Hormonal acne: Best treatment according to Dermatologists

What is hormonal acne?

Acne is caused by a combination of changes in your skin (enlargement and clogging of your sebaceous glands, bacterial proliferation, inflammation) and hormonal factors.

If you're dealing with hormonal acne, you should know that you're not alone! Hormonal acne is very common, particularly for women in their 20’s and 30’s. Unlike your teenage acne, predominantly on the upper part of the face, hormonal acne usually appears mostly on the lower parts of the face and around the mouth and jawline.

Hormonal acne is when your acne breakouts by hormonal fluctuations or an imbalance in your hormone levels. Genetics also plays a role in hormonal acne. One study found that 67% of women in the study group with hormonal adult acne had an acne family history. Hormonal acne is typical of women and can happen at any age. It can happen in teenagers but is very common in young adult women and even order peri-menopause and menopause menopausal women.

Hormonal acne is common. It affects 50 percent of women between 20 to 29 and 25 percent of women between 40 to 49.

Hormonal acne vs teen acne on the face

What are the symptoms of hormonal acne?

For teenagers, hormonal acne breakouts in teenage girls will often appear in the same places as the typical teen acne, forehead, cheeks around the mouth, and chin.

In adult women, hormonal acne is located in different areas, on the lower half of the face, around the mouth, chin, and lower jawline. Though the chin and jawline are the most common locations for hormonal acne, pimples can also appear on the face and neck sides.

Like teen acne, hormonal acne will include (comedones( blackheads and whiteheads, papules, pustules, a cyst. Many women with hormonal acne will also have under-skin bumps = cysts that are not red and are not seen on the skin's surface.

Acne and mestrual cycle

What are the causes of hormonal acne breakouts?

Hormonal levels can trigger hormonal acne breakouts during the menstrual cycle, higher amounts of a specific hormone in women with polycystic ovarian syndrome (PCOS), hormonal changes before and during menopause, and increased androgen levels.

The hormones that influence hormonal acne are estrogen, progesterone, which fluctuates during the menstrual cycle month, testosterone (the male hormone that females also have), and cortisol that rises in periods of stress. These hormones can also fluctuate during pregnancy and breastfeeding and cause acne flare-ups.

When is hormonal acne most likely to breakout out?

  1. Around the time of your period.
  2. When you start or stop using hormonal birth control.
  3. During or after pregnancy.
  4. During perimenopause and menopause.

What is menopausal acne?

Menopausal acne is when acne appears in women in their 40s and 50s. The cause of menopausal acne is a decrease in estrogen levels or an increase in androgen hormones like testosterone in menopause. Some of the hormonal treatments for menopausal symptoms can also cause hormonal acne. This is especially common in women taking a progestin.

What is the best treatment for hormonal acne?

A personalized over-the-counter topical medical-grade acne treatment will be able to reduce mild hormonal acne in most women. For severe hormonal acne cases, there is a need to complement the topical treatment with oral treatments: oral contraceptives, spironolactone, or DIM supplements.

What is the best topical treatment for women with hormonal acne?

The same as teen acne – adult acne treatment should be personalized to the skin type and acne and acne severity type. The best topical ingredient for mild hormonal acne is salicylic acid, retinol, niacinamide, and benzoyl peroxide for moderate acne. Benzoyl peroxide is regarded by the American Academy of Dermatology (AAD) as the best FDA-approved single anti-acne ingredient. It is frequently more effective than any other over-the-counter prescription acne medication. Unlike adapalene (Differin, Epiduo), they are often very irritating; new preparation of micronized benzoyl peroxide 2.5% can be used on acne-prone and sensitive skin without significant side effects.

The best cleansers for women with hormonal acne include a low percentage of salicylic acid. Salicylic acid at a concentration of 0.5% can help unclog the skin pores without over-drying the skin. Plant-based ingredients; can further help fight skin inflammation and reduce the dryness and redness frequently associated with regular anti-acne cleansers.

Choosing the right moisturizer is crucial for women with hormonal acne. Anti-wrinkle moisturizers can increase the risk of acne breakouts. For best results, look for moisturizers oil-free and specially formulated for acne or acne-prone skin people. Women with normal - oily skin can benefit from an active moisturizer with niacinamide, and women with drier skin can befit from a more hydrating moisturizer.

Retinoids are especially useful for women with mild hormonal acne. A new formulation that combines retinol and niacinamide can help with hormonal acne and initial signs of skin aging, i.e., fine wrinkles and sunspots. For best results, start with a retinol 0.25% + niacinamide 2%, and after a few weeks, switch to the more potent retinol 0.5% + niacinamide 4%.

Using the wrong sunscreen can also cause acne. Same as when choosing a moisturizer - look for an oil-free sunscreen that will not clog the oil skin glands. A lighter, non-comedogenic, invisible sunscreen is usually better than the heavier "white powder" sunscreens.

Hormonal acne oral treatment infographic

What are the best oral contraceptives for women with hormonal acne?

We know that dealing with hormonal acne can be super frustrating, so the idea (and popular method) of taking a birth control pill sounds like an appealing way to help to regulate hormones and get breakouts under control. However, before you start taking birth control pills, you should know that not all contraceptives work the same way and that some birth control pills can actually make acne worse. Seriously. Talk about a bummer. But knowledge is power, and here's what you need to know.

The best oral contraceptives to control hormonal or adult acne are the ones that contain Ethinyl estradiol and one of the following: drospirenone, norethindrone, or norgestimate. Beware that oral contraceptives (birth control pills) are contraindicated in women with a history of blood clots, high blood pressure, breast cancer, and women that smoke.

A study recently published in the Journal of Drugs in Dermatology categorized the different types of contraceptives (i.e., birth control) by their efficiency in clearing acne. These are the birth control pills the study said significantly improve hormonal acne: Yaz, Ocella, Yasmin, Trinessat, MonoNessa, Apri, and Reclipse. Pretty long list, right?

There are also some contraceptives that the study found to have little or no effect on acne. Those are Nuvaring, Microgestin pills, and Orthoevra (that's the patch). The study also found that some contraceptives can actually make acne WORSE. That list includes Depo-Provera (it's a shot), Skyla, Lylema, Implanon, and Nexplanon (this one's a subdermal implant).

If you're struggling with acne, note the lists above and the various options available to you. Some of these are your more standard oral medications (i.e., pills), while others are IUDs, shots, patches, and other implantation devices.

What is spironolactone?

Too much androgen can increasing oil production, increase the risk for clogging of the skin's sebaceous glands, and thus increases the risk for acne breakouts. Spironolactone (Aldactone), initially used to treat hypertension, was found to have an anti-androgenic effect and help with hormonal acne.

DIM for acne

What is the best natural treatment for hormonal acne?

Diet can be a factor in hormonal acne. Some foods can act as anti-inflammatories and help with acne. These are vegetables, fish, nuts, and some healthy oils like olive oil and avocado. Coconut oil, avocado, omega-3 fats, dark chocolate, pumpkin seeds, Brazil nuts, and carrots are also beneficial to people with acne in general and, more specifically, hormonal acne. Eliminating specific acne triggers, like cow's milk, dairy, and sugars, can also help.

The DIM + cruciferous supplement is an excellent addition to hormonal acne treatment. They contain a natural extract of cruciferous vegetables (kale, broccoli, alfalfa, and spinach), specially formulated to help balance hormones and reduce acne signs in adult women.

References:

DIM -The best supplements for adult acne and hormonal acne
Adult female acne: a guide to clinical practice. Anais brasileiros de dermatologia vol. 94,1 (2019): 62-75.
Adult-onset acne: prevalence, impact, and management challenges.” Clinical, cosmetic and investigational dermatology vol. 11 59-69.
Emerging Issues in Adult Female Acne. The Journal of clinical and aesthetic dermatology vol. 10,1 (2017): 37-46.

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