Hormonal Acne: What You Should Know

Acne is a skin condition that affects approximately 650 million people worldwide. Hormonal acne develops due to changing hormones. It occurs in males and females during puberty and is more common in males during adolescence. In adulthood, it is more common in women. 

This article reviews hormonal acne causes, symptoms, and over-the-counter (OTC), natural, and prescription treatments.

What Is Hormonal Acne?

Acne occurs when skin pores get clogged and create whiteheads, blackheads, or sores. Hormonal acne is the term for breakouts caused by reproductive hormone fluctuations. 

These hormone fluctuations occur with puberty, menstruation (period), pregnancy, and health conditions such as polycystic ovary syndrome (PCOS). 

Symptoms

Hormonal acne develops on the face, neck, shoulders, chest, and back. This is most likely because of the large number of oil glands in these areas. 

During puberty, breakouts are often on the nose, chin, and forehead. Adult acne typically appears on the lower cheeks and jawline.  

The various kinds of breakouts include:

• Comedones: Clogged pores called whiteheads and blackheads
• Papules: Small pink bumps with no pus 
• Pustules: Red bumps with visible white or yellow pus
• Nodules: Large, firm, painful lumps lodged under the skin
• Cysts: Pus-filled nodules deeply lodged under the skin

What Causes Hormonal Acne?

Your skin produces sebum (a waxy oil) that typically leaves the body through pores. With acne, sebum and dead skin cells clump together and don’t empty, clogging the pore. 

Puberty, menstruation (menstrual periods), menopause, PCOS, and pregnancy can cause hormonal imbalances that increase sebum production. If bacteria join the mix, inflammation occurs, causing redness, swelling, heat, and pain.

The following are examples of medications that can trigger hormonal acne:

• Corticosteroids such as Deltasone (prednisone)
• Mood stabilizers such as Priadel, Camcolit (lithium) 
• Progestin birth control pills including Camila, Errin, Heather (norethindrone)
• Selective serotonin reuptake inhibitors (SSRI) such as Zoloft (sertraline hydrochloride)
  

The following factors do not cause acne but may make it worse:

• Environmental pollutants
• Excessive skin washing or scrubbing
• Obesity
• Smoking
• Squeezing or picking at sores
• Stress or lack of sleep
• Tight, non-breathable clothes, hats, or helmets
  

Menopausal Acne

Estrogen normally inhibits excessive male hormones and the growth of sebaceous glands. In menopause (the time indicating 12 months since your last menstrual period), estrogen levels drop, causing enlarged sebaceous glands and more sebum production.

Forms of Acne

Acne can be mild, moderate, or severe based on the amount and type of breakouts.

Mild Acne

Mild acne breakouts are mostly whiteheads or blackheads, and less than half of the face is involved. Pimples, papules, pustules, inflammation, or tenderness are minimal. It can usually be treated at home and doesn’t typically leave scars. 

Moderate Acne

Moderate acne breakouts involve more than half of the face. They include comedones, but papules and pustules make up over half of the acne and are usually tender or sore. Any nodules that may be present are minimal. 

Severe Acne

Severe acne covers the entire face with multiple comedones, papules, and pustules. There may also be painful nodules and cysts that can cause scarring. 

Misconceptions of Acne Causes

Common misconceptions about hormonal acne include:

• Dirty skin causes acne: Washing the skin often helps minimize oil buildup, but hormonal acne still occurs with clean skin. 
• Chocolate and greasy foods cause acne: There is not much evidence that chocolate or greasy foods cause acne. However, eating excessive amounts of foods high in sugar and dairy can worsen acne. 

How to Get Rid of Hormonal Acne

OTC medications may work for mild acne. Moderate or severe acne typically require a combination of prescription topical and systemic medications.

Topical medications are those that you put on your skin. Systemic medications are those you take by mouth or shot and work internally, throughout the body. 

OTC Medications

OTC acne medications may help with mild acne. You can buy them in a store or online without a prescription. They include:

• Benzoyl peroxide: Benzoyl peroxide is an ingredient in various name brands and generic OTC cleansers, creams, and lotions. It also comes in prescription strength.
• Glycolic acid: Glycolic acid is a type of alpha hydroxy acid (AHA) found in skin care products from Neutrogena, SkinCeuticals, No7, L’Oreal, and more. Be careful with this product if using retinoid products, as this can over-exfoliate your skin.
• Salicylic acid: You can find salicylic acid in some Oxy products, Noxzema or Stridex anti-acne pads, and anti-acne gels. 
• Sulfur and resorcinol: You can find this combination in Clearasil medicated blemish products and Rezamid lotion. 
• Pore strips: Pore strips help temporarily remove blackheads. 

Prescription Topical Medications

For moderate to severe acne, your healthcare provider may prescribe topical medications such as:

• Azelex, Finacea (azelaic acid)
• Winlevi (clascoterone cream)
• Apzone (dapsone gel)
• Retinoids such as Retin-A, Avita (tretinoin) or Tazorac, Fabior (tazarotene) or Differin (adapalene) 
• Topical antibiotics such as ATS, Akne-MycinEmcin. Emgel. Ery, Erycette. Eryderm, Erygel, Theramycin Z (erythromycin) or Cleocin T, Clindagel, ClindaDerm, Clindets, and Evoclin (clindamycin)
• Epiduo Gel (adapalene and benzoyl peroxide)

Oral Medications

Healthcare providers often prescribe topical and oral therapies for patients with severe acne. 

Common oral antibiotics prescribed for acne include:

• Sumycin, Actisite, and Achromycin V (tetracycline) 
• Vibramycin, Doryx, Doryx MPC, Oracea, Acticlate, Atridox, Doxy 100, and Doxy 200 (doxycycline) 
• Dynacin, Minocin, Minocin Kit, Solodyn, and Ximino (minocycline)
• Cleocin, Cleocin T, Evoclin, and Clindesse (clindamycin)
• Erythrocin, Ilosone, E-Mycin, Erythrocin Lactobionate (erythromycin). Erythromycin is safe for pregnancy and lactation.

Oral contraceptives (OCPs or birth control pills) commonly prescribed for acne include:

• Ortho Tri-Cyclen (norgestimate/ethinyl estradiol)
• Estrostep (norethindrone acetate/ethinyl estradiol)
• YAZ (drospirenone/ethinyl estradiol)

Other medications include:

• Aldactone (spironolactone) which is an anti-androgen
• Glucophage, Glucophage XR, Fortamet, Glumetza, and Riomet (metformin) decrease insulin resistance associated with PCOS or hyperinsulinemia

Your healthcare team may recommend professional specialty skin treatments performed by an aesthetician or a healthcare provider who specializes in dermatology. They include:

• Chemical peels
• Corticosteroid injections
• Laser therapy
• Light therapy
• Microdermabrasion
• Removal of clogged pores or cysts 
  

How to Treat Hormonal Acne Naturally

While the research regarding their effectiveness is still limited, there are natural acne creams and gels you can try. These treatments often have anti-inflammatory and antibacterial properties and include:

• Basil (Ocimum basilicum) may help reduce or prevent inflammation. It can be ingested as an herb or essential oil or used as a cream. 
• Green tea: One study showed that providing a daily dose of 856 milligrams of epigallocatechin gallate (EGCG), the antioxidant found in green tea, may help with acne around the mouth, nose, and chin. 
• Oregon grapes (Mahonia aquifolium or Berberis aquifolium) have been used for skin conditions for years as a part of traditional Chinese medicine. They come in teas, pills, powders, extracts, topical creams, or tinctures.
• Raw potatoes have been used to draw out infection and relieve inflammation for hundreds of years. They are a good source of phenolic compounds which have antibacterial properties. Place the white part of a small slice of potato against the skin. Use an adhesive bandage or gauze to secure it, and leave it on overnight for several nights. 
• Tea tree oil (Melaleuca alternifolia) is an essential oil used in skin care products, soaps, bath washes, and shampoos. 
  

When to See A Healthcare Provider

If you have any of the following, contact your healthcare provider: 

• Acne that's not responding to conventional treatments at home
• Prescribed treatments that are not working
• Psychological distress related to hormonal acne
• Severe breakouts or flare-ups before menstruation
• Sudden severe breakouts
  

Summary

Hormonal acne develops due to changing hormones from puberty, menstruation, pregnancy, menopause, some medications, and polycystic ovary syndrome (PCOS). You can usually treat mild acne at home. However, moderate to severe acne typically requires medical attention. Your healthcare provider may prescribe a combination of oral and topical (on-the-skin) medications or treatments to combat hormonal acne. 

A Word From Verywell 

Regardless of the severity, having acne can be frustrating and cause anger, low self-esteem, depression, and anxiety. It can be helpful to see a healthcare provider who specializes in skin problems. Communicate with them often so they can adjust treatment until you find the combination that works best for you.