Hormonal Acne

Overview

What is hormonal acne?

Hormonal acne, also known as adult acne, affects adults between the ages of 20 and 50. Acne causes bumps on your face, shoulders, chest and back in the following forms:

  • Pimples.
  • Blackheads.
  • Whiteheads.
  • Cysts.

Hormonal acne is the direct result of excess sebum in oil glands.

Who does hormonal acne affect?

Hormonal acne affects both men and women, but the majority of cases occur in women, pregnant women and women going through menopause.

How common is hormonal acne?

Acne is the most common skin condition in the U.S. It affects nearly 80% of the population during their lifetime. About 50% of women in their 20s and 25% of women in their 40s get hormonal acne.

What is fungal acne vs hormonal acne?

Fungal acne and hormonal acne are often confused with each other because both types of acne start in the hair follicles. Fungal acne occurs when excess yeast develops, whereas hormonal acne is caused by excess sebum. Fungal acne can result in whiteheads, itchiness and often becomes red, irritated and inflamed.

Symptoms and Causes

What causes hormonal acne?

Acne is caused by clogged pores. Hormonal acne develops when hormonal changes increase the amount of oil your skin produces. This oil interacts with bacteria on the pores of your skin where hair grows (hair follicles) and results in acne.

Clogged pores are the result of:

  • Excess sebum (the oily substance created from the sebaceous glands in the middle layer of your skin).
  • Dead skin cells.
  • Bacteria.

Causes of hormonal acne that you can control

  • Stress.
  • Lack of sleep.
  • Using hair and skin care products that aren’t oil-free or free of ingredients that won’t clog pores (non-comedogenic or non-acnegenic).

Causes for hormonal acne that you can’t do anything about

  • Changing hormone levels in women, including around your period, irregular periods, during pregnancy, during menopause or after discontinuing birth control.
  • Men undergoing testosterone treatment.
  • Family history of acne (genetic predisposition).
  • Side effect of a medication (steroids).
  • Pre-existing medical conditions (polycystic ovary syndrome, other ovarian conditions and metabolic conditions).

Is hormonal acne caused by pregnancy?

When you are pregnant, hormonal fluctuations can cause acne. Often, acne gets better as your pregnancy progresses. There are several treatments that you should avoid during pregnancy, including topical retinoids, salicylic acid and isotretinoin. Ask your healthcare provider about the safest acne treatment for you to reduce and eliminate breakouts during pregnancy.

What are the symptoms of hormonal acne?

Acne causes lesions (damaged skin tissue) that can become inflamed and be red, painful or sore. Lesions are most likely to appear on your cheeks, but may also appear in the following places:

  • Face.
  • Neck.
  • Back.
  • Shoulders.
  • Chest.

Hormonal acne can appear as the following types of lesions:

  • Whiteheads.
  • Blackheads.
  • Papules (raised skin tissue, 2-5 mm in diameter).
  • Pustules (skin bumps that contain pus, 2-5 mm in diameter).
  • Cysts (pockets under the skin that contain fluid).

What can make hormonal acne worse?

  • Stress.
  • Pollution.
  • High humidity.
  • Squeezing or picking at blemishes.
  • Poor diet (specifically refined carbohydrates and sugars).

Diagnosis and Tests

How do I know if I have hormonal acne?

Hormonal acne is diagnosed during a physical examination by a healthcare provider who will look at the acne and assess contributing factors. This includes discussing:

  • Skin care products you use regularly.
  • Stress and sleep habits.
  • Current medications you use.
  • Changes in your health (hormonal changes).

Management and Treatment

How do I treat hormonal acne?

Based on the severity of your acne, different treatment options are available to reduce sebum production, pimple formation and painful inflammation:

  • Blackheads and whiteheads: Topical cream (tretinoin).
  • Inflammatory acne: Topical retinoid and/or topical antibiotic and/or benzoyl peroxide.
  • Moderate to severe acne: Antibiotic and/or isotretinoin (retinoid).
  • Cystic acne: Steroid injection (intralesional triamcinolone).

What are other treatments for hormonal acne?

  • Daily skin cleansing.
  • Birth control (oral contraceptives).
  • Change in diet.
  • Laser or light therapy.

When should I treat my hormonal acne?

It is recommended to treat acne when it begins to prevent breakouts from continuing, which could lead to permanent scarring and potential self-esteem issues if left untreated.

Prevention

How can I reduce my risk of hormonal acne?

Though hormonal acne can be unavoidable, there are several things you can do to reduce your risk of getting breakouts:

  • Make lifestyle changes to reduce stress, get better sleep and eat a healthy diet.
  • Use skincare products that won’t clog pores.
  • Discuss treatment options with your healthcare provider for persistent acne.

Outlook / Prognosis

How does hormonal acne affect my skin?

Hormonal acne causes breakouts. These appear as lesions or bumps on your skin that could become red, inflamed, painful and sore if not treated. Moderate to severe acne and untreated acne can lead to scarring where lesions formed.

How long does hormonal acne last?

Acne affects each person differently. It can last as little as a few days to as long as a few weeks. If not treated, acne can persist for months at a time.

How soon after treatment will hormonal acne go away?

Treating acne can be different for each individual, but patience is key. Generally, it could take up to four to six weeks to see improvement in your skin after you begin treatment. Even if you don’t notice that the treatment is clearing your skin, it is recommended that you continue treatment to prevent new acne from forming.

Living With

Do I need to see a dermatologist to treat my hormonal acne?

If the acne is not going away or worsening, it is recommended that you see a dermatologist. A dermatologist will be able to offer more advanced treatment in order to control your acne.

What questions should I ask my healthcare provider?

  • How severe is my acne?
  • What lifestyle changes should I make to prevent hormonal acne from forming?
  • What are the side effects to my acne treatment?
  • Can I take this treatment if I become pregnant?

A note from Cleveland Clinic

It can be frustrating to see breakouts on your skin as an adult, considering they are most frequent among adolescents. Talk with your healthcare provider if your acne is persistent and they will be able to offer advanced treatment options to eliminate pesky pimples.

Last reviewed by a Cleveland Clinic medical professional on 09/10/2021.

References

  • American Academy of Dermatology Association. Adult Acne. (https://www.aad.org/public/diseases/acne/really-acne/adult-acne) Accessed 9/29/2021.
  • DermNet New Zealand Trust. Acne in Pregnancy. (https://dermnetnz.org/topics/acne-in-pregnancy/) Accessed 9/29/2021.
  • Merck Manuals. Acne. (https://www.merckmanuals.com/home/skin-disorders/acne-and-related-disorders/acne?query=hormonal%20acne) Accessed 9/29/2021.
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne. (https://www.niams.nih.gov/health-topics/acne/advanced#tab-causes) Accessed 9/29/2021.

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