Acne has a reputation for being a young person's problem. In fact, acne may develop at any time after puberty up to our middle years and beyond. Acne can be caused by many things, one of which is a hormonal imbalance.
Therefore, hormonal acne treatments might be a consideration for many of us, regardless of our age or gender.
What Causes Hormonal Acne?
Our hormones play an important role in many factors and milestones in our lives. Puberty, pregnancy, the menopause - they’re all under the influence of our hormones.
Hormonal breakouts are caused by an imbalance of the sex hormones in our body - specifically, the male hormones called androgens. When these androgens become more dominant, they trigger the release of sebum - the wax-like oily substance naturally secreted by the skin to protect it and keep it hydrated.
The problem is, when we have too much sebum, it can block the pores, trapping dirt and bacteria, leading to hormonal acne on the cheeks and elsewhere on the face.
So let’s take a look at hormonal acne causes in more detail.
Causes of Hormonal Acne - Growth Hormones
Having high levels of two hormones called human growth hormone and insulin-like growth factor can lead to severe acne formation.
These hormones exist naturally in the body, but levels can become high due to artificial versions introduced into the body by consuming foods such as red meat and milk. Animal bodies also naturally contain these hormones, so consuming them or their secretions such as their milk can cause our own levels to rise.
Artificial Changes in Hormone Balance
Over-the-counter bodybuilding and dietary supplements may contain added anabolic steroids - which are synthetic androgens. They can cause an increase in androgen levels, leading to hormonal acne, especially in males.
Hormonal Breakouts Due to Polycystic Ovary Syndrome (PCOS)
A medical condition called polycystic ovary syndrome, or PCOS, that affects one in five women in the UK can also cause acne.
This is because PCOS causes the ovaries to produce a higher level of androgens, leading to an increase in sebum production and hormonal acne.
Hormonal Acne During Puberty
During puberty, an increase in androgens causes the skin follicle glands to grow larger and make more oily sebum, therefore causing a hormonal acne flare up.
Both female and male sex hormones surge during puberty which can cause hormonal acne. Ultimately, they increase skin oil production and the chance of developing acne.
Adult Hormonal Acne Related to the Menstrual Cycle
During our menstrual cycle, our hormones are constantly fluctuating. When levels of the female hormones are relatively low compared to testosterone (the most common androgen), it allows testosterone to be dominant and cause an increase in sebum and hormonal acne.
Many women say their skin feels worse in the days leading up to their period.
Hormonal Acne and the Menopause
The menopause is also a time when the female hormones are declining, leading to a relative rise in testosterone as it’s no longer masked. This can then lead to an increase in hormonal acne. Or even a woman experiencing acne for the first time in her life.
Pregnancy Hormonal Acne
During pregnancy, androgen production also increases which again causes the skin follicle glands to grow larger and make more oily sebum. Many pregnant women develop acne, mostly in their first trimester when hormonal imbalances are more severe.
Treating pregnancy acne is difficult as many prescription and over the counter acne medications and preparations aren’t suitable for pregnant women.
That’s why doctors strongly advise avoiding medicated and chemical remedies during pregnancy and advocate the use of natural remedies for hormonal acne.
Where Does Hormonal Acne Usually Form?
Hormonal acne usually forms on the lower third part of the face around the mouth, chin and jawline.
Acne – including hormonal imbalance acne – progresses through several stages. The earliest stage is the formation of a plug made from dead skin cells stuck together with sebum in the pore of a hair follicle. The plug is called microcomedone. Propionibacteria, which naturally reside on the skin, colonise the microcomedone in acne prone skin.
The skin pigment melanin that’s responsible for our skin tone, accumulates in the plug. If it is then oxidised by oxygen in the air, it causes the microcomedone to become black. This stage is known as an open comedo or blackhead.
On the other hand, when microcomedones form deep within the hair follicle, and there is no oxygen, it remains white. White or open comedones are called whiteheads.
If left untreated and the hormonal imbalance remains, hormonal comedonal acne will proceed to the next, most severe stage of hormonal acne - cystic acne.
The colonisation of open and closed comedones by propionibacteria causes inflammation in and around the blocked hair follicles.
Chemical signals such as IL-1 produced by skin cells, attract immune system cells that deal with a bacterial infection. However, they also have a side effect of increasing skin cell reproduction. Rapid skin cell accumulation then speeds up the formation of comedones.
The inflammation process around hair follicles leads to the formation of progressively worsening inflammatory acne lesions. These lesions are called papules, nodules, and pustules.
These are the characteristic symptoms of hormonal cystic acne. If the inflammation is severe, the content of comedones breaches the skin layer underneath the hair follicle and causes the formation of deep nodules and pustules filled with pus.
Deep nodules often result in skin scarring in the form of:
- Shallow depressions in the skin
- Small but deep skin pits called 'ice-pick’ scars
- Red-raised scars
The best treatment for hormonal cystic acne lies in managing acne development. This means tackling the earlier stages of acne including blackhead and whitehead treatment. This will significantly alleviate or even prevent cystic acne formation.
How Common is Hormonal Acne?
If you have hormonal acne, take comfort from knowing that you’re not alone - as it;s a very common skin condition, affecting men and women of all ages. It can begin in our teenage years and can often persist into late adulthood.
It’s thought that around 50% of women in their 20s will experience hormonal acne, along with around 25% or women in their 40s.
How Do I Know If I Have Hormonal Acne?
Hormonal breakouts will often occur around the time of your period or if you’re pregant, breastfeeding or experiencing the perimenouse or menopause. So if your acne breakouts are coinciding with hormonal events such as these, you’ve probably got hormonal acne.
Acne caused by hormonal fluctuations will also be more likely to occur on your chin, jawline and neck. Another sign of hormonal acne is that it’s often more difficult to treat than other types of acne.
What Can Make Hormonal Acne Worse?
There are certain things that can make adult hormonal acne worse, including:
- Living a stressful life as stress releases the stress hormone cortisol that can increase sebum production
- Taking medications that contain hormones such as the oral contraceptive pill
- Using harsh or oil based skincare products and makeup
- Eating an unhealthy, acidic diet
- Food allergies
When Should I Treat My Hormonal Acne?
As soon as your hormonal acne begins to bother you, it’s time to start thinking about how to treat it. Early treatment is often the most effective way of helping hormonal acne and to stop it from causing further breakouts.
Caring for Hormonal Acne
Tips on how to look after hormonal acne include:
- Using the correct skincare for your skin, which is especially important during pregnancy
- Try not to irritate your skin by touching your face
- Use your mobile on the hands-free setting or with earphones to prevent skin rubbing and irritation
- Change your pillowcases frequently to avoid discarded skin cells and bacteria accumulating on the skin
- Wash your face twice a day and after heavy sweating
- Avoid over cleansing because it can stimulate skin oil production
- Use a gentle, oil-free, alcohol-free, non-abrasive cleanser
- Use a washcloth made from natural materials such as cotton and change it daily
- Frequently wash your hair as scalp oil production is linked with face oil production
How to Treat Hormonal Acne
Different treatment options exist for acne. They work in different ways, including hormonal balancing, reducing inflammation and killing propionibacteria.
Other groups of medications work by normalising skin cell shedding and sebum production to prevent blockages. We look at some of the commonly used treatments below.
Natural Treatments for Hormonal Acne
Before you go to your doctor and start taking medications, we think it's better to try natural and holistic remedies for your hormonal acne treatment.
The only cause of acne you can do nothing about is your genes. The other causes of acne including stress, diet and especially skin care regime during acne can all be adapted.
Reduce Levels of Stress
Persistent stress leads to the release of the stress hormone cortisol and an increase in male sex hormones. These high hormone levels lead to acne outbreaks or can make the condition worse.
Reducing stress is the best place to start your acne treatment. Look at your work, commuting, home life and other factors to see what might be stressing you out.
It’s easier said than done to simply ‘calm down’ and reduce stress. But factors such as mindfulness and yoga can be effective remedies for stress. Getting enough sleep is shown to reduce stress significantly.
Hormonal Acne Diet
How our diet affects our skin is an important factor to consider. Our diet is one of the most essential and preventable causes of excessive skin oil production.
The best foods for controlling hormonal acne are oily fish and vegetables, and replacing cows milk with non-dairy alternatives such as almond or oat milk. Avoiding sugar, excessive animal fat and unregulated dietary supplements will help balance hormones and manage acne.
Does Exercise Help Hormonal Acne?
The amount of exercise we get can correlate with the extent of our acne. Hormonal acne depends not only on the level of our sex hormones but also on the presence of the stress hormone, cortisol. The higher the level of cortisol, the more severe our acne outbreaks.
Moderate physical exercise such as hiking, running or yoga reduces the level of stress hormones in our body.
Besides physical activity, mental exercise such as mindfulness or meditation can help to reduce the severity of hormonal acne.
Just don't forget that any exercise should be followed by a shower to remove sweat and a proper skincare routine.
Does Homoeopathy Work for Hormonal Acne?
Some people may find that homoeopathic remedies for acne help them. Homoeopathy works by introducing the irritant that causes acne, in minimal quantities.
Mainstream science thinks that the effects of homoeopathic remedies are psychological. While the result of homoeopathic preparations is very variable and not guaranteed, there are no known side effects of homoeopathic treatments so it could be worth a try.
How to Control Hormonal Acne with Supplements
While it’s important to maintain a healthy diet to help manage hormonal acne, it’s possible to help support healthy skin by taking vitamins and supplements for hormonal acne.
Zinc Supplements for Hormonal Acne
Zinc helps to reduce sebum production and alleviates inflammation that leads to severe acne. It also works as an antibacterial agent that inhibits propionibacteria growth.
The possible side effect of a high concentration of zinc as a result of combining supplements and topical remedies is a copper deficiency. So it’s essential that you don’t exceed the daily recommended amount of zinc.
Selenium Supplements for Hormonal Acne
Selenium is another nutrient that reduces skin inflammation. Selenium is often sold as a vitamin complex along with zinc and vitamin E. Because we only need selenium in micro amounts, selenium supplements shouldn't have any side effects.
Other Vitamins for Hormonal Acne
Several vitamins, mostly involved in the normal functioning of the immune system that can help to treat hormonal acne include:
- Vitamin A - involved in the maintenance of a healthy immune system as well as skin cells regeneration
- Vitamin B3 -has anti-inflammatory properties, suppresses sebum production and promotes wound healing
- Vitamin C - reduces skin damage by free radicals and improves collagen renewal
- Vitamin E - an antioxidant with anti-inflammatory properties
While omega-3 fatty acids found in oily fish such as mackerel and krill are not ‘classical' vitamins, they are shown to strengthen skin and nails. Omega-3 fatty acids also help to maintain healthy hormonal levels that are especially important in hormonal acne treatment.
If you do decide to supplement your diet with vitamins, multivitamins rather than individual vitamins are better. Multivitamins contain a combination of a daily dose of most vitamins. Some formulations also contain zinc and selenium.
Except for vitamin A, the overdose of which increases skin sensitivity to UV light, there are no side effects to the other vitamins.
Herbal Supplements for Hormonal Acne
Herbal or plant supplements can form a useful part of the holistic factors and lifestyle changes that can help to manage hormonal breakouts.
Supplements of this type contain compounds found in medicines but in a less concentrated form. Variation in the concentration of active ingredients between different preparations makes them less effective than medications. However, decreased efficiency is more than compensated for by the rarity and mildness of any side effects.
Vitex for Hormonal Acne
One of the best herbs for hormonal acne, Vitex agnus castus is a shrub common to the Mediterranean region. It contains essential oils rich in flavonoids and steroids and is made from the leaves and fruits of the shrub.
Research suggests that Vitex can help to balance both the male and female sex hormones. As such, it may help to control hormonal acne. Possible side effects include nausea, headache, gastrointestinal disturbances. However, even if you have side effects, they are mild and reversible.
Tea Tree Oil for Hormonal Acne
A traditional skin clearing remedy, tea tree oil is thought to be as effective as benzoyl peroxide or salicylic acid in managing acne prone skin.
Tea tree oil has antibacterial properties that work against propionibacteria as well as anti-inflammatory properties that help to reduce inflammation. It’s associated with allergic contact dermatitis in some individuals, so use sparingly to begin with.
Other Plant Derived Therapies for Acne
Other plant derived therapies that can have a positive effect on acne include basil oil and oligosaccharides from seaweed. Flax and chia seeds that contain omega-3 are effective against skin inflammation and recommended for consumption by acne prone individuals.
Best Topical Treatments for Hormonal Acne
Topical treatments for hormonal acne work by targeting the early stages of comedo formation and are generally ineffective for visible skin lesions.
They are applied to the sites of acne as creams, gels, lotions and have a local effect. Topical medicines usually contain antibacterial agents like salicylic acid or antibiotics. Vitamins are also frequently used in topical applications.
Benzoyl Peroxide for Hormonal Acne
Benzoyl peroxide serves as an active anti-acne agent that is applied topically in the form of a gel, cream or liquid and is prescribed for cases of mild to moderate acne. For more severe cases it’s recommended in combination with antibiotics or synthetic retinoids.
It works as an antimicrobial agent and can cause initial dryness and sometimes skin irritation, although the skin usually develops tolerance after a week or so. Less frequent are cases of a burning sensation as well as swelling. An even smaller number of people develop an allergy to benzoyl peroxide.
Does Proactiv Work for Hormonal Acne
Proactiv is a brand of skincare products best known for its three-step anti-acne kit that includes a cleanser, toner, and lotion.
Proactive products contain benzoyl peroxide that is effective against acne. However, other less expensive products also contain this compound. A Consumer Reports study compared Proactiv with two less expensive AcneFree and OXY Maximum. It found all three equally effective.
How to Control Hormonal Acne with Medication
Hormonal acne medication is divided into treatments that kill propionibacteria, reduce inflammation, and normalise the skin cell renewal cycle.
Different groups of medicines are often prescribed together to strengthen the effect. For example, for longer courses of antibiotics benzoyl peroxide or a retinoid can be used at the same time.
Antibiotics for Hormonal Acne
Antibiotics are prescribed for mild to moderate acne. They kill propionibacteria and help to reduce inflammation.
Topical antibiotic creams can be applied to the skin where acne is forming. Oral antibiotics are designed to be taken over several weeks to help manage more severe acne.
Different antibiotics should not be taken together. Also, it’s essential not to take antibiotics for shorter or longer periods than prescribed. An incomplete course or prolonged antibiotic treatment may lead to the appearance of antibiotic-resistant bacteria that are difficult to treat.
A general side effect of antibiotics prescribed for acne treatment is the development of an allergy. Specific side effects depend on the particular antibiotic prescribed and can be checked with your GP.
Does Accutane Work for Hormonal Imbalance Acne
Accutane or Roaccutane is the brand name for prescription drugs that contain isotretinoin or 13-cis-retinoic acid.
Isotretinoin is a very strong, effective retinoid, or vitamin A precursor, prescribed for severe acne. After a single course, about 80% of people report an improvement in hormonal acne, with more than 50% having a complete remission.
The confirmed side effect is skin, nasal and eye dryness. Other effects may include mood changes.
Due to the potential adverse effect on the development of unborn babies, women of childbearing age are required to use two forms of contraception before, during and after the course of isotretinoin and have regular negative pregnancy tests.
In conclusion, Accutane and its generic variants can cure hormonal acne, but you need to be aware of side effects.
Oral Retinoids for Hormonal Acne
Oral retinoids are the first-line medical treatment for acne. They are precursors of vitamin A that is itself responsible for active skin cell regeneration. Retinoids influence the cell life cycle in the follicle lining, reducing inflammation and decreasing sebum production.
Downregulation of inflammation and oil accumulation prevents the accumulation of skin cells within the hair follicle, helping to prevent acne breakouts.
Side effects of retinoids include skin sensitivity to UV light, which is why retinoids are usually taken in the evening. Generally, the stronger the effect of a retinoid, the stronger the side effects.
Using Hormones to Manage Hormonal Acne
Because male sex hormones are the underlying cause of increased sebum production, female sex hormones are often prescribed to help correct the hormone imbalance.
In women, acne improves in most cases with the use of the combined oral contraceptive pill that contains the female hormones, oestrogen and progesterone. They help to lower the amount of male hormones, helping to manage acne breakouts.
The pill can be as effective as antibiotics in acne reduction with an additional benefit in normalising the menstrual cycle. Side effects of hormonal contraception pills include mood swings and weight gain. Hormones are not prescribed to normalise male acne.
Skincare for Hormonal Acne
A good skincare regime is very important for fighting hormonal acne. Water based products rather than oil based can help to keep your skin clear. Makeup should also be oil free and gentle.
Moisturisers are commonly used alongside acne medications. One study has shown that the application of a moisturiser before topical acne medications did not interfere with the efficiency and enhanced tolerability of the drug.
The Sönd was formulated with acne prone skin in mind. The alkaline approach helps sooth acne and customers have seen great results which they haven't been able to achieve with other products they have tried.
Best Facial Cleanser for Hormonal Acne
Facial cleansers for hormonal acne are important for regular removal of excess sebum. They should be gentle and shouldn’t strip the skin. The gentle creamy cleanser from Sönd is ideal!
Best Moisturiser for Hormonal Acne
While cleansing is a foundation of our skincare routine, it should always be followed by a moisturiser that supports the acne healing process. It’s crucial to hydrate skin and lock in moisture to prevent skin irritation that will result in inflammation and excessive oil production.
Sönd has the solution for this problem with its Calming Hydration Day Cream. It’s important to use a replenishing night cream that provides long term nourishment for your skin helping it to fight acne.
This article is not meant to treat or diagnose. Please visit your doctor for advice about any health concerns you may have.