Hormonal Acne
18th November, 2020

Hormonal Acne

Hormonal acne is exactly as it’s described — acne that is linked to fluctuations in your hormones.

Although acne is typically associated with hormone fluctuations during puberty, hormonal acne can affect adults of any age. It’s especially common in women. A number of factors may contribute to this, including menstruation and menopause.

It’s estimated that 50% of women ages 20 to 29 have acne. It also affects about 25% of women ages 40 to 49.

Yes, adults can get acne. It is even possible to get acne for the first time as an adult. Dermatologists call this “adult-onset acne.”

Reasons for adult acne 

Fluctuating hormone levels: An imbalance can lead to breakouts.

Women often experience fluctuating hormones: 

  • Around their periods 
  • During pregnancy, peri-menopause, and menopause
  • After discontinuing (or starting) contraceptive pills 

Stress: Research has found a strong relationship between stress and acne flare-ups. In response to stress, our bodies produce more androgens (a type of hormone). These hormones stimulate the oil glands and hair follicles in the skin, which can lead to acne. This explains why acne can be an ongoing problem when we find ourselves under constant stress.

Family history: Does a close blood relative, such as a parent, brother, or sister have acne? It is believed some people may have a genetic predisposition for acne. People who have this predisposition are more likely to get adult acne.

Skincare products: If you have adult acne, you should be very careful when selecting your home care products, some readily available skin care products can actually make the problem worse.

Salicylic acid, AHAs, Retinol and Vitamin C can be helpful ingredients to improve the texture and appearance of the skin. This will then reduce the chance of scarring.

It is always best to see a skincare expert to determine the best course of action when choosing your home care products.

Medication side effect: Acne can be a side effect of some medicines. If you suspect that a medicine is triggering your acne or making it worse, continue taking it, but talk with the doctor who prescribed it for you.  Ask if acne is a possible side effect. You may be able to take an alterative. If there is no alternative, you may want to see a dermatologist who can help you to control the acne.

Undiagnosed medical condition: Sometimes, acne is a sign of an underlying medical condition. Once the medical condition is diagnosed and treated, the acne often clears. 

What are the characteristics of hormonal acne?

During puberty, hormonal acne often appears in the T-zone. This includes your forehead, nose, and chin.

Hormonal adult acne typically forms on the lower part of your face. This includes the bottom of your cheeks and around your jawline.

For some people, hormonal acne takes the form of blackheads, whiteheads, and small pimples that come to a head, or cysts. Cysts form deep under the skin and don’t come to a head on the surface. These bumps are often tender to the touch.

Hormonal acne may be caused by influxes of hormones from:

  • Menstruation
  • Polycystic ovaries syndrome
  • Menopause
  • Increased androgen levels

Specifically, these hormone fluctuations may aggravate acne issues by increasing:

  • overall skin inflammation
  • oil (sebum) production in the pores
  • clogged skin cells in hair follicles
  • production of acne-causing bacteria called Propionibacterium acnes

Is menopausal acne a form of hormonal acne?

Many women begin to experience menopause in their 40s and 50s. This causes a natural decline in your reproductive hormones, resulting in an end to menstruation.

Some women experience acne during menopause. This is likely due to a drop in estrogen levels or an increase in androgen hormones like testosterone.

You may still experience menopausal acne even if you’re using hormone replacement therapies (HRTs) to ease your menopause symptoms. This is because some HRTs use an influx of the hormone progestin to replace the estrogen and progesterone your body loses. Introducing this hormone to your system can cause your skin to break out. In most cases, correct skincare and medication can clear up menopausal acne.

Traditional treatments for hormonal acne

Oral contraceptives

Oral contraceptives specifically used for acne treatment contain ethinylestradiol plus one of the following:

  • drospirenone
  • norgestimate
  • norethindrone

Together, these ingredients target the hormones that can contribute to acne. This can be especially helpful during peaks in hormones, such as during ovulation.

Oral contraceptives may not be an option for you if you have a history of blood clots, high blood pressure, or breast cancer. You also shouldn’t take these if you smoke.

Anti-androgen drugs

Anti-androgen drugs work by decreasing the male hormone androgen. Both men and women have natural levels of this hormone. Too much androgen, though, can contribute to acne issues by interfering with hair follicles that regulate skin cells and increasing oil production.

Although spironolactone (Aldactone) is primarily used to treat high blood pressure, it has anti-androgen effects. In other words, it can prevent your body from producing more androgen and allow your hormone levels to stabilize.

Retinoids

If your hormonal acne is mild, you may be able to use topical retinoids. Retinoids are derived from vitamin A.

Many retinoid creams, gels, and lotions are available over the counter.

If your acne is severe you may want to see your doctor about a prescription-strength formulation or in worst-case scenarios oral retinoids such as Isotretinoin and Roaccutane. These can be used effectively in very severe cases but please consider this carefully as the side effects can be intense and irreversible.

If you add a topical or oral retinoid to your regime, it’s important to apply sunscreen daily. Retinoids can increase your skin's sensitivity to the sun.

Hormonal acne: Diet do’s and don’ts

The exact role between diet and hormonal acne isn’t fully understood. Some foods are thought to help prevent acne — particularly inflammation-fighting foods.

Plant-based foods high in antioxidants may help reduce inflammation and promote clearer skin. Omega-3 fatty acids may also decrease skin inflammation.

Contrary to popular belief, junk food alone doesn’t cause acne. But overdoing it on certain foods may lead to increased inflammation.

You may consider limiting the following:

  • sugar
  • dairy products
  • refined carbs, such as white bread and pasta
  • red meats