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Hormonal acne is a common issue, especially in adult women, and requires treatments that tackle internal hormonal imbalances. Here’s what you need to know:
Key Takeaways:
- What It Is: Hormonal acne is caused by androgen fluctuations, leading to deep, painful cysts, often on the jawline, chin, and lower face.
- Who It Affects: 50% of women in their 20s and 25% in their 40s experience hormonal acne. It’s also common in women with PCOS.
- How to Identify: Look for deep cysts, inflammation, and breakouts tied to menstrual cycles or life stages like pregnancy or menopause.
- Treatment Options:
- Topical: Retinoids, azelaic acid, benzoyl peroxide, and spironolactone creams.
- Oral: Spironolactone, metformin (for PCOS), and birth control pills.
- Lifestyle: Low-glycemic diets, stress management, and consistent skincare routines.
- Diagnostic Tools: Blood tests for hormones and PCOS criteria (irregular cycles, high androgens, ovarian cysts).
Quick Comparison of Acne Types:
| Acne Type | Cause | Location | Appearance | Timing |
|---|---|---|---|---|
| Hormonal | Androgen fluctuations | Jawline, chin, neck | Deep, painful cysts | Cyclical (e.g., periods) |
| Bacterial | C. acnes overgrowth | T-zone (forehead, nose) | Surface blemishes | Random |
| Fungal | Yeast (Malassezia) | Chest, back, forehead | Uniform, itchy bumps | Triggered by moisture |
Next Steps:
- Identify patterns in your acne (location, timing, severity).
- Consult a dermatologist for tailored treatments and hormone testing.
- Combine medical treatments with lifestyle changes for lasting results.
Hormonal acne requires patience and consistent care, but with the right approach, clear skin is achievable.
How to treat hormonal acne with spironolactone in 2025: dermatologist and acne expert explains
How to Identify Hormonal Acne
The clues to recognizing hormonal acne lie in its location, timing, and the type of breakouts it causes.
Common Signs of Hormonal Acne
Hormonal acne has certain characteristics that make it stand out from other types of acne. One of the biggest indicators is where it appears on your face and body.
Location matters. Hormonal acne tends to show up along the jawline, chin, lower cheeks, and sometimes extends to the neck, chest, shoulders, and back. This pattern differs from teenage acne, which is usually concentrated in the T-zone (forehead, nose, and upper cheeks). These areas are rich in androgen-sensitive oil glands, which explains the difference in distribution.
The type of breakouts is another telltale sign. Hormonal acne is often more severe and painful than surface-level blemishes. You might notice:
- Deep, painful cysts
- Swollen, inflamed papules
- Pustules that take longer to heal
- Occasional blackheads or whiteheads
"Hormonal acne often forms painful cysts or papules that are deeper - and more painful - than your typical whiteheads or blackheads." - Niccia diTrapano, MD, Gynecologist
Age can also be a factor. While teenage acne usually starts to fade by the early 20s, hormonal acne is more common in your late 20s, 30s, and even later. If you’re experiencing acne as an adult for the first time or after years of clear skin, hormones are likely playing a role.
Beyond how it looks, timing is another key clue.
Hormonal Triggers and Monthly Patterns
The timing of your breakouts can strongly suggest a hormonal cause. Monthly patterns are one of the clearest indicators.
For instance, about 65% of people notice their acne gets worse around their period, which directly ties to hormonal fluctuations. The most severe breakouts often occur during ovulation or right before menstruation begins, when progesterone levels drop and androgen activity increases.
To confirm this, try tracking your breakouts alongside your menstrual cycle for at least three months. Write down when the acne appears, worsens, and clears up. If the timing consistently lines up with your cycle, hormones are likely to blame.
Other life stages can also bring hormonal changes that trigger acne. Pregnancy, perimenopause, and menopause often involve shifts in hormone levels that can cause new breakouts or make existing ones worse. In fact, 44% of adult women experience premenstrual acne, making it a common issue during reproductive years.
Hormonal medications can also play a role. Starting or stopping birth control pills, using progesterone-based contraceptives like the mini pill or Mirena IUD, or undergoing hormone replacement therapy can all trigger hormonal acne. If your acne started after beginning a new medication, it’s worth discussing with your doctor.
These patterns highlight the importance of identifying hormonal imbalances when diagnosing and treating acne.
Hormonal vs. Other Types of Acne
Understanding the differences between hormonal acne and other types helps explain why specific treatments are necessary.
Hormonal acne vs. bacterial acne: These two types differ in their causes, locations, and appearance. Bacterial acne is caused by an overgrowth of Cutibacterium acnes bacteria, leading to inflammation. It’s more likely to show up in the T-zone and appears as surface-level blemishes like blackheads, whiteheads, and pustules. Hormonal acne, on the other hand, is driven by androgen-related oil production and shows up as deep, painful cysts on the lower face. Timing is another difference - bacterial acne occurs randomly, while hormonal acne follows predictable monthly cycles.
"Hormonal acne is caused by the skin's sensitivity towards male dominant hormones called androgens - testosterone being a major culprit. Androgens stimulate oil glands to overproduce oil, which feeds acne-causing bacteria, causing them to overgrow [and] clog pores." - Azadeh Shirazi, MD, Board-Certified Dermatologist
Hormonal acne vs. fungal acne: Fungal acne is caused by an overgrowth of yeast (Malassezia) in hair follicles. It appears as small, uniform, and itchy bumps, typically on the chest, back, and forehead, rather than the lower face. The key difference here is itchiness - fungal acne is itchy, while hormonal acne usually isn’t. Additionally, fungal acne responds to antifungal treatments, not traditional acne medications.
Here’s a quick comparison:
| Acne Type | Primary Cause | Common Locations | Appearance | Timing Pattern |
|---|---|---|---|---|
| Hormonal | Androgen fluctuations | Jawline, chin, neck | Deep cysts | Cyclical with menstrual cycle |
| Bacterial | C. acnes overgrowth | T-zone (forehead, nose) | Surface blemishes | Random, triggered by oil buildup |
| Fungal | Yeast overgrowth | Chest, back, forehead | Uniform itchy bumps | Related to moisture and heat |
If your acne tends to flare around your menstrual cycle, appears on your lower face, and consists of deep, painful lesions, it’s likely hormonal acne. This distinction is crucial because hormonal acne requires treatments that address the underlying hormonal imbalances, rather than just surface-level skincare.
Diagnostic Tests and Evaluations
Once hormonal acne patterns are identified, diagnostic tests can help uncover the specific imbalances responsible for the condition.
Blood Tests for Hormones
Blood tests, typically conducted between 8:00–10:00 AM during the early menstrual phase, are a reliable way to check for hormonal imbalances. These tests measure a range of factors, including androgens (testosterone, DHEA-S, DHEAS, androstenedione), LH/FSH ratios, insulin and blood sugar levels, cortisol, and thyroid function. Women showing signs of hyperandrogenism, excessive prolactin, or conditions like Cushing syndrome may be advised to undergo these tests. Your dermatologist will determine which tests are most relevant based on your symptoms and medical history.
Androgen testing is particularly important, as male hormones play a major role in boosting oil production. For instance, a 2013 study found that 55% of 835 women with hormonal acne had elevated androgen levels. Similar findings were reported in studies from Turkey (207 women) and the Czech Republic (90 women), where 55% and 81% of participants, respectively, showed elevated androgen levels.
PCOS Diagnosis Criteria
Polycystic ovary syndrome (PCOS) is a frequent cause of hormonal acne, affecting up to 10% of women of reproductive age. The Rotterdam criteria are commonly used to diagnose PCOS, requiring the presence of at least two of the following:
- Irregular ovulation, often indicated by an irregular or absent menstrual cycle
- Signs of elevated androgen levels, either through symptoms or confirmed by blood tests
- Multiple small cysts on the ovaries
| Rotterdam Criteria for PCOS Diagnosis |
|---|
| At least 2 of the following: |
| • Oligoanovulation and/or anovulation |
| • Clinical and/or biochemical evidence of hyperandrogenism |
| • Polycystic ovarian morphology (PCOM) |
The diagnostic process involves a physical exam to check for signs of high androgen levels - such as excessive facial or body hair, thinning hair on the scalp, and acne - and a review of menstrual history. Blood tests measuring hormones like testosterone, LH, FSH, and progesterone are also essential. Elevated testosterone, high DHEA-S, or an increased LH-to-FSH ratio can point to PCOS. However, it’s worth noting that testosterone and DHEA-S levels may sometimes appear normal or only slightly elevated. While a pelvic ultrasound may show polycystic ovaries, this finding alone doesn’t confirm PCOS. If you experience hormonal acne alongside other PCOS symptoms, consulting an endocrinologist is key to getting an accurate diagnosis. Notably, PCOS is responsible for 75% of anovulatory infertility cases.
After confirming hormonal imbalances and PCOS through blood tests and ultrasounds, a physical examination of the skin provides additional clarity about the acne’s characteristics.
Skin and Oil Production Tests
A physical exam helps evaluate the acne’s specifics, such as its location, type, and severity. This step aligns with earlier hormonal findings by assessing oil production, lesion types, and their distribution, solidifying the diagnosis.
For acne that doesn’t respond to conventional treatments, additional tests like lesion cultures can help rule out conditions such as gram-negative folliculitis. Discussing hormone testing with your dermatologist during a consultation can provide further insight into your acne’s underlying causes. For mild cases, advice from a pharmacist might suffice, but for moderate to severe acne - or if the condition worsens - consulting a general practitioner or dermatologist is highly recommended.
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Treatment Options for Hormonal Acne
Once hormonal imbalances are identified, treatment often involves a combination of topical remedies, oral medications, and lifestyle adjustments. These approaches aim to tackle both the visible symptoms and the hormonal triggers behind the acne.
Topical Treatments
Topical treatments are a go-to for managing moderate hormonal acne. They work directly on the skin to reduce oil production, combat bacteria, and prevent clogged pores. Here's a breakdown of some common options:
- Retinoids: These vitamin A derivatives are highly effective at clearing dead skin cells and keeping pores unclogged. Apply a small amount 20 minutes after washing your face, ideally once daily before bed. Start slowly to allow your skin to adjust.
- Azelaic Acid: A gentler alternative for those with sensitive skin, azelaic acid helps clear dead skin cells and reduce bacteria. It’s available as a cream or gel and can be used once or twice daily depending on your skin’s tolerance.
- Benzoyl Peroxide: This powerful antiseptic reduces bacteria and inflammation. Apply it once or twice daily after cleansing, but don’t forget sunscreen, as it can make your skin more sensitive to the sun.
- Topical Antibiotics: These target bacteria in clogged hair follicles. Use them as a lotion or gel once or twice daily for 6–8 weeks, but keep the duration limited to prevent bacterial resistance.
For hormonal acne specifically, topical spironolactone can be a game-changer. It blocks androgen receptors in the skin, offering a targeted solution without affecting the entire hormonal system.
Dermatologists often recommend combining these treatments to address multiple aspects of acne formation, enhancing overall effectiveness.
If topical solutions don’t provide enough relief, oral medications may be the next step.
Oral Medications
Oral treatments work from within to address the hormonal roots of acne, making them a strong choice for moderate to severe cases.
- Spironolactone: This medication blocks the effects of androgens and progesterone on the skin, reducing oiliness and inflamed spots. Studies show that it improves hormonal acne in 60–65% of women, with one study reporting that 93% of women who hadn’t tried other acne treatments saw improvement. Spironolactone should only be used under a dermatologist’s guidance, and pregnancy must be avoided during treatment.
- Metformin: Commonly prescribed for women with PCOS, metformin improves insulin sensitivity and lowers insulin levels, which can help reduce acne linked to ovarian hyperandrogenism. A dose of 500 mg three times daily has been shown to significantly reduce acne severity within eight weeks. Though generally well-tolerated, about 20% of users may experience temporary gastrointestinal side effects. Taking it with food and avoiding heavy alcohol consumption can help minimize these issues.
- Birth Control Pills: These regulate androgen levels and menstrual cycles, offering another hormonal solution. A Cochrane review found that oral contraceptives were more effective than metformin in treating acne in women with PCOS.
Lifestyle Changes
Lifestyle adjustments can complement medical treatments by addressing external factors that contribute to acne. These changes can enhance the effectiveness of other treatments.
Dietary Adjustments
Focus on foods that help stabilize hormones and reduce inflammation. Avoid sugary, dairy-heavy, and refined carbohydrate-rich foods like white bread and pasta. Instead, opt for low glycemic index choices such as non-starchy vegetables, whole grains, legumes, nuts, seeds, and fruits like berries and apples. Adding omega-3-rich foods like salmon, flaxseeds, and walnuts can also help reduce inflammation. If cow’s milk seems to worsen your acne, consider switching to milk alternatives.
Skincare Routine
A consistent and gentle skincare routine is key. Cleanse your face twice daily with mild, non-comedogenic products to avoid clogging pores. Use acne treatments sparingly - just a pea-sized amount is enough to prevent irritation. Daily sunscreen application is also essential. Including regular exfoliation and moisturizing in your routine can further improve skin health.
Stress and Sleep Management
Managing stress and maintaining healthy sleep habits can help balance hormones and reduce oil production, contributing to clearer skin.
Tracking Progress and Long-Term Care
Dealing with hormonal acne takes time and consistent effort. Most treatments require 8 to 16 weeks to show noticeable results, so staying patient and tracking your progress is key to maintaining improvements over the long haul.
How to Track Results
Tracking your progress effectively can help you understand what’s working and what’s not. One popular method is acne mapping, which involves noting the location, type, and severity of breakouts on your face. This helps identify patterns unique to your skin.
Another helpful approach is taking regular photos and keeping a skincare diary. Document breakout locations, severity, and possible triggers, like stress or new products. Apps like Miiskin can make this easier by offering features like push notification reminders for follow-up photos and secure image storage. Comparing photos side-by-side can reveal improvements that might not be obvious day-to-day.
In your skincare diary, log details like your daily routine, hormonal changes (such as your menstrual cycle), stress levels, and dietary habits. This information can help pinpoint triggers or confirm what’s working. Reviewing your progress every 6 to 8 weeks allows enough time to see the effects of your treatment.
As you track your progress, don’t forget to monitor your medications for safety.
Safety Monitoring for Medications
If you’re using medications like spironolactone, regular medical supervision is essential. Blood tests are used to monitor potassium levels and ensure the medication is working safely. Typically, these tests are done at 2 and 6 weeks after starting the medication and after any dose adjustments.
Follow-up appointments with your healthcare provider are usually scheduled every 6 to 8 weeks during the early stages of treatment to monitor your skin's response and check for side effects. Once your dosage stabilizes, monitoring can shift to quarterly or biannual checkups. For patients under 45, blood tests may be reduced to every 6 months in the second year of treatment. However, individuals over 45 might require monthly monitoring during the first 3 to 6 months, especially when starting treatment. After stabilizing, dermatologist visits typically occur every 4 months for ongoing care.
Once your treatment reaches a steady state, your focus should shift to maintaining clear skin and preventing future breakouts.
Preventing Acne from Coming Back
Keeping your skin clear after treatment requires a long-term commitment to both skincare and lifestyle adjustments. Start with a gentle skincare routine. Cleanse your face twice daily using non-comedogenic products, and apply treatments in small amounts - just a pea-sized portion - to avoid irritation.
Dr. Jeremy Fenton, a Board-Certified Dermatologist at Schweiger Dermatology Group, advises against overusing topical treatments:
"Women with adult female hormonal acne can cause their acne to flare up if they're too aggressive with the topicals".
Daily sunscreen is a must for maintaining skin health and preventing acne scars from worsening. Dr. Fenton stresses the importance of consistent sunscreen use, recommending a non-comedogenic, broad-spectrum formula with SPF 30 or higher.
Lifestyle choices also play a big role in preventing hormonal acne from returning. Limiting sugar, dairy, and refined carbohydrates can make a difference. Adding omega-3 fatty acids to your diet, managing stress, and getting enough sleep can help keep hormones balanced, reducing the chances of future breakouts.
For some women, long-term androgen control through medication may be necessary to maintain clear skin. Work closely with your healthcare provider to determine if ongoing treatment is right for you, and schedule regular follow-ups with your dermatologist to fine-tune your maintenance plan.
Key Takeaways
Managing hormonal acne effectively involves a thoughtful, personalized approach that combines medical treatments, regular check-ins, and lifestyle changes. Hormonal acne can affect women of all adult ages and often requires ongoing care due to its chronic and recurring nature.
Tailored Treatment Plans: Because everyone's hormonal profile is unique, treatment plans must be customized. A healthcare professional can help determine the right combination of treatments based on factors like acne severity, past responses to treatments, emotional impact, and considerations like potential pregnancy.
Consistent Monitoring: Regular follow-ups with a medical provider are crucial. These check-ins allow for adjustments to treatment plans, ensuring they remain effective over time.
Lifestyle Adjustments: Beyond medical treatments, lifestyle plays a big role. Stress management, good sleep habits, a proper skincare routine, and mindful dietary choices can all support acne management. As Dr. Ivy Lee of Pasadena Premier Dermatology points out:
"The most important thing you can do in terms of preventing or minimizing acne is to decrease stress in your life."
Oana Health’s telehealth platform offers personalized solutions for hormonal acne, such as Topical Spironolactone and Oral Minoxidil. These options come with ongoing support from licensed medical professionals, making it easier to stick to a treatment plan that works for you.
FAQs
How can I tell if my acne is hormonal or another type?
Hormonal acne is often recognizable by its deep, painful cysts that typically show up along the lower face - think jawline, chin, and sometimes even the neck. These breakouts are usually tender, don’t develop into whiteheads, and often shrug off standard over-the-counter treatments. On the other hand, more common types of acne - like blackheads, whiteheads, or surface-level pimples - tend to crop up in the T-zone (forehead, nose, and upper cheeks) and are usually triggered by external factors such as bacteria or excess oil.
The key link with hormonal acne? Hormonal fluctuations. It’s notorious for flaring up during your menstrual cycle, pregnancy, or conditions like PCOS. It often follows a predictable pattern, worsening at specific times of the month. If your acne pops up randomly and doesn’t seem tied to these hormone-driven shifts, it’s more likely the run-of-the-mill type.
What lifestyle changes can help support medical treatments for hormonal acne?
Making a few lifestyle tweaks can go a long way in boosting the impact of medical treatments for hormonal acne. Let’s start with diet. Cutting back on sugar and refined carbs can help keep insulin levels steady, which is key for managing breakouts. Adding foods packed with omega-3s - like salmon, walnuts, and flaxseeds - may also help reduce inflammation. And while everyone’s skin reacts differently, limiting dairy and sugary treats might lead to fewer flare-ups.
Then there’s stress management, which is often overlooked but incredibly important. Stress can spike cortisol levels, triggering more oil production and, in turn, more acne. Incorporating activities like yoga, meditation, or even a simple daily walk can help keep stress in check. Don’t underestimate the power of quality sleep and proper hydration either - they’re essential for healthier skin and overall wellness. These small shifts can lead to noticeable improvements over time.
How can blood tests identify hormonal imbalances that contribute to acne, and which hormones are typically checked?
Blood tests play an important role in uncovering hormonal imbalances that might be causing acne. By evaluating specific hormone levels tied to skin health, they help identify potential underlying problems.
Hormones often checked include androgens (like testosterone and DHEA), cortisol, estrogen, progesterone, and luteinizing hormone (LH). Imbalances in these hormones can point to conditions like polycystic ovary syndrome (PCOS), which is a frequent culprit behind hormonal acne. These tests offer valuable insights, allowing for personalized treatment plans that address the root cause.
