How to combat hormonal acne

What makes acne hormonal?

Hormonal changes can increase the oil your skin produces. Oil and dead skin cells block hair follicles, and bacteria inside those blocked follicles can cause inflammation and pus. Hormones are part of the cause, but treating blocked pores and inflammation still matters.13

Hormone levels naturally rise and fall, which makes "balance" an ambitious skincare slogan. Breakouts can accompany puberty, periods, pregnancy and menopause; testosterone therapy can also contribute. A hormonal imbalance means having too much or too little of a hormone, rather than simply having normal fluctuations.13

Build a routine around treatment

1. 1Wash with a gentle cleanser in the morning and evening. Avoid scrubbing, which can irritate skin and worsen acne.
2. 2Use your acne medication as directed. Follow the prescribed order if your treatment plan contains several medicines; topical retinoids are often applied in the evening.
3. 3Use noncomedogenic skincare and makeup, meaning products designed not to clog pores. If a prescribed retinoid irritates your skin, ask whether applying moisturizer first would help.
4. 4Protect exposed skin with broad spectrum, water resistant sunscreen rated SPF 30 or higher. Seek shade and wear protective clothing, especially while using a retinoid.
5. 5Remove makeup at the end of the day. Leave spots alone rather than picking or squeezing them, which can cause scars.

Choose skincare labelled noncomedogenic, rather than asking an ambitious product name to do the work of a treatment plan.1

Which treatments can you put on your skin?

For mild to moderate breakouts, benzoyl peroxide or salicylic acid can be a starting point; a pharmacist can help you choose. Topical treatments can also improve acne associated with an underlying hormonal condition. Persistent acne can need prescription topicals, hormonal medication or both.6

When should you consider hormonal medication?

Spironolactone and certain combined birth control pills are options for women whose acne has not responded adequately to other treatments. Oral antiandrogens counter the effects of hormones such as testosterone on the skin, reducing oil production and the formation of blocked pores. They can be combined with other acne treatments.5

The combined pill contains estrogen and a progestogen; a progestogen only pill generally does not treat androgen driven acne. Combined pills can increase the risk of blood clots and can be unsuitable with certain cardiovascular conditions or significant liver disease. Do not switch contraception without discussing both acne treatment and pregnancy prevention with your prescriber.5

Bring a list of medicines, supplements and medical conditions to the appointment, including any history of blood clots, migraines, heart disease or high blood pressure. Spironolactone treatment involves blood tests and follow up visits, often every 4 to 6 weeks initially while the dose is adjusted. Avoid potassium supplements and coconut water while taking spironolactone.2

Do you need a hormone assessment?

Tell your clinician if acne comes with irregular periods, new excess facial or body hair, or scalp hair thinning. These can accompany a sex hormone imbalance. Persistent, deep breakouts on the lower face can occur with an ovarian hormone condition, but their appearance alone cannot diagnose it. Depending on your symptoms, assessment can include hormone testing or an ultrasound.36

How long does treatment take?

Most acne treatment plans need at least 6 to 8 weeks before you start seeing fewer breakouts. With hormonal treatment, the combined pill typically shows improvement after 2 to 3 months; spironolactone can start reducing oiliness and breakouts within a few weeks. Take prescribed hormonal medication at the same time each day and keep follow up appointments.24

Effective hormonal treatment can be continued long term to prevent new breakouts. Acne can return within months of stopping a combined pill.25

Pregnancy and treatment side effects

Tell your prescriber if you are pregnant or planning pregnancy before choosing treatment. Spironolactone can harm a developing fetus, and combined oral contraceptives must not be taken during pregnancy. Benzoyl peroxide and salicylic acid are generally considered safe during pregnancy; discuss the product with your clinician. Oral isotretinoin must not be used during pregnancy or for at least one month before becoming pregnant.567

Topical medicines can cause dryness, peeling, burning and irritation. Applying extra medication does not clear acne faster. If a prescribed retinoid irritates your skin, ask your dermatologist about a smaller amount, less frequent use or moisturizer before medication. Contact your dermatologist immediately for signs of a serious hormonal treatment side effect, such as cramping in an arm or leg.24

When skincare is not enough

See a doctor for deep or painful lumps, scarring, lots of spots, treatment that is not helping, or acne affecting your mental health. Hot, swollen or red skin also needs assessment for infection. Redness can be harder to see on brown and black skin.1

Severe, scarring or treatment resistant acne can need oral medication beyond hormonal therapy. Oral antibiotics are used for inflammatory acne; isotretinoin is an option for severe acne or acne that has failed other treatments. Isotretinoin requires medical supervision because of pregnancy risks, dryness and other adverse effects. It must not be taken with tetracycline antibiotics.7