Hormonal Acne: What and Why | Causes, Treatments, and Types

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Hormonal acne, or hormonal imbalance acne, is a form of acne created by fluctuations in hormone production. But it turns out that all types of acne are hormonal acne.

At it's root, hormonal acne is an inflammatory condition causing changes in hormones and clogged pores. Along with a good acne skin care routine, following an anti-inflammatory acne diet is necessary to control hormonal acne.

To treat hormonal acne, you'll need to understand what it is, what the causes and symptoms are, what can happen if you don't treat it, which foods to eat, natural treatments like changing your diet, and which acne treatment options are available.

What is Hormonal Acne?

Hormonal acne, or hormonal imbalance acne, is acne that is caused by a change in hormones. But all acne is hormonal at it's core!

Hormonal acne happens when your body releases more of the hormones that stimulate the production of sebum, like androgen, estrogen and progesterone. Sebum keeps your pores clean, skin soft, and is a necessary component to good skin health.

But with hormonal acne sebum turns from thin and watery to thick and sticky.

Inflammation causes increased hormone production which trigger acne. Then we develop mild to moderate, and sometimes severe acne.

What Causes Hormonal Acne?

Hormone fluctuations cause sebaceous glands to respond by changing sebum from thin and water to thick and sticky. Leaving you with clogged pores and an overgrowth of acne-causing bacteria.

But the reason your hormones fluctuate is the most interesting part.

Inflammation

Inflammation is the root cause. Eating foods that cause blood sugar spikes, like foods high in sugar and processed foods, trigger inflammation. This starts a process where androgen hormones begin to overproduce. This causes a change in that lovely thin, watery sebum and makes it thick and sticky. This ends up causing clogged pores, more inflammation, infections, and acne.

Hormone Fluctuations

Research indicates that an enzyme in oil glands called 5-Alpha Reductase plays a role in hormonal acne. This enzyme converts testosterone, which both men and women have naturally, to a more potent form called dihydrogen testosterone.

Testosterone And Androgens

According to Dr. Andrea Suarez, "Women (and men) with high levels of 5-Alpha Reductase in their sebaceous glands leads to high levels of dihydrogen testosterone which leads to more oil production. It is theorized is the underlying driver of hormonal acne....it is a systemic problem of the entire body.

Insulin-like Growth Factor (IGF-1)

Insulin-like Growth Factor (IGF-1) is a hormone that is released in response to blood sugar spikes, or glycemic load. It helps our bodies manage food metabolism and drives oil production in the skin. But when our bodies have high levels of IGF-1, it is linked to acne. Levels are also high in those with obesity.

Blood Sugar Spikes

Lifestyle and diet, like eating foods high in sugar, drive IGF-1 and increase acne. Overconsumption of sugary foods and skim milk drive hormonal acne. The less processed foods you eat, the better off you are. Stick with plant-based anti-inflammatory foods that don't come out of a window." says Dr. Suarez.

Medical Conditions

There are medical conditions like polycystic ovary syndrome (PCOS) that cause high androgen levels and hormonal imbalance acne in women. Adrenal and pituitary gland diseases can also contribute to adult acne for both men and women. See your Physician if you think you might have a medical condition.

Hormonal Acne Symptoms

Hormonal acne outbreaks are typically found along the jawline, but pimples can also occur in other areas of the face. They are typically deep, painful, and inflamed.

It is known as 'adult acne' because it extends past the teenage years. Since it is caused by hormonal fluctuations, this type of acne can happen up until or even after menopause. It is the main type of acne in women.

Hormonal acne can be mild to moderate with just a few pimples cropping up around the time of a woman's menstrual cycle, during times of high stress, or after eating high sugar or starchy foods.

It can take a mild form with just a few whiteheads and blackheads or become severe acne with painful, cystic, nodular lesions.

What Happens If I Don't Fix Hormonal Acne?

When left untreated, hormonal acne is particularly prone to leaving acne scars. These can be very difficult to treat.

Acne Scars

Acne scars from this type of acne can look like a small divot or indent or be large and dark. These can require chemical peels, microneedling, and other invasive procedures.

Post Inflammatory Hyperpigmentation

Hormonal imbalance acne is known for leaving behind dark spots. These are leftover pigments from the healing acne. They can go away on their own, but it takes a long time for most people.

Depression and Low Self Esteem

Having acne can take a real toll on our psychological health. When we have breakouts, it's easy to want to stay inside and hide. This can lead to depression, isolation, and low self esteem.

How Can I Prevent Hormonal Acne Without Medication?

The best natural treatments are to change your diet and lifestyle. Any diet that is focused on reducing inflammation, like the Paleo diet, Whole Foods diet, and other plant-based diets work well as an acne diet. Add in foods or supplements with probiotics and vitamins to help your skin get balanced.

"Hormonal acne has an internal component that drives it" says Dr. Andrea Suarez. It's important to get control over inflammation in our whole body.

What Foods Help Hormonal Acne?

According to Dr. Josh Zeichner in an interview with Byrdie, "Stay away from sugar or starchy foods because they increase blood sugar, promote inflammation, and lead to increased breakouts. Cow's milk, particularly skim milk, is also associated."

A good acne diet focuses on keeping the glycemic index steady so your body does not have blood sugar spikes. This reduces hormonal imbalance acne by keeping hormones in balance. Makes sense, right?

Hormonal Acne Treatments

The number 1 best thing you can do for hormonal imbalance acne is to get inflammation under control. The best way to do this is by eating foods that reduce inflammation and not eating foods that cause inflammation. A good acne diet has both.

It is possible to get hormonal acne by using a variety of treatments. It is possible for someone with hormonal acne to treat it without medication. If hormonal acne gets worse, you should be using antibiotic tretinoin or isotretinoin for your skin. Below is a listing of all possible treatments for hormonal acne from lifestyle changes to medication for oral hormonal acne to topically or in combination.

Hormonal Acne Skin Care Routine

But every good acne diet also needs a good acne skincare routine. A Board Certified Dermatologist can help you get fully customized acne treatment options so you don't end up with acne scars.

But the main idea is to be gentle so you don't end up creating irritation which will make acne look worse.

Cleanser

Removing makeup and sunscreen with a mild fragrance-free cleanser is a great start. Using microcellar water after washing with a cleanser works well to remove residue.

Use a cleanser with actives like salicylic acid to exfoliate dead skin cells, dirt, and excess oil. Salicylic acid is the only Beta Hydroxy Acid (BHA) and it does a great job of penetrating pores and hair follicles to break up thick sebum. But it can be irritating for some people.

Glycolic acid is an Alpha Hydroxy Acid (AHA) that works by exfoliating dead skin cells, dirt and excess oil. It's different from salicylic acid because it is a smaller molecule and can penetrate deeper into pores.

Moisturizer

An oil-free moisturizer, even for oily skin, will maintain the skin's moisture barrier. This reduces redness and irritation and prevents increased inflammation.

Sunscreen

Sunscreen is very important for all skin types. Don't be afraid to use it because you have acne. It's especially important if you're using actives like topical retinoids because these increase sun sensitivity.

Avoid Toner

Toners are typically alcohol-based and can dry out skin. Alcohol-free witch hazel is the one exception, according to Dr. Suarez, because it's soothing, unscented, and won't dry out your skin.

Topical Retinoids

Topical retinoids help breakouts by boosting the production of new skin cells, encouraging cell turnover, and can help unclog pores.

Oral Contraceptives

Oral contraceptives, aka birth control pills, with estrogen and progesterone reduce acne by reducing androgen levels. This lowers sebum production and prevents clogged pores.

Spironolactone (Anti Androgen Drugs)

Taking oral anti androgen drugs (like Spironolactone) treat hormonal acne by slowing down your body's production of androgens.

Topical Antibiotics

Clindamycin is a commonly prescribed topical antibiotic you can get from your dermatologist. Dapsone may be a better choice depending on the amount of inflammation your skin has.

Topical Benzoyl Peroxide

Benzoyl peroxide is an over the counter (OTC) topical antibiotic that works by killing bacteria under the skin. It helps the skin shed dead skin cells and reduces excess sebum production.

Oral Antibiotics

Because hormonal imbalance acne is an internal problem, you're dermatologist may put you on oral antibiotics. These really reduce inflammation and kill the bacteria in skin, like P. acnes, that cause acne.

Taking antibiotics long term can cause bacterial resistance and kills off the good bacteria that helps acne go away. They are usually prescribed for a few months, but your dermatologist will decide what's right for you. Take probiotics if you're on antibiotics to balance your microbiome.

Final Thoughts

The best way to get rid of hormonal imbalance acne is by eating an anti-inflammatory acne diet, using a gentle acne skin care routine, and seeing your dermatologist. It's a common skin condition that has a number of causes. But the underlying cause is inflammation causing hormone levels to change, clogged pores and breakouts. If you can get inflammation under control, you can get acne under control, too.