How does hormonal acne work?

What are hormones doing inside the skin?

Androgens are hormones, including testosterone, that stimulate oil production in both sexes. During puberty, rising androgen levels enlarge the oil glands and increase sebum, the oil that helps keep skin from drying out. The oil glands also have machinery to produce and process hormones locally. Acne involves more than the amount of oil: changes in the oil's composition, blocked follicles and inflammation also matter.234

Normally, oil and shed skin cells travel out through a pore. In acne, they stick together inside the hair follicle, trapping oil and allowing bacteria that normally live on skin to grow. The resulting inflammation causes redness, swelling and pain. If the follicle wall breaks down, its contents spill into nearby skin and create an inflamed lesion.2

Why do breakouts come and go?

Hormone fluctuations around periods, pregnancy, perimenopause and menopause can trigger adult breakouts. Starting or stopping birth control pills can also change the pattern. Stress stimulates androgen production, which helps explain repeated flares during stressful periods. Family history, products that clog pores and some medicines can contribute too. Adult acne is not automatically caused by hormones alone.5

Can you tell whether acne is hormonal?

Repeated flares around your period and breakouts along the chin or jawline are useful clues. Hormonal acne can also affect the cheeks, chest, shoulders and back, and can include blackheads and whiteheads as well as deeper bumps. The word "hormonal" describes a driver of breakouts, not a separate species of pimple that needs its own shopping aisle.13

Hormone influenced acne can occur without unusually high hormone levels in the blood. A clinician assesses your skin alongside menstrual patterns, medicines and changes in your health. Hormone testing is not necessary for everyone, particularly when acne responds to standard treatment. Persistent acne or accompanying hormonal symptoms can make further assessment useful.36

Does skincare help if hormones are the trigger?

Yes. Acne treatments can act on clogged follicles, bacteria and inflammation even when hormones contribute. Retinoids help treat lesions, reduce inflammation and prevent new acne. Benzoyl peroxide kills bacteria, while salicylic acid helps break down blackheads and whiteheads. Treatments can target several parts of the process, so the bottle does not need a special relationship with your menstrual calendar.6

Prescription hormone therapy, used primarily in women, works by reducing androgen effects on oil glands. Oral contraceptives are one treatment option. Hormonal treatment can be considered for recurring monthly flares or acne that resists standard treatment; a high hormone test result is not a requirement. Improvement can take four to six weeks after treatment begins.136

What should you do day to day?

• Wash gently with a mild cleanser morning and evening, and after heavy exercise. Rinse with lukewarm water rather than using rough scrub pads.
• Choose cosmetics and hair products labeled oil free or noncomedogenic, meaning designed not to clog pores.
• Avoid picking or squeezing, which can cause scars or dark marks.
• Use sunscreen outdoors, particularly because many acne medicines increase susceptibility to sunburn.

When should you get medical help?

See a dermatologist if acne persists, worsens or develops deep, painful bumps, because untreated or severe acne can leave scars. Discuss burning, irritation or redness from treatment with your doctor. If a prescribed medicine seems to trigger breakouts, keep taking it and contact the prescriber. During pregnancy, ask your healthcare provider to choose an appropriate treatment; avoid topical retinoids and isotretinoin.156