You might assume that pimples disappear later in life. However, according to the American Academy of Dermatology, fifty percent of women ages 20 to 40 deal with adult acne. Fluctuating hormones, bacteria, excess oil, and dead skin cells all contribute to these types of breakouts. They usually occur throughout your chin, T-zone, and jawline. It can be challenging to keep your skin blemish-free. Luckily, dermatologist-backed solutions do exist, and we’re here to help. Read on to learn why hormonal acne happens and what to do about it.
What causes hormonal acne?
“The term hormonal acne speaks for itself. It’s acne caused by an imbalance in your body’s hormones,” explains Dr. Bobby Buka, a leading dermatologist in New York City and contributing founder of the First Aid Beauty skin care line. “Typically, for women, that means you’re over-producing testosterone or other androgens (sometimes referred to as ‘male hormones’). When androgens exceed certain levels, they can disrupt the body’s healthy functioning and lead to acne flare-ups. The worst breakouts are often a perfect storm of out-of-whack hormones combined with bacteria-infected hair follicles that are clogged with dead skin cells and oil.”
Dr. Jennifer Haley, an Arizona-based dermatologist, says hormonal acne is actually becoming more and more common in comparison to a few decades ago. This is due to changing lifestyles and diets, alongside some of the usual culprits, such as menstruation cycles, PCOS, menopause, and general skin inflammation.
“The term hormonal acne typically is used to describe acne that develops in women around the time of their periods,” adds Dr. Josh Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital. “Hormonal fluctuations during the menstrual cycle lead to changes in the skin that result in pimples every month. However, all acne is ultimately caused by your hormones, which stimulate your oil glands to rev up oil production. This oil gets trapped with[in] the pores, allowing acne-causing bacteria to grow, and leading to inflammation.”
Are some people more prone to hormonal acne than others?
Although acne affects 80 to 90 percent of teens in the Western world, says Dr. Buka, it’s more likely to occur in young adults and teenagers. But, that doesn’t mean that adults, especially women, are off the hook when it specifically relates to hormonal acne. Dr. Zeichner indicates that it is becoming increasingly more common for women to continue to suffer into adulthood. In some cases, women who have never had acne as a teenager develop it for the first time as an adult.
“Hormonal acne typically presents [itself] in women over the age of 20 with very tender, red, inflammatory papules around the chin and jawline,” notes Dr. Haley. “The pimples seem to last forever, and if there is any attempt to squeeze or pick, nothing will come out and only scarring will occur. We typically don’t see blackheads and whiteheads all over the T-zone, as in normal teenage acne.”
Is hormonal acne different than regular acne?
In a sense, yes—mostly in terms of where it happens on your skin and how often. Standard acne can occur anywhere on your face or body, whereas hormonal acne tends to show up in the same spots: pimples in your T-zone, plugged pores throughout your cheeks and forehead, and/or painful bumps that linger for weeks on your chin. While Dr. Zeichner admits that experts don’t totally understand why this happens, there are treatments that can help.
“Because women have a cyclical pattern of hormonal fluctuations leading to breakouts, we can use hormone-targeted treatments in this group of patients,” he continues. “Controlling the effect of the hormones on the skin can reduce oil production, treat breakouts, and prevent new ones from developing. Common treatments for hormonal acne include oral contraceptive pills—four of which are FDA-approved to treat acne separate from contraception—and a medication called spironolactone. We commonly prescribe these oral medications alongside topical [medications] to maxim[ize] benefit.”
How can I treat hormonal acne?
To treat hormonal acne, you have a couple of options: over-the-counter products, oral treatments, light therapies, or prescription medications. Some dermatologists also recommend adjusting certain lifestyle approaches to help minimize the recurrence of hormonal acne.
Over the counter treatment
“Over the counter, look for products that contain benzoyl peroxide or salicylic acid,” shares Dr. Zeichner. “Benzoyl peroxide reduces levels of acne-causing bacteria on the skin, which promote inflammation. It can also help remove blockages on the surface of the skin. Salicylic acid is a beta hydroxy acid that removes excess oil and exfoliates dead cells from the surface of the skin.”
Some of his favorite products include Neutrogena Stubborn Acne Rapid Clear Daily Facial Mask, which he says can help treat pimples that you already have, as well as ones that have not yet surfaced, plus Clean & Clear Bubble Cleanser with Salicylic Acid. If those approaches don’t seem to be helping much, it’s a good idea to visit a dermatologist for more powerful treatments—like a topical retinoid, antibiotics, hormone-blocking drugs, or topical acne prescriptions—that can both treat acne and prevent permanent scarring.
As mentioned, Dr. Haley does advocate for lifestyle shifts in addition to treatment in order to help keep acne at bay. “Avoid sugar, processed foods and drinks, and dairy (including whey protein bars and powders), as these are all inflammatory and may contribute to acne,” she says. “Take a probiotic, high-quality fish oil supplement, and 25 mg of zinc daily. Choose organic foods to avoid pesticides and hormones added to meat, as those may contribute to acne formation. I also recommend avoiding all plastic products—drink only from glass or stainless steel water bottles and look for substitute containers, because plastic can cause hormonal disruption.”
“There are three factors that play a role in acne: bacteria, hormones, and exfoliation (or lack thereof),” concludes Dr. Buka. “This trio of skin influencers is involved in every case of acne, but some are more prominent than others. Whichever the most prominent factor of your acne is will determine your specific treatment.”