Hormonal acne and how to treat it
By: Sophia Erickson
Growing up I considered myself pretty lucky when it came to acne. Unlike most of my pubescent peers who constantly seemed to struggle with clusters of red superficial bumps on every inch of their faces, I would only get a handful of deep, under-the-skin pimples each month. Over time, however, I realized that while my acne wasn’t plentiful it was severely more painful than what my friends experienced, and no matter how many products I tried, it just wasn’t going away by itself. It wasn’t until I went to the dermatologist and finally found out the correct way to treat hormonal acne that I found a permanent solution to cure my pain.
Why does hormonal acne happen?
Acne occurs when pores become clogged by sebum, an oily substance produced in the sebaceous glands (Kraft, 2011). Hormonal acne occurs when hormonal changes increase the amount of oil your skin produces, leading to more clogged pores and in turn more acne, especially throughout puberty.
Testosterone, a well-known androgen hormone, increases sebum production at the base of hairs which can lead to acne (Gosh, 2014). In both males and females, testosterone levels go up in the teenage years as part of puberty which is the main reason why many teens suffer from acne. Testosterone also fluctuates around periods, pregnancy, and menopause, making women the main target of hormonal acne.
And if you are wondering why you may experience more acne before your period, you can thank estrogen: a female sex hormone that decreases before menstruation. In fact, studies show that low levels of estrogen are linked to increases in the size of sebaceous glands and an increase in sebum production (Pochi, 1973).
Does it just occur around my period?
Nope, other things such as birth control or stress can mess with your hormones — and your skin. And I know what you’re thinking, you don’t feel that stressed, but remember the body recognizes things such as sugary foods or lack of sleep as stress. This in turn signals your adrenal glands to release cortisol, which happens to have a positive correlation with testosterone (Brownlee, 2005). (cough cough hello excess oil and hello acne).
What does hormonal acne look like?
One of the telltale signs of identifying whether a breakout is hormonal or bacterial is seen in its location on the face. If you’re noticing inflamed cysts around your lower face—especially your chin and jawline area—you can bet your bottom dollar that it’s probably hormonal acne. Many people don’t realize that the chin contains more oil glands than other parts of the face, making it a prime spot for these types of breakouts to occur.
How to treat hormonal acne?
Because hormonal acne is multifaceted, I recommend seeing a board-certified dermatologist who can help you find a treatment plan that works best for you and your acne. This being said, some tried and true treatments for hormonal acne include:
Tretinoin: a prescription topical that prevents breakouts by instructing your skin cells to shed more quickly, preventing a build-up of dead skin cells and oil (Leyden, 2017). This being said, tretinoin does not directly treat the hormonal causes of acne, so it is helpful to combine it with other treatments (see below!)
Spironolactone: an oral prescription medication that blocks the effects of androgens (testosterone) on the skin leading to fewer inflamed acne lesions and a decrease in oil production (Charny, 2017).
Isotretinoin (aka Accutane): a powerful oral medication only used to treat severe cystic acne that has not responded to other treatments. This medication works by shrinking” or deactivating the oil gland in acne-prone pores thereby preventing the overactivity of the oil glands that are necessary for acne to develop (Bagatin, 2019).
Reference List:
Bagatin, E., Freitas, T. H. P., Rivitti-Machado, M. C., Machado, M. C. R., Ribeiro, B. M., Nunes, S., & Rocha, M. A. D. D. (2019). Adult female acne: a guide to clinical practice. Anais brasileiros de dermatologia, 94(1), 62–75. https://doi.org/10.1590/abd1806-4841.20198203
Brownlee, K. K., Moore, A. W., & Hackney, A. C. (2005). Relationship between circulating cortisol and testosterone: influence of physical exercise. Journal of sports science & medicine, 4(1), 76–83
Charny, J. W., Choi, J. K., & James, W. D. (2017). Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. International journal of women's dermatology, 3(2), 111–115. https://doi.org/10.1016/j.ijwd.2016.12.002
Ghosh, S., Chaudhuri, S., Jain, V. K., & Aggarwal, K. (2014). Profiling and hormonal therapy for acne in women. Indian journal of dermatology, 59(2), 107–115. https://doi.org/10.4103/0019-5154.127667
Kraft, J., & Freiman, A. (2011). Management of acne. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 183(7), E430–E435. https://doi.org/10.1503/cmaj.090374
Leyden, J., Stein-Gold, L., & Weiss, J. (2017). Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatology and therapy, 7(3), 293–304. https://doi.org/10.1007/s13555-017-0185-2
Pochi, P. E., & Strauss, J. S. (1973). Sebaceous gland suppression with ethinyl estradiol and diethylstilbestrol. Archives of dermatology, 108(2), 210–214.