Hormonal Acne in Adults: Causes and Treatment Options

Hormonal acne is a form of acne that develops when hormonal fluctuations increase oil (sebum) production in the skin. This increased sebum production clogs the sweat glands, which allows bacteria to invade and colonise the skin. This causes inflammation, which leads to acne. 

Unlike occasional breakouts of acne, hormonal acne tends to be linked to defined changes in hormones of the body such as menstrual cycle changes, pregnancy or stress. 

Although this condition is common in puberty, it can also frequently occur in adults (especially in women) and sometimes persist into an adult’s 30s and 40’s. 

Treating Hormonal acne in adults includes a mix of topical and oral medications depending on the severity of the acne, the frequency of breakouts and how you individually respond to medications. The range of medications used to treat hormonal acne includes topical antiseptics (Benzoyl peroxide), antibiotics (Doxycycline and Minocycline). and retinoids (topical Tretinoin or Adapalene). 

In this article, we discuss what hormonal acne looks like and how to treat hormonal acne in adults. 

You can find out more about our acne treatments and other dermatology medications from our website at Meds For Less. 

What Is Hormonal Acne in Adults? 

Hormonal acne is acne that is triggered or worsened by fluctuations in hormones, especially hormones called androgens (to which the hormone testosterone belongs). 

This can increase sebum (oil) production; excess oil clogs the skin and leads to blackheads (sweat pores open to the air), whiteheads (clogged sweat pores that are not open to the air), and small inflamed pimples (papules). Hormonal acne is particularly common during puberty, but it can also affect adults. 

While both adult men and women can get it, it is more common in adult women, as the natural hormone fluctuations throughout the menstrual cycle make them more prone to acne. 

What Does Hormonal Acne Look Like?  

Hormonal acne presents differently in different people because everyone has their own skin and an individual constitution. But common signs and symptoms of hormonal acne include:

• Breakouts of blackheads, whiteheads and papules on the jawline, lower cheeks and neck 
• Deep or painful cysts under the skin 
• Acne that flares around the menstrual cycle
• Oily skin accompanying breakouts

Some signs that you may be dealing with hormonal acne as compared to normal acne include:

• Women experiencing acne breakouts around their periods
• Acne being concentrated on the lower face and jawline
• In addition to whiteheads and blackheads, you also develop painful cysts (fluid filled blisters on the skin)
• Stress seems to trigger acne flare-ups
• Acne begins or persists after the age of 25 

A picture is available in Figure 1 of what hormonal acne looks like, and in this article we will discuss how to treat it. 

Figure 1: What hormonal acne looks like and how to treat hormonal acne in adults

You may also be wondering, “How long do hormonal breakouts last ?”. The answer is that hormonal breakouts vary from person to person, and an individual pimple may last only a few days or persist for several weeks before resolving. Conversely, more severe hormonal acne could last weeks to months. Please speak to your healthcare provider if you are concerned about the duration of your acne symptoms. 

What Causes Hormonal Acne in Adults? 

Hormonal acne occurs in adults when fluctuations in hormone levels increase skin oil (sebum) production in the skin. This excess oil combines with dead cells and bacteria, clogs pores and triggers inflammation that leads to breakouts. Hormonal acne is common during puberty, but it can also affect adult women, particularly around the menstrual cycle. Causes of Hormonal acne in adults include:

Hormonal Changes in Women 

Women are especially prone to hormonal acne (Figure 2)  because hormone levels naturally fluctuate during the menstrual cycle. Changes in oestrogen, progesterone and testosterone levels throughout the menstrual cycle can stimulate the sebaceous glands to produce more oil, increasing the risk of clogged pores and acne. 

Hormonal fluctuations during pregnancy can also trigger new breakouts or worsen existing acne. 

During perimenopause and menopause, the levels of oestrogen and progesterone decline in irregular patterns; this can also lead to adult-onset acne, especially around the jawline. 

Starting and stopping hormonal contraception can also cause an alteration in the body’s hormonal levels, which can cause an acne breakout. 

       PCOS and Other Underlying Conditions 

Certain medical conditions such as PCOS, now known as Polyendocrine Metabolic Ovarian Syndrome (PMOS) can increase androgen levels (testosterone levels) and decrease other hormones like oestrogen and progesterone. 

These conditions can stimulate excess oil production in the body and increase the likelihood of deep, cystic acne. PMOS may also be accompanied by other symptoms such as weight changes, irregular periods, and abnormal hair growth patterns in the body. 

     Medications and Testosterone in Men 

In men, hormonal acne is often linked to androgen (testosterone) over-activity . Higher testosterone levels can stimulate the skin’s oil glands, leading to clogged pores and inflammation.  Certain medications can also trigger or worsen acne, these include:

• Testosterone replacement therapy
• Anabolic steroids
• Some corticosteroids
• Certain prescription medications with acne listed as a side effect

Figure 2: Causes of hormonal acne in adults

Treatment Options for Hormonal Acne in Adults 

Treating hormonal breakouts can be managed with a range of topical medications, oral treatments and in severe cases, advanced therapies. The most appropriate treatment would depend on the severity of the acne, the underlying cause and the person’s individual factors such as age, sex and individual disposition to acne. 

Topical Treatments 

Topical acne treatments are the first-line treatment for hormonal acne, especially for mild-to-moderate cases. These medicines help to reduce clogging of pores and inflammation and thereby reduce acne. These examples include:

• Topical retinoids: These increase skin cell turnover and reduce clogged pores
• Benzoyl peroxide reduces inflammation by acting as an antiseptic and killing pore-forming bacteria
• Azelaic acid helps to clear pores, reduce redness and improve post-acne skin marks

Consistent use of these topical treatments is required, as most require several weeks of regular use before improvement occurs. 

 Oral and Hormonal Treatments 

If, despite consistent use of topical treatments, there is still no resolution of acne and you are wondering “How to cure hormonal pimples ?” The answer is that in this case, oral or hormonal medications may be recommended. These examples include:

• Oral antibiotics to reduce inflammation and bacterial overgrowth in moderate acne cases 
• Combination hormonal contraceptives (containing oestrogen and progesterone) that regulate hormone fluctuations associated with acne breakouts
• Anti-androgen medication that lowers oil production and decreases the frequency of hormonal breakouts. 

 Treatments for Severe or Cystic Acne 

Severe Acne can cause painful cysts (fluid-filled lesions on the skin), nodules (firm pimple-like structures on the skin) and permanent scars, especially if left untreated for a long time. 

Severe hormonal pimple treatment options include:

• Isotretinoin- a powerful oral medication often used for treatment-resistant acne or severe cystic acne. 
• Steroid injections to rapidly reduce the inflammation in large cysts

Sometimes treatments like chemical peels, light-based treatments or laser treatments may also be appropriate for severe acne. 

For severe acne, please consult with your doctor or specialist dermatologist before starting treatment, as most treatment options require a consultant doctor’s supervision for this type of acne. 

How to Prevent Hormonal Acne Flare-Ups 

If you’re asking yourself questions like “How to prevent hormonal pimples ?”, then this section is for you. 

While hormonal acne flare-ups cannot always be prevented completely, having good skincare habits and lifestyle choices can help reduce the frequency and intensity of breakouts. Consistency in good hygiene for skin is very important to reduce hormonal acne occurrence. 

It is important to follow a good and consistent skincare routine, which can help keep the pores clear and minimise excess oil without irritating the skin. This includes practices such as:

• Cleansing the face twice daily with a gentle, non-comedogenic cleanser 
• Using an oil-free, non-comedogenic moisturiser or sunscreen
• Avoid harsh scrubbing or over-cleansing, which can cause irritation and inflammation. 
• If recommended by a doctor, use topical or oral medications containg antiseptics, antibiotics and/or retinoids. 

Hormones and acne in adults have a very close relationship, especially stress hormones. It is also important to manage stress levels to prevent hormonal acne flare-ups. Helpful stress management techniques include:

• Regular exercise
• Meditation or mindfulness practices
• Adequate sleep
• Relaxation techniques such as yoga or deep breathing exercises 

Avoiding picking at or squeezing pimples. This can be very tempting; however, picking at lesions can cause increased inflammation, delay in healing and spread of bacteria (causing more acne breakouts). 

For acne that is particularly triggered by hormonal fluctuations, keep track of your hormonal cycles and changes (e.g. for women with menstrual cycles). If required, please speak to your healthcare provider about using hormonal contraceptives to regulate body hormone levels. 

When to See a Doctor About Hormonal Acne

Occasional acne breakouts are common, but severe and persistent hormonal acne may require professional treatment. 

A doctor or dermatologist can help you identify underlying hormonal issues causing acne and recommend therapies that can target the root cause of the acne rather than just the symptoms. 

You should schedule a medical professional about acne if:

• Your acne is severe or painful and has deep cysts, nodules or widespread inflammation that is difficult to treat with topical over-the-counter medications
• If over-the-counter (OTC) treatments are not effective in treating your acne, please consult with your doctor before moving to more potent medications.
• If your acne is causing scars or dark marks, repeated hormonal flare-ups can cause acne scarring and post-inflammatory pigmentation. Early treatment can also help prevent long-term skin damage. 
• You have symptoms of hormone imbalance despite acne, these may include:
  • Irregular or missed periods
  • Excess facial or body hair growth
  • Hair thinning or hair loss
  • Unexplained weight changes
  • Difficulty becoming pregnant 

Your doctor can assess your symptoms, their frequency and their severity before recommending the most appropriate treatment option for you.