Beauty Breakdown: Everything You Need To Know About Hormonal Acne
Do you know anyone who takes spironolactone? If you're a woman in your mid-20s, chances are you probably do. This medication is used off-label to treat hormonal acne in women, a skin condition 50.9% of women in their 20s and 25% of women in their 40s struggle with—plus, research shows this kind of "adult acne" can persist even after the age of 501. Men can experience hormonal acne as well, but it's much more common in women, especially in adulthood.
But has hormonal acne always been a major part of the female experience? Given the increased stress levels, hustle culture, hormonal birth control, and hormone disrupters found in the world today, it's safe to say probably not.
This kind of acne is particularly frustrating because you simply cannot completely control the root trigger—imbalanced hormones. Not to mention, getting acne in your adult years can make you feel insecure, as if you don't give off a mature, professional appearance when you need to.
However, dermatologists have been treating this form of acne for decades, with more trusted options available now than ever before. If you've been going through it with hormonal breakouts, we hear you. We asked dermatologists for help, so you can feel more in control of what's happening underneath your skin and learn how to ease these pesky breakouts.
To come, the 101 on hormonal acne—from root causes to a full skin care routine and how to support hormonal health from within.
The 101 on hormonal acne.
Acne is a very complex skin condition. There are several factors that contribute the formation of acne. On a basic level, sticky skin cells and excess sebum production clump together and clog your pores, trapping bacteria underneath and triggering inflammation. This process can be influenced by a plethora of internal and external forces, such as hormones, diet, stress, and the list goes on. But, essentially, sebum production is at the heart of acne.
Not-so-fun fact: Sebum production is controlled by hormones, specifically androgens, board-certified dermatologist and founder of NicholsMD of Greenwich Kim Nichols, M.D., FAAD, tells mbg. Androgens cause the enlargement and overstimulation of the sebaceous glands found in the hair follicles, she explains. Then, this sebum snatches up dead skin cells and clogs the pores, resulting in a breakout.
Estrogens have the opposite effect, meaning they inhibit the secretion of androgens, modulate genes involved in the growth of the sebaceous gland, and inhibit their function. The activity of the sebaceous gland, therefore, depends on the estrogen and androgen ratio1—which is why many people consider birth control pills containing estrogen as a possible form of treatment.
You'll generally find hormonal breakouts on the chin and along the jawline, often going down onto the neck as well. Back and chest acne can also be linked to hormone imbalances. Some breakouts can be pustules and papules (inflamed zits with a white head), while others can be cystic and under the skin.
"Cystic pimples are deeper, larger, and can occur when the bacteria, sebum, and dead skin cells become trapped beneath the surface of the skin and can cause a large and painful bump," Nichols explains. And yes, you can have a combination of both.
5 Things we're getting wrong right now.
Half the battle of treating acne is watching out for additional triggers. Below, five things that might be making your breakouts worse:
- Ignoring lifestyle factors: While you can't completely control your hormones, there are plenty of ways to support them (many of which don't cost a dime). How much you sleep, what you eat, and how stressed you are will impact your hormones, so keep reading for a few ways to tend to each area of your life for more balance within.
- Popping your pimples: Squeezing any pimple is a major no-no, especially inflamed hormonal breakouts. If you do this, you'll run the risk of indented scarring, hyperpigmentation, infection, and even a worse reboot of the same breakout.
- Treating every pimple the same: The protocol for treating cystic pimples versus blackheads and whiteheads versus inflammatory breakouts is all quite different. More on how to treat each kind to come—but remember, what works for your best friend may not work for you, and vice versa.
- Using pore-clogging ingredients: Unfortunately, anyone with acne-prone skin will need to be a bit more mindful about what products they put on the skin. If you use pore-clogging ingredients, your breakouts will only persist, no matter how many preventive treatments you're using. Run the full ingredient list for your skin care and makeup products (which most of the time can be found online) through a pore-clogging ingredients checker like this one from Acne Clinic NYC.
- Expecting instant results: While there are a few great treatments out there for hormonal breakouts, they will all take at least a few months to see significant results. It can be frustrating to wait it out, but giving each treatment a few months to kick in before moving to another option will only help you in the end—otherwise, you might miss your holy grail.
The 6 steps you need to know.
Now that you know what to avoid, let's dive into how to treat your hormonal acne:
Figure out what type of breakouts you're dealing with.
Nichols notes the key to treating hormonal acne is first figuring out what kinds of pimples you have. Here's a quick guide to help you out:
- Whiteheads: These pimples have a white tip and may be slightly raised on the skin but won't be super red or inflamed. This can also look like skin texture (especially along the cheeks) or "congested skin" as some people call it.
- Blackheads: As expected, these look more like clogged pores and appear a dark brown or black. They typically show up around the nose, chin, and the center of the forehead (aka the T-zone). Most of the time blackheads are flat, but they can be raised as well.
- Papule and pustule: This type of inflamed acne will be red, raised, and may be tender. If there's no whitehead, that's a papule. When the red papule forms a white, pus-filled head, you now have a tender pustule—both of these call for similar treatment, which is why we're grouping them together for now.
- Cystic acne: This is the most severe type of acne. Cysts are large, inflamed red pimples that lie under the skin, never coming to a head. These are typically soft to the touch, but you may experience harder cysts, which are technically called nodules, too.
Put together your topical routine.
If you have a combination of any of the following, you'll want to focus on the most severe type of pimple you have and treat it from there. Before we get into that, you should know that many of these treatments can take anywhere from a few weeks to a few months for the best results to show—so don't switch it up too early and give each method at least three months to show you what it can do.
Here, the best active ingredients for each form of acne:
- Whiteheads and blackheads: Opt for retinol treatment. You'll want to start low and slow, with a gentle retinol serum like the Medik8 Crystal Retinal 3. This cream contains 0.03% retinaldehyde, which falls right below prescription-grade retinoids in terms of strength. You may not need a stronger retinoid, but if this doesn't work, know there are other options out there. You can also use an exfoliating face wash with salicylic acid to clear out the dirt oil stuck in your pores, but be sure to leave it on for a minute or two for the exfoliant to work its magic.
- Inflammatory acne: For this kind of acne, you'll want to follow the tips above. However, you may benefit more from a prescription-grade retinoid, if your dermatologist recommends it. You'll also want to use spot treatments like the Hero Cosmetics Micropoint for Blemishes patches to encourage quicker healing and block your chance to pick or pop.
- Cystic acne: For this kind of hormonal breakout, you'll likely need a bit more than the steps above. You can consider swapping out your salicylic acid wash for a benzoyl peroxide cleanser (again, leave it on for two minutes before rinsing it off), but be sure to moisturize your skin well afterward as this ingredient can be drying. In addition, consider the oral prescription options below.
In the meantime, tend to your hormones internally.
As mentioned before, you can support healthy hormones from within. This includes lifestyle choices surrounding diet, exercise, sleep, and mental health.
Diet-wise, do your best to craft up balanced plates. This means getting your leafy greens, protein, healthy fats, and carbohydrates. Include other foods like those rich in probiotics and fiber as well—here are more ideas if you want to dive deeper.
A lack of high-quality sleep will increase cortisol levels, which, as you now know, can manifest into more sebum production and more breakouts. Do your best to get a full night's rest as often as you can (helpful tips here if you struggle catching Z's).
If at all possible, try to manage your stress levels, too. Stress can cause an increase in sebum production—which you don't need on top of a hormonal uptick. Experiment with meditation, breathwork, yoga, journaling, or any other activity that makes you feel calm.
Lastly, exercise! Exercise produces endorphins2—chemicals in the brain that make you feel good—which help decrease tension, elevate mood, improve sleep, and boost self-esteem. Plus, it may double as a stress management technique.
Don't overdo it.
It can be tempting to deploy all of your acne fighters at once, but here's the thing—you don't need to "fight" your acne; you need to heal it. This means selecting those targeted treatments (like retinoids, exfoliants, benzoyl peroxide, etc.) and sandwiching them in a barrier-supporting skin care routine.
Be sure to keep the rest of your products (like serums and moisturizers) solely focused on replenishing hydration—but be sure to scan them for pore-clogging ingredients first. Apart from your cleanser and treatment, look for hydrating serums, nourishing moisturizers, and of course, SPF.
You'll know you've overdone it if your skin becomes red, itchy, and sensitized. This means you have a damaged skin barrier, and you'll need to lay off the actives for a few days and repair it (here's how).
Know your prescription options.
Unfortunately, there is a stigma surrounding acne medication, but let us be very clear: If your acne is causing you psychological stress and your dermatologist thinks you're a great candidate for oral medication, you shouldn't feel shame for following their suggestion.
As we mentioned before, acne is a very complex skin condition, and it's equally personal. While the steps above will help many people struggling with hormonal breakouts, plenty of other folks may need something stronger to fully clear their acne and keep it at bay.
For hormonal, you have four main oral prescription options:
- Birth control pills: "Utilizing birth control to help acne is a popular choice and helps since oral dose consists of synthetic forms of female hormones estrogen and progestin, which help to lower androgen levels," board-certified dermatologist Gary Goldfaden, M.D., tells mbg. However, some people experience mood swings, trouble managing weight, and other negative side effects from oral contraceptives, so just know this is not your only option but rather one of them.
- Spironolactone: This medication was originally developed to help manage hypertension but has been used off-label as a hormonal acne treatment for years—but is only cleared for use by women. According to the American Academy of Dermatology (AAD), "In looking at the medical records of 85 women who took spironolactone, researchers found that one-third of the women had complete clearing and one-third had noticeably less acne. Only 7% saw no improvement." However, Goldfaden notes this medication can interfere with regular menstrual cycles on occasion, so talk to your dermatologist about this before you commit.
- Winlevi: "Winlevi3 is a topical cream used to treat acne on the surface and usually people 12 years or older use this treatment. This treatment is used to lower the amount of oil produced on our skin that leads to acne," Nichols says. This one is one of the best options available for hormonal acne in men, as birth control pills and spironolactone are only available for women.
- Isotretinoin: Formerly known as Accutane, isotretinoin is an oral form of vitamin A used to treat severe cystic and nodular acne. This is generally the last resort for those with severe acne and can be a life-changing medication. Those taking isotretinoin have to follow strict guidelines and protocols including monthly pregnancy tests (for those who can get pregnant), bloodwork, skin care, and frequent visits to the dermatologist.
Visit the derm.
Last but not least, don't hesitate to see your dermatologist. Many people are under the impression that anything less than cystic acne should just be treated at home, but every kind of breakout can benefit from a derm visit if you have access to one.
What's more, prescription-grade retinoids can be cheaper than OTC options, depending on your medical insurance. If you visit the derm, they can help you assess the most affordable options for your financial situation.
Every person has unique skin, even if they experience similar breakouts. A dermatologist can help you figure out which products will work best for your skin type and give you some peace of mind that what you're doing right now is the best path to take.
3 extra tips.
If you want to go even further to treat your acne, consider these add-ons:
- Get acne facials: For those with whiteheads, blackheads, or inflammatory acne, acne facials might help limit the breakouts. Anyone with cystic pimples should avoid them, but for all other kinds of acne, they can be super beneficial—here's what you should know before you book.
- Talk to your derm about cortisone shots: Cortisone shots can be administered by your dermatologist if a particular cyst is giving you trouble—whether the motive is to prevent scarring, clear up a pesky cyst before a big event, or just bring you some mental peace—these shots can be extremely helpful.
- Keep a skin care journal: To keep track of your personal triggers, take note whenever you experience a breakout, and write down what your skin looks like with each passing day. Depending on how often they appear, you might discover a few patterns. If you want, you may even take photos every week or month to see your progress with new treatment methods.
6 best products to try.
Here, the six best products to get you started.
Best cleanser: The INKEY List SuperSolutions 5% Benzoyl Peroxide Cleanser
- May be drying
- Not the best for sensitive skin
Those with whiteheads and blackheads only will want to stick with a salicylic acid cleanser or a gentle cleanser. However, those with inflammatory breakouts and cystic acne may want to call upon benzoyl peroxide. This ingredient helps to kill acne-causing bacteria on the skin, thus preventing future breakouts and managing active ones. Leave this cleanser on for two minutes before rinsing it off and scatter the use to every other day if your skin feels too dry.
Best exfoliant: Naturium Salicylic Acid Serum 2%
- Simple ingredient list
- Helps even skin tone
- Reviewers note occasional package malfunction
Plenty of derms will tell you to lookout for salicylic acid as a first-defense acne treatment. This BHA dives deep down into pores and clears out dirt and buildup, helping to treat breakouts and prevent future ones from popping up. This simple SA serum from Naturium has everything you need and nothing you don't for quicker results without the extra dryness and irritation.
Best retinol: Medik8 Crystal Retinal 3
- Stable formula and safe packaging
- Increasing strengths up to 0.2% available
- Contains hyaluronic acid, vitamin E, and glycerin as well
- Stronger formulas may be irritating for hypersensitive skin types
Legendary esthetician and acne specialist Sofie Pavitt recommended this retinal serum to me a while ago for those with acne-prone skin. Not only does the formula contain hydrating ingredients to cushion the active retinaldehyde, but you can also increase the strength of your formula should you want to level up in the future. Think of it like a one-stop-shop for OTC retinol.
Best mask: Biba Los Angeles The Zinc Mask
- Skin looks immediately smoother and less inflamed
- Can be used 2-3 times a week
- May be drying for those with already dry skin types
Biba De Sousa is a Los Angeles esthetician well-known for her work in the world of acne. She created this mask to be used twice to three times a week by anyone with oily or acne-prone skin. The Bentonite clay along with zinc helps pull out impurities and balance oil on the skin while sulfur encourages a smoother complexion and even skin tone post-use. On a personal note, I swear by this mask as a spot treatment as well.
Best spot treatment: Hero Cosmetics Micropoint for Blemishes
- Micropoints deliver actives deep into breakouts
- Helps you resist the urge to pick
- Won't help prevent future breakouts
Popping your pimples can be addicting and hard to resist, which is one of the reasons these pimple patches are so great. The micropoints deliver salicylic acid and niacinamide right to the breakout, helping to ease its appearance and encourage quicker healing. Be sure to leave your pimple patch on overnight, or for six to eight hours during the day.
Best for body: Soft Services Clearing Mist
- Easy to apply via spray
- Large bottle
- Contains SA and zinc
- May be messy
It's pretty difficult to find a con for this one—it's a great product for back, chest, and body breakouts in general. Inside the easy-to-use spray bottle, you'll find both salicylic acid and zinc—two ingredients known to help ease breakouts anywhere on the body. Plus, the large bottle means you can apply it to larger surface areas without draining your supply in a few days.
Best moisturizer: Skinfix Skin Barrier Restore Gel Cream
- Enhances skin hydration without clogging pores
- Developed by dermatologists
- Safe for all skin types
If you're going to be using strong treatments like benzoyl peroxide, retinoids, and exfoliants, you'll need a good moisturizer on hand. Finding a hydrating cream that won't break you out isn't always easy, as many of them contain ingredients like coconut oil, beeswax, etc.—but not this one. Beyond the rich hydration, you'll also get a dose of niacinamide and zinc, both of which help to regulate oil production and ease breakouts.
Best SPF: Biossance Squalene + Zinc Sheer Mineral Suncreen
- Won't clog your pores
- Reef safe
- Great for all skin types
- May leave a white cast
Every skin care routine should end with SPF. Especially for those using exfoliants and retinoids, sunscreen is critical because these actives can make you more susceptible to burn and sun damage. Plus, any hyperpigmentation you may have from acne scars will only get darker if you don't wear your sunscreen. This one is free of pore-clogging ingredients, which isn't always easy to find in sunscreen.
The beauty breakdown.
As you now know, hormonal acne is not simple topic. It's crucial to remember that everyone's skin is different, and even if two people have hormonal acne, the best treatments and products for them could be completely different—so listen to your skin. Finally, remember that healing your acne takes time, so be patient and kind to yourself during the process. If you are struggling with your mental health during this time, you may consider visiting a therapist for some support—here's how to find one if you're not sure where to start.