How do the two compare?

What to compareHormonal acneBacterial contribution to acne
Main roleHormone changes increase oil production and contribute to blocked pores.Bacteria contribute to inflammation and pus in blocked follicles.
Typical cluesInflamed or deep bumps on the chin, jawline and lower cheeks, often before a period.Inflamed bumps and pus filled spots; these can also occur with hormonal acne.
Treatment targetsBlocked pores and inflammation, with hormone treatments considered when appropriate.Bacteria and inflammation, using treatments such as benzoyl peroxide or prescribed antibiotics.
Contagious?No.Acne is not an infectious disease and cannot be passed to another person.
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These labels describe different parts of the same process, despite sounding like rival departments. Excess oil, called sebum, mixes with dead skin cells and plugs a hair follicle, the opening where a hair grows. Normally harmless skin bacteria can then contribute to inflamed spots. Cutibacterium acnes, often shortened to C. acnes, is one bacterium involved. Acne severity does not depend simply on how many bacteria are present.14

Can you tell from where the spots appear?

Jawline location and repeated flares before a period are useful clues, not a diagnosis by themselves. Pay attention to when breakouts appear and what makes them better or worse. Hormonal changes during puberty, menopause and pregnancy can also contribute to acne. A clinician can examine the types of spots and use their severity and behaviour to choose treatment.123

Does hormonal acne need different treatment?

Treatment is chosen by the spots and their severity, not by which label wins the naming contest. Treatments applied to the skin can address several parts of acne, while prescription hormone treatments address hormones' effects on excess oil production.3

  • Retinoids, medicines related to vitamin A, unclog pores. Prescription options include adapalene and tretinoin.
  • Benzoyl peroxide reduces acne bacteria and also has an anti inflammatory effect.
  • Salicylic acid helps ease inflammation and is an option to discuss with a pharmacist.
  • Prescription antibiotics target bacteria involved in inflammation and pus.
  • The combined contraceptive pill and spironolactone are hormone treatments a dermatologist can consider.
  • Isotretinoin is a prescription option for acne when other treatments do not work.
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What should you do first?

  1. 1For mild acne, ask a pharmacist about a suitable treatment, such as a low concentration benzoyl peroxide product.
  2. 2Wash with a gentle cleanser and lukewarm water twice a day. More frequent washing does not clear the blockage inside the follicle.
  3. 3Keep the rest of the routine gentle when adding acne treatment. Use a moisturizer to help manage dryness.
  4. 4Choose products labelled noncomedogenic, meaning less likely to block pores, and remove makeup before bed.
  5. 5Avoid scrubbing, picking or squeezing spots, which can worsen acne or cause scars.
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Acne treatments can take up to three months to work. Dryness is common with acne products, and benzoyl peroxide can bleach clothing. Washing harder or more often is not a substitute for treatment.13

When should you get medical help?

See a doctor for deep, painful lumps, lots of spots, scarring, acne that is not improving with self treatment, or acne affecting your mental health. Hot, swollen, red skin also needs medical assessment for possible infection; redness can be harder to see on brown and black skin. Do not assume these signs are simply "bacterial acne."2

Where this answer comes from

  1. 1NHS 111 Wales - Health A-Z : Acne111.wales.nhs.uk
  2. 2Acnenhs.uk
  3. 3Think that DIY acne trick is helping? Here’s what dermatologists want you to knowaad.org
  4. 4Bacteria in acnedermnetnz.org