Medical Review By: John Minni, DO
Getting acne in your twenties, thirties or forties seems unfair, but blame your hormones.
“Hormonal acne, or adult acne, is more common than you’d think,” said John Minni, DO, a board-certified dermatologist at Water’s Edge Dermatology. “In my practice, there are times when the number of adult patients I see for acne is higher than the number of teenage acne patients.” Some of them never even had acne earlier in life.
To learn how to get rid of hormonal acne, read on.
What is hormonal acne?
As you probably guessed, hormonal acne is acne caused by fluctuating hormone levels. Women naturally experience more hormone fluctuations than men, so most hormonal acne patients are female. More than 50% of women between ages 20 and 29 and more than 25% of women ages 40 to 49 have hormonal acne.
“The changes in the balance of estrogen and progesterone women experience when they have their period, are pregnant or are going through menopause are usually to blame,” said Dr. Minni. It’s not clear how imbalances of these hormones trigger acne. They may stimulate the sebaceous glands to produce more sebum, which contributes to acne outbreaks.
The stress hormone cortisol can also play a role in hormonal acne because it causes inflammation throughout the body, including the skin.
Hormonal acne can take many forms, including pimples and whiteheads, but it typically appears as deep, painful cysts. “These can cause significant red or brown scars and leave behind a little dip in the skin,” Dr. Minni said. “Concern about scarring is one of the main reasons why people with hormonal acne seek treatment.”
You’re most likely to get hormonal acne on your jawline and around your mouth, but it can also appear on the scalp, shoulders and chest.
What causes hormonal acne?
Anything that causes hormone levels to fluctuate can trigger hormonal acne, including:
Menstruation. Hormonal acne can develop during PMS, during your period, and even in the few days after it ends. “The skin may clear up between periods, but some women never get a break because the inflammation lingers even after the hormone levels return to normal,” Dr. Minni said.
Pregnancy. When hormonal acne occurs during pregnancy, it’s usually worse in the first trimester. Then it eases for a few months and returns as you get closer to your due date. It usually clears up following the birth but may return once you get periods again.
Menopause. Estrogen levels decline during menopause and the years leading up to it, and the decline can cause hormonal acne. The average age of menopause is 51, so some women will experience hormonal acne in their 50s.
Certain health conditions. Hormonal acne often occurs in women with polycystic ovary syndrome (PCOS) due to high levels of hormones called androgens. These hormones cause the sebaceous glands in the skin to produce excess sebum. Other conditions that cause hormonal acne include Cushing syndrome and androgen-secreting tumors. Any type of chronic inflammatory disease, such as irritable bowel disease or rheumatoid arthritis, can also trigger hormonal acne according to Dr. Minni.
Testosterone supplementation or steroid abuse. When hormonal acne occurs in men, it’s usually due to taking testosterone supplements or abusing steroids, either to feel more youthful or build muscle. “Trying to get your testosterone levels back to where they were when you were a teenager can cause tons of acne as well as prostate problems,” Dr. Minni said.
Medications. Several types of drugs can cause hormonal acne, including certain forms of hormonal birth control, corticosteroids, blood pressure medications and stimulants for conditions such as ADHD, which can increase cortisol levels. Even some vitamins, particularly those labeled for “stress relief” or intended to manage menstrual symptoms, can trigger hormonal acne because they contain synthetic forms of hormones.
Hormonal acne treatments
There are several ways to treat hormonal acne. One option is to take birth control pills that contain estrogen and progesterone. Pills FDA-approved to treat acne include Ortho Tri-Cyclen, Yaz, Beyaz and Estrostep Fe. They treat hormonal acne by decreasing the circulation of androgens.
“Unfortunately, birth control pills can have serious risks, so they’re best for people who have hormonal acne and are also looking for a form of birth control,” Dr. Minni said.
If you don’t need birth control, Dr. Minni recommends spironolactone, a prescription medication that blocks androgens. “I like spironolactone because it has few side effects and the cost is low,” he said.
Dr. Minni also suggests an antibiotic called doxycycline, taken in doses that are too low to cause antibiotic resistance but high enough to tame inflammation.
Very deep cysts can be treated with steroid injections. These must be used cautiously, however, because higher doses of steroids can cause skin dimpling.
In-office treatments such as chemical peels and HydraFacial MD can help treat hormonal acne. Chemical peels are a particularly good choice for women in their 40s, according to Dr. Minni, since they also diminish signs of aging such as fine lines and sun damage.
For pregnant women, the safest options for treating hormonal acne are topical products that combine azelaic acid and clindamycin (an antibiotic) and metronidazole, a topical antibiotic, Dr. Minni said.
Dietary changes may also help. “Some people find that their hormonal acne worsens when they eat certain foods, such as shellfish, red wine or hot sauce,” Dr. Minni said.
And, of course, follow the same practices that help prevent other types of acne. Wash your face with a gentle cleanser, don’t scrub, and don’t smoke.
Article Written By: Jessica Brown, a health and science writer/editor based in Brooklyn, New York. She has written for Prevention magazine, jnj.com, BCRF.org, and many other outlets.