Hormonal acne treatment

What hormonal acne is

Hormonal acne is acne in adulthood linked to hormone changes; doctors often call it adult female acne. It means breakouts that keep coming back after your teens, often around your period. The cause of hormonal acne is androgens such as testosterone, which make the oil glands grow and produce more sebum.

Where

Mostly the lower face: jawline, chin, around the mouth and neck, though cheeks, back and chest can break out too.

When

It worsens before a period in 60 to 70% of women, and around pregnancy, before menopause or after stopping birth control.

Who

Adults between 20 and 50, mostly women: about 50% of women in their 20s and 25% in their 40s. Men get it too.

What it feels like

Red bumps and pus-filled spots, a few blackheads, sometimes deep, tender bumps that can scar.

Itchy, same-size bumps on the forehead are more likely fungal acne, which hormone treatment won't help. Not sure which pattern yours is? A photo analysis can read it.

Spironolactone

Spironolactone is a pill prescribed for high blood pressure and fluid retention that dermatologists also use for acne in women. It means the androgens that drive oil production are blocked. The result of spironolactone in the medical records of 85 women: a third cleared completely, a third had noticeably less acne and 7% saw no improvement.

Who it's for

Women with deep, tender acne on the lower face, jawline or neck when other treatments fail. Not for men.

Side effects to ask about

Painful or irregular periods, breast tenderness, tiredness, headache and dizziness. You'll pee more, and extra potassium is risky.

Pregnancy

Never during pregnancy: it can cause serious birth defects. If you can get pregnant, you'll need birth control while taking it.

How long

Fewer breakouts and less oil within a few weeks. Expect visits every 4 to 6 weeks at the start.

Birth control pills

Combined oral contraceptives are birth control pills that pair an estrogen with a progestin. They mean less androgen activity at the oil glands, because estrogen works against androgens. The approval of some pills by the FDA for acne reflects how well they work, even on cysts.

Pills with an anti-androgen progestin, such as drospirenone, are the ones used for acne; progestin-only implants and hormonal IUDs can make acne worse. Ask your doctor first if you smoke, are 35 or older, or have had high blood pressure, heart disease, a blood clot, a stroke or migraines. The pill raises the risk of blood clots, heart attack and high blood pressure.

Skincare and lifestyle

Skincare and lifestyle care for hormonal acne is what you do alongside treatment. It means supporting the medicine, not replacing it. The role of diet and stress is suspected rather than proven.

Gentle Routine

Wash twice a day with a mild, soap-free cleanser close to skin pH. Use a noncomedogenic moisturizer and sunscreen.

Dietary Support

High-glycemic foods and dairy raise insulin and IGF-1, which can push up androgens. Whey supplements and refined sugars can make acne worse.

Stress Management

Stress and lack of sleep are known triggers. In two studies, 71% and 50% of women said stress made their acne worse.

Men and hormonal acne

Hormonal acne in men is acne driven by the same androgens, for example during testosterone treatment. It means rung 3 is off the table: spironolactone can make men develop breasts. Treatment for men is topical care, clascoterone cream, and isotretinoin for severe acne.