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Hormonal Acne: What It Is, Symptoms, Causes & Treatment Options

HealthcareOnTime Team 2024-02-10 2024-02-11 3 Min Read
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  • Hormonal Acne

    Adult-onset acne, known as hormonal acne, affects adults aged between 20 and 50 and leads to the formation of various types of acne, such as blackheads, whiteheads, pimples, and cysts.

    In women specifically, acne is a common issue that usually happens for around 50% of women in their twenties, and roughly about 25% of them in their forties are experiencing what is known as hormonal acne 1.

    Excess androgens are mainly behind the problem of hormonal acne due to the importance that these sex hormones play in both reproductive development and body growth.

    Acne triggered by hormonal imbalance often displays on the lower face along with the jawline but can be found elsewhere, like on the face, neck, back, shoulders, or chest.

    Is Hormonal Imbalance a Cause of Acne? 

    The hormonal imbalance that causes acne is caused by fluctuations in the levels of estrogen, testosterone, and progesterone. 

    Menstrual cycles, Polycystic ovary syndrome (PCOS), menopause, or increased levels of the male hormone androgen make acne worse by causing seborrhea (abnormal production of sebum), inflammation, and pores clogging, thus increasing the irritation caused by bacteria.

    The fact that your hormones are balanced or not can be easily checked with a hormonal profile test.

    How To Tell If Acne Is Hormonal or Bacterial?

    The easiest way to distinguish between hormonal and bacterial acne is the appearance level of your hormonal zit 2

    Hormonal Imbalance Acne often appears as deep, cystic, and inflamed blemishes, which can be more painful than the typical bacterial pimple. These blemishes may have a purplish or deep red hue and are usually not filled with pus, unlike bacterial acne, which often presents as pus-filled pimples. 

    When Hormonal imbalance causes acne:

    • Location: Commonly takes on a mandible, chin, cheeks, and neck region.
    • Occurrence: Frequent in women or girls instead, particularly during menses, pregnancy, and menopause 3.
    • Characteristics: Develops painful cysts that don't seem to be cured by topical and local remedies like medications and antibiotics.
    • Triggers: Hormonal imbalance in women becomes more significant while they develop, and there is more increase in male-type hormones like androgens.
    • Treatment Options: Light-based therapy, topical creams, birth-control pills, principles of managing stress, and a good diet are the most common methods to effectively treat acne caused by hormonal imbalance.

    When It's a Bacterial Acne: 

    • Location: Most frequently, as the size of the follicles is bigger on the forehead, nose, and chin, the blackheads become visible on the surface of oily skin areas.
    • Appearance: Gives us blood red, inflamed cysts, pustules, and pimples that probably aggravate during stressful times and hormonal fluctuations periods.
    • Response to Treatment: The treatment is most likely to be effective in mild cases/ infections when applied topically or taken orally in the form of retinoids, benzoyl peroxide, salicylic acid, and antibiotics.

    What Causes Acne From Hormonal Imbalance?

    Menstrual cycles, pregnancy, and menopause are times when hormonal imbalance-induced acne, a condition aggravated by hormonal malfunction, occurs.

    It is a result of elevated levels of androgen hormones, including prolactin and testosterone, and the corresponding accelerated sebum production and inflammation 4.

    In contrast to bacterial acne, which occurs when bacteria outgrows, hormonal imbalance acne requires a different approach, and antibiotics are not the right medication to fight against it.

    For some individuals, both hormonal and bacterial acne appear together, resulting from insufficient secretion of sebum.

    What Are The Signs and Symptoms of Hormonal Acne?

    Hormonal acne symptoms cause damage to skin texture, allowing their inflammations to reach the surface of the skin either inflamed, itchy or in a positive, painful manner.

    The lesions can also appear in the mentioned other spots, such as on the face, shoulders, neck, chest, or chin.

    Hormonal imbalance acne can appear as the following types of lesions:

    • Whiteheads.
    • Blackheads.
    • Papules (compact inflammatory tissue which is 1-2 cm in diameter).
    • Pustules (skin bumps that are filled with pus, also known as pustules, from 2-5 mm in diameter).
    • Cysts, that are hollow sacs under the skin filled with fluid.

    How To Control Hormonal Acne? 

    To control hormonal acne, several strategies can be effective: 

    • Ointments: Aczone, an oral contraceptive containing anti-inflammatory and antibacterial properties, is one of the topical agents used in the treatment of hormonal acne 5.
    • Oral Medications: Spironolactone and certain birth control pills 6 that contain a synthetic hormone hinder the production of androgen, and so decrease acne breakouts.
    • Hormonal Therapy: Hormonal therapy is a method to control fluctuating hormone levels and clear hormonal pimples in women.
    • Combination Therapy: Integrating oral medications with topical creams such as retinoids 7 can be highly effective.

    Diagnosis and Tests For Hormonal Imbalance Acne

    The diagnosis of hormonal acne depends not only on symptoms but may also be due to hormonal imbalances that contribute to this state.

    There are multiple ways to do it. The most convenient one is to book female hormone test packages online which involve dermatologists checking testosterone, insulin, DHEA, and other hormones 8.

    Management and Treatment of Hormonal Acne

    When the question is ‘how to treat hormonal acne’ effectively, a variety of strategies can be employed based on individual needs and preferences, some of the best treatments for hormonal acne are:

    • Hormonal Therapy: Hormonal medications, including oral contraceptives and diuretics like spironolactone, can be quite effective, especially when simpler home remedies for hormonal acne fail to show any significant improvement.
    • Topical Acne Treatments: if you want to avoid birth control pills, topical creams and ointments can be a direct way to tackle acne spots and lessen skin inflammation.
    • Oral Medications: If your acne triggered by hormonal imbalances is severe, oral medications such as isotretinoin may offer relief.

    Please remember that isotretinoin should not be taken if pregnancy is considered due to potential risks to the baby 9. So, make sure you consult a doctor before starting any medication.

    How To Treat Hormonal Acne Naturally? 

    Some of the natural hormonal acne remedies you can consider are:

    • Tea Tree Oil: Tea tree oil is highly effective against bacteria and contains both antibacterial and anti-inflammatory properties; hence, it can be effectively used as an acne-fighting ingredient 10.
    • Argan Oil: Argan oil is non-comedogenic and can balance sebum production on oily skin, as well as have a hydration layer on dry skin especially in winters.
    • Jojoba Oil: Jojoba oil, applied specifically on inflamed skin areas, gives a reduction in redness, swelling and pimples, meaning its positive effect on acne is seen.
    • Aloe Vera: A natural antibacterial and non-inflammatory agent that may regulate acne outbreaks and slow down the skin healing process. It works primarily as part of a treatment plan.
    • Dietary Changes: Consuming foods with low GI index, excluding, for example, milk that comes from cow or cow's milk, and consuming foods rich in antioxidants and omega-3 fats may help acne caused by hormonal imbalance 11.
    • Self-Care Practices: According to the AAD guidelines, the core effective practices for skin care include washing facial skin twice a day to remove dirt and dust and applying sunscreen only in the morning in order to protect the skin from the damaging effects of the sun.
    • Consulting a Healthcare Provider: If separate hormonal acne remedies don't produce the required outcomes, consult a doctor and have a hormone test performed.

    Read More: 11 Tips to Manage and Prevent Acne: Expert Skincare Advice

    How To Treat Hormonal Acne With Medications? 

    To treat acne related to hormonal imbalances with medications, you can consider several options, but always remember to consult a doctor before taking any:

    • Oral Contraceptives: The medication Ethinyl-Estradiol may be combined with drospirenone, norgestimate, or norethindrone 14, which can be effective in treating acne since the peak of hormones that may cause acne occurs at the time of ovulation 12.
    • But, remember, some people may be unfit for birth control pills, for example, those with health problems and individuals who smoke 13.

    • Anti-Androgen Drugs: Drugs such as spironolactone, which are usually used for low blood pressure conditions, can inhibit androgens by limiting the amount of androgens 15; therefore stabilizing the hormone level.
    • Topical Retinoids: Topical retinoids, which are the compounds of vitamin A, are likely to reduce inflammatory episodes in acne scars for mild hormonal acne 14

    The sunscreen should not be neglected even when bombarding your face with retinoids in order to avoid burning from the sun.

    Prevention Tips

    To prevent acne due to hormonal imbalance issues, consider the following tips:

    • Skincare Routine: Wash the face twice a day with a mild soap to get rid of accumulated dirt, oil, and bacteria. Wearing a moisturiser will let your skin feel hydrated enough and prevent the blemish from being seen.
    • Light Therapy: A phototherapy, which is based on damaging bacteria and lessening inflammation, with the help of LED, has been found to be one of the most efficient treatment methods for acne 16. Sessions generally occur at a dermatologist's outpatient clinic, and each appointment lasts for around 15 minutes.
    • Natural Remedies: To avail of home remedies, it is advisable to choose non-drug treatments such as cucumber face masks and spot treatments composed of honey and apple cider vinegar.
    • Lifestyle changes: Stick to a well-rounded diet with minimum highly processed foods and sugary ingredients while taking up your daily vegetable intake. Frequent sweating, extreme lack of sleep, and stress 17 can also result in hormonal acne breakouts.

    Hormonal acne diet: Foods to eat and avoid with hormonal acne

    To manage hormonal acne through diet, it is essential to consider both foods to eat and avoid:

    Foods to Eat:

    • Whole Grains and Cereals: Consider taking whole grains and cereals like wheat, germ, brown rice, puffed whole grains, bulgur, quinoa, couscous, and popcorn into your diet.
    • Non-Starchy Vegetables: Instead of ignoring it, including nonstarchy veggies like spinach, kale, and broccoli should help control blood sugar levels and skin health.
    • Fruits: Instead of simply adding nourishing oil or drinking nutrient-rich juices, you can eat more fruits like berries, apples, and bananas that contain vitamins and antioxidants that are crucial for healthy skin.
    • Nuts and Seeds: Eating nuts such as almonds, walnuts, chia seeds, and flaxseed gives a great amount of important nutrients that can be useful to the skin.
    • Omega-3 Fatty Acids: Foods such as fish, peanuts, and olive oil are rich in Omega-3 fatty acids. Research has proven these foods have an impact on reducing inflammation and the overall health of the skin 18.

    Foods to Avoid:

    • High Glycemic Index (GI) Foods: Avoid eating too much of the foods, which can increase insulin output in the body and result in flaring of acne. This refers to the sugar-rich treats, white bread, potatoes, and white rice. 19
    • Dairy Products: Cut off the cow's milk, cheese, yogurt, and whey protein from your diet because they increase acne cases due to the effect on the hormones.
    • Inflammatory Fats: Make sure to avoid all saturated fats that are present in coconut oil, butter, meat, and cheese because they can really worsen acne by stimulating inflammation.
    • Alcohol: Alcohol intake enhances the corporeal outbreak of acne. If you've been an alcohol drinker and are curious about how alcohol impacts your body uniquely, an alcohol impact check-up could give you a lot of clarity. 
    • Processed Foods: Try to eat less processed foods such as sugary cereals, soft drinks, snacks, frozen food, packaged bread, ice cream, candy, or spreads because they are most at risk for acne development.

    Other Tips To Follow

    • Eliminate meats that may have inflammatory concerns, as well as sugar, dairy, refined carbs, and red meat.
    • Adopt a diet with a low glycemic index and abundant antioxidants and vitamin E.
    • Rinse your face in the morning and night, use a small amount of advice when applying the acne regimen, use sunscreen daily, and buy cosmetic products that are non-comedogenic to help reduce hormonal cheek acne.
    • In severe cases, doctors will prescribe antibiotics, spironolactone, oral retinoids, or birth control pills, and if they have the qualifications, they'll be able to prescribe a dermatologist.
    • Consult a doctor if you get bad acne, as it can cause scars and also have an impact on your mental health. 

    Ref Links: 


    Can working out cause hormonal acne?

    Exercise-induced hormonal acne may worsen as sweat and oil glands are activated with exercise. This leads to clogged pores and the growth of pimples, especially on the skin, if gym equipment and tight clothing are used, which puts pressure on the skin. 

    Intensive exercise frequently can also be the cause of hormonal stress like cortisol, which may add stress and develop acne 20. One should not dismiss the importance of maintaining proper hygiene after their workouts to reduce hormonal acne.

    What age is acne the worst?

    Acne is a common skin condition that mostly affects adolescents during hormonal change, and oily skin can result in the formation of skin lesions like whiteheads, blackheads, papules, pustules, nodules, and cysts 21.

    Is menopausal acne a form of hormonal acne?

    Yes, hormonal imbalances are the reason the menopausal acne a part of the acne form is because of. Treatment options include hormone replacement therapy, oral contraceptives, and anti-androgen drugs, and they also include prescription medications.

    What causes back acne in females?

    An overwhelming majority of back acne in females is due to some simple reasons, such as active acne-producing bacteria, excessive dead skin cells, and usually oily skin 22. Common among most acne cases are dead skin cells and oil that clog the pores, as well as an overgrowth of a type of yeast called Malassezia in the skin, which may cause your back to break out in pimples.


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