What is hormonal acne?
Acne is caused by a combination of changes in your skin such as enlargement and clogging of your sebaceous glands, bacterial proliferation, inflammation, and hormonal factors. Hormonal acne occurs when there is an imblance in your hormone levels.
If you're dealing with hormonal acne, you should know that you're not alone! Hormonal acne is very common and affects 50% of women between 20 - 29 and 25% of women between 40 - 49. While not as prevalent, hormonal acne is also seen in teenagers, peri-menopausal and menopausal women.
What are the symptoms of hormonal acne?
For teenagers, hormonal acne breakouts will often appear in the same places as typical teen acne: the forehead, cheeks, around the mouth, and the chin. Unlike teenage acne which is predominantly on the upper parts of the face, hormonal acne appears mostly on the lower parts of the face around the mouth, chin, and lower jawline. Though the chin and jawline are the most common locations for adult hormonal acne, the face and sides of the neck may also be affected.
Like teenage acne, hormonal acne will include comedones (blackheads and whiteheads, papules, pustules, and cysts). Many women with hormonal acne will also have "under-the-skin bumps", cysts that are not red or visible on the skin's surface.
What are the causes of hormonal acne?
Hormonal acne is essentially caused by fluctuations in hormone levels. The hormones that influence hormonal acne are estrogen and progesterone (which fluctuate throughout the menstrual cycle), testosterone (the male sex hormone that is also present in females), and cortisol (the stress hormone).
The causative hormonal changes typically occur around the time of your menstrual period, when you start or stop using hormonal birth control, during or after pregnancy, and during perimenopause and menopause. Less commonly, it can be triggered by certain medical conditions such as polycystic ovarian syndrome (PCOS). Genetics also play 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.
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 for 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.
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.
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.
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.
To find the right acne treatments for your unique skin, take the free skin assessment by clicking here.