How to treat hormonal acne

What hormonal acne is

Hormonal acne is acne linked to shifts in hormone levels and excess oil, called sebum, that can clog pores. Androgens, including testosterone, affect oil production. Breakouts often show on the chin and jaw, but can also appear elsewhere on the face, chest, shoulders or back. Adult acne often appears on the chin or jaw, but no cleanser gets a seat on the hormone committee just for having a confident name.234

Hormone changes around menstrual periods can trigger breakouts, which may flare just before a period. Hormonal acne can continue into adulthood; pregnancy and menopause are also periods of hormonal change. Greasy hair or skin products can clog follicles, and some medicines can contribute to new acne. If breakouts begin after a medicine is started or stopped, mention that timing and the medicine to your doctor rather than stopping it on your own.24

Hormonal acne on the chin and jaw

The chin and jaw are common places for hormone related breakouts, especially when spots repeatedly flare around a menstrual period. Deep, painful lumps can occur there too. Acne in this area is a useful pattern to describe to a clinician, along with when it appears and any other changes. Acne together with irregular periods, excess hair growth or weight gain is also worth raising with a clinician, as these symptoms can occur with polyendocrine metabolic ovarian syndrome, or PMOS.24

What to do at home

1. 1Wash with a gentle cleanser twice a day; the sink does not hand out points for brand loyalty.
2. 2Remove makeup at the end of the day and choose skin care and makeup products labelled non comedogenic.
3. 3Try an over the counter acne product containing salicylic acid or benzoyl peroxide, and keep the rest of your routine gentle.
4. 4Do not scrub or pick at spots, because irritation can make acne worse and picking can cause scars.
5. 5Avoid greasy hair and skin products on acne prone areas, since they can plug hair follicles.

Acne products can dry skin, so use a gentle cleanser and moisturizer around them. Stronger is not automatically better: a product that irritates your skin can make it harder to keep using the routine. A topical retinoid, another acne treatment a clinician may recommend, is applied across the acne affected area rather than used only on individual spots. It can take several months to see positive results.23

When skin care is not enough

A clinician can match treatment to the type and severity of acne. Options include topical retinoids, benzoyl peroxide, salicylic acid, azelaic acid and clascoterone. Retinoids help prevent clogged pores, while topical antibiotics target bacteria that can worsen inflammation. Antibiotics are often used with benzoyl peroxide, and acne guidelines recommend limiting oral antibiotic use. Prescription treatment may be appropriate when breakouts are persistent or more severe.1235

If a clinician thinks hormones are driving the acne, options can include a combined oral contraceptive or spironolactone. Combined pills contain estrogen and progestin; estrogen can lower circulating testosterone and reduce excess oil production. Not every contraceptive works the same way for acne, so discuss the specific method with a clinician rather than choosing by name alone. These medicines can also be used with other acne treatments when needed.467

Combined oral contraceptives are not suitable for everyone. They are not for use during pregnancy, are not advised while breastfeeding, and may be unsuitable for people who should not take estrogen. They can also raise the risk of blood clots, so a clinician needs to review your health and risk factors before prescribing them. A clinician should guide acne treatment during pregnancy; do not start hormonal contraception for acne while pregnant.67

How long treatment takes

A topical retinoid often takes several months to show positive results. Combined birth control pills do not clear acne overnight; give them time, and talk with your health care provider if acne has not started to improve after about six months. Do not judge a treatment only by a few days of use.37

When to see a clinician

See a GP or dermatologist if self care is not helping, you have many spots, breakouts are deep or painful, or acne is causing scars. Get medical advice if acne is affecting your mental health. Sudden, severe acne in adulthood can also merit assessment for an underlying condition. Bring a list of current medicines and any you recently stopped, since some medicines can contribute to adult acne.14