflamed pores. 
• The overproduction of sebum plays a major role in its development. 
• While anyone can develop hormonal acne, it is more prevalent among women than men across all age groups.
• Treatments include over the counter and prescription-strength topicals, oral medications and hormonal therapies.

Hormonal acne develops when pores become plugged by debris such as dead skin cells, dirt and excess sebum, the oily substance that protects the skin. Hormones are responsible for regulating sebum production.

While it is typically most severe during adolescence, a significant number of adults are also affected, due to hormonal changes that occur during menstruation, pregnancy or menopause.

Acne can range from mild to severe. Mild cases can be treated with other-the-counter (OTC) topicals and natural remedies, while more severe symptoms must be addressed with prescription medications.

What Is Hormonal Acne?

Hormonal acne is simply acne that develops due to hormone fluctuations, and is characterized by clogged and inflamed hair follicles. It typically develops on the face, but can also appear on the neck, back and on other areas of the body where there are a large number of sebaceous glands.

The eruptions that form do so at different levels of severity including blackheads, whiteheads, papules, pustules, nodules and cysts.

Hormonal acne falls within one of two categories:

• Noninflammatory acne occurs when pores become blocked with debris and oil, and develop into blackheads and whiteheads
• Inflammatory acne is characterized by inflamed pores that are deeply clogged with debris and bacteria, resulting in inflammation and the formation of papules, pustules, nodules and cysts

Is there a cure for hormonal acne?

There is no known cure for hormonal acne. Whether or not breakouts clear up depends on the body’s reaction to the treatments, and the efficacy of these treatments.

Many people see their complexion clear up at the end of puberty but others continue to experience acne well into adulthood. While there are several factors related to acne—such as genetics—hormone fluctuations are one such factor.

Causes of Hormonal Acne

Hormones play a central role in the development of acne, as they drive the skin’s secretion of natural oils. Sebum production is regulated primarily by androgens – hormones such as testosterone and DHT. Although referred to as male sex hormones, they play an important role in the physical development of both men and women.  

When androgen levels in the body are higher than normal, there is an increase in the production of sebum. This buildup of oil and other debris, such as dirt and dead skin cells, can result in pore’s becoming blocked.

These blockages cause Cutibacterium acnes, a bacteria that is naturally present on skin and pores, to multiply. The body’s immune system reacts, causing the surrounding tissue to become swollen and inflamed, resulting in the appearance of papules, pustules, nodules or cysts.

Additional factors that contribute to hormonal acne formation vary, and include other hormones, such as progesterone, estrogen and cortisol.

Hormonal acne in women

Acne is much more common in women than in men, as women undergo more dramatic hormone fluctuations. In addition to androgens, they also experience regular fluctuations in progesterone and estrogen levels, which are also associated with acne development.

One study found more than half of women aged 20 and older are affected by this condition. Cases are less prevalent in aging women as hormone production decreases with age.

The main causes of hormonal changes for women include the following:

• Menopause
• Menstrual cycles
• Polycystic ovary syndrome (PCOS)
• Pregnancy
• Puberty

Hormonal acne in men

Men tend to experience acne less frequently than women. However, their acne tends to be more severe; they are more susceptible to severe inflammation, nodules and cysts.

Men commonly develop acne in their adolescent years. This is because testosterone production increases dramatically during puberty, stimulating the sebaceous glands to produce more sebum.

Hormonal acne in men and women

Additional factors that contribute to the development and severity of hormonal acne in both men and women include the following:

• Genetics affect hormone levels and  immune system functionality, making some more predisposed to breakouts
• Psychological stress triggers the release of cortisol, a hormone that increases sebum production and is associated with acne development

Medical Treatments for Hormonal Acne

There are a variety of treatments available to treat hormonal acne. Choosing the best one for you will depend on the severity of your condition as well as your skin’s needs and sensitivities.

Dermatologists usually recommend OTC medication as a first-line treatment. For more severe cases, they may recommend a prescription-strength topical or combination therapy, involving both retinoids and antibiotics.

Over-the-counter treatments

OTC treatments are generally safe for most users, and can be used to effectively treat mild to moderate acne. However, they are unlikely to be potent enough to treat severe symptoms, such as nodules and cysts.

Treatments include benzoyl peroxide, salicylic acid cleansers, retinoid topicals and certain dietary supplements.

Benzoyl peroxide 

Benzoyl peroxide is one of the safest and most effective ingredients used in OTC treatments for mild to moderate acne. It is an antimicrobial agent that kills acne-causing bacteria, and helps to remove excess oil and dead skin by increasing skin cell turnover. This treatment is effective in reducing the number and severity of lesions.

Salicylic acid 

Salicylic acid treats mild forms of acne such as blackheads and whiteheads by breaking up the debris trapped within pores. It also helps to prevent pore blockage by exfoliating dead skin cells and reducing oil buildup on the skin’s surface.

Retinoids

Topical retinoids are creams, lotions and gels that are chemically derived from vitamin A. OTC retinoids are recommended as a first-line treatment for mild to moderate acne due to their safety and efficacy. They exfoliate dead skin cells, remove excess oil, prevent pore clogs, reduce inflammation and help prevent scarring.

Although topical retinoids are effective treatments, they do carry a risk of potential side effects. These include increased photosensitivity and skin irritation, which may lead to dryness, redness, scaling, itching and a stinging sensation.

Common examples of OTC topical retinoids include:

• Adapalene
• Retinol
• Retinyl Palmitate

Supplements

Vitamin, mineral and plant-based compounds can help reduce the frequency and severity of breakouts. Such supplements include the following:

• Fish oil alleviates the symptoms of moderate to severe acne
• Green tea extract has powerful antioxidant and anti-inflammatory qualities, and have been proven to treat moderate to severe acne
• Magnesium is known to reduce the severity of inflammatory acne symptoms; it also helps keep pores clear by increasing cell turnover
• Nicotinamide, a form of vitamin B, is a powerful antibiotic that is most effective in treating papules and pustules that are associated with inflammatory acne
• Vitamin D has anti-inflammatory properties that are thought to reduce acne severity; vitamin D deficiency is associated with worsened symptoms
• Zinc is essential for skin health and helps reduce acne formation by controlling sebum production and killing bacteria

Prescription medications

Severe acne that resists OTC formulas can be treated with prescription medications. Such products include antibiotics, retinoid creams and hormonal medications such as contraceptives and anti-androgens.

All these products carry an elevated risk of serious side effects compared to OTC treatments. As such, their usage must always be closely monitored by a healthcare provider.

Antibiotics

Oral and topical antibiotics are prescribed for moderate to severe inflammatory acne and prevent the proliferation of bacteria within inflamed pores. For greater overall results, they may be prescribed in combination with benzoyl peroxide or retinoids.

Oral antibiotics can cause a range of side effects depending on the medication. Common side effects include indigestion, nausea and increased photosensitivity. Tetracycline is not recommended for pregnant women.

Prescription antibiotics include:

• Clindamycin
• Doxycycline
• Erythromycin
• Minocycline
• Tetracycline

Prescription retinoids

Topical retinoids are often prescribed for moderate or severe acne that does not respond to OTC treatments. They work the same way as OTC retinoids, but contain a higher concentration of active ingredients. This means they are more potent, but also carry a higher risk of side effects. 

Potential side effects of prescription-strength retinoids include dry, peeling skin, nosebleeds, thinning hair, and psychological symptoms such as irritability and depression. Retinoids are not recommended for pregnant women.

Prescription retinoids include:

• Alitretinoin
• Bexarotene
• Isotretinoin
• Tazarotene
• Tretinoin

Oral contraceptives

Certain oral contraceptives can help treat symptoms of mild to severe acne in some women. These treatments suppress androgen production, which in turn reduces sebum buildup and the risk of breakouts. However, they are not suited for everyone, and may cause side effects such as weight gain, breast tenderness and nausea.

Oral contraceptives may be prescribed as an alternative for women whose acne is resistant to OTC treatments, or who experience sensitivity to other prescription medications. Treatment usually takes 2–3 months to see noticeable results.

The following three oral contraceptives are considered safe and effective, and are FDA-approved for acne treatment.

• Estrostep
• Ortho Tri-Cyclen
• Yaz 

Natural Treatments for Hormonal Acne

Although not as effective as OTC and prescription treatment options, several natural home remedies have been shown to effectively reduce the severity of acne by inhibiting bacterial growth, reducing inflammation and decreasing sebum production.

Tea tree oil

Tea tree oil is extracted from the leaves of the Melaleuca alternifolia plant native to Australia. This oil has anti-inflammatory and antimicrobial properties and has been shown to reduce and prevent lesions in cases of mild to moderate acne. 

Green tea

Studies show that green tea extract as a topical treatment helps treat acne by reducing sebum production, fighting inflammation and inhibiting bacterial growth. Creams and lotions containing green tea can be purchased OTC or made at home.

Tips and Tricks to Manage Hormonal Acne

Whether or not you are using any form of medication, a well-structured skin care routine is essential for effective acne management. Regular cleansing, exfoliation and moisturization will result in clear pores, balanced sebum levels, reduced skin inflammation and an overall reduced likelihood of breakouts.

To prevent acne from forming, include these three simple steps in both your morning and evening routine:

1. Wash your face with a cleanser formulated for your skin type
2. Apply an exfoliating toner to rebalance your skin’s pH after cleansing, as well as slough off layers of dead skin, remove excess oil and clear pores
3. Apply moisturizer to soothe inflammation and ensure adequate skin hydration

Dietary considerations

Recent studies suggest that dairy products and glycemic-rich diets may exacerbate acne formation. However, no conclusive evidence has yet been found to suggest a causal relationship between food consumption and acne.

When to See a Dermatologist

If OTC treatments prove to be ineffective, you should schedule a visit with your healthcare provider. They will be able to properly assess your skin and recommend a course of action to effectively meet your needs. This may include more potent treatments, such as retinoids, hormonal therapy or a combination of both topical and oral medications.

Takeaway

Hormonal acne is a skin condition characterized by clogged and inflamed pores. It develops as a result of hormonal fluctuations during puberty, menstruation, pregnancy or menopause which trigger an increase in sebum production, causing pores to become blocked and inflamed.

Acne can be treated through a variety of means, and the best treatment for you will depend on many factors: gender, age, severity and sensitivity to certain ingredients.

OTC topical treatments and natural remedies can improve the condition of mild to moderate hormonal acne. Prescription treatments such as topical retinoids, antibiotics and oral contraceptives can effectively treat more severe symptoms, but also carry a higher risk of side effects.

For best results, opt for a multilayered treatment plan that includes OTC or prescription treatments, an added supplement and a well-structured daily skin care routine.