Overview

One of the reasons people call hormonal acne is because it is more common in adolescents who go through the hormonal changes of puberty and associate it with the fact that it is more common. While other types of acne can take the form of the known white heads or blackheads on our hands that we sit to prevent them from appearing, hormonal acne is deeper on the skin surface. While near-surface brownish spots cause more disquiet than one would expect from a blackhead (tiny white dots of bacteria sticking out of pores), bald heads do not fall into the same category as hormonal acne, which often happens in the form of painful cysts.

What is hormonal acne?

Hormonal acne refers to breakouts that occur due to hormone fluctuations, particularly a rise in androgens such as testosterone. Although the acne that results from hormonal fluctuations in puberty is typically called hormonal acne, it may affect adults at any age. It’s particularly common during menstruation and menopause.

How common is hormonal acne?

Studies show that 50% of women in the population between 20 and 29 years of age have acne and 25% of all women between 40 and 49 years of age have acne. According to Sapna Palep, MD, a certified dermatologist and founder of the Spring Street Dermatology in New York City, the acne in these women is caused by our hormones. A review in 2018 found that only 3% of adult men have chronic acne. 

Symptoms of hormonal acne

Hormonal acne in adults may start on the lower area of the face, which includes the jawline and lower cheeks.

When this happens, normal skin bacteria (Propionibacterium acne) cause devastating damage by causing increased inflammation on the skin surface, especially in the deeper layers of the skin. Blackheads, bald heads, pimples and cysts begin to form. Whiteheads themselves do not cause pain, inflammation or swelling, but they can form cysts and pustules.

Acne may also appear as:

Papules: Small, raised, red bumps from inflammation or infection of the hair follicles.

Nodules: Similar to papules but larger in diameter, this type is also dense and painful and lies deep in the skin.

Cysts: Large lumps under the skin that contain pus and may be painful and tender.

What causes hormonal acne?

Hormonal acne in women who are not going through menopause is the result of fluctuations in your body's hormone levels. In both men and women, fluctuations in hormone levels (e.g. If you have a disease that affects hormone levels, such as Polycystic Ovarian Syndrome (PCOS) there may be an overproduction of androgens that can lead to hormonal acne.

Women tend to experience more hormonal fluctuations than men due to puberty, menstrual cycles, pregnancy and menopause. More androgen, a type of hormone that stimulates the oil glands and hair follicles on the skin, can lead to acne. Men do not experience a monthly cycle of fluctuating hormones, but female activity can alter testosterone levels in the body and skin, causing more acne.

Other factors that can exacerbate acne in adults include poor diet, medication, stress, tobacco and endocrine disorders. Mayo Clinic says that hormones alone are not a factor in adult acne, but hormonal imbalances in adults with underlying conditions can contribute to acne. In other cases, adult acne may not have measurable hormone problems.

Testosterone and acne: are they connected?

Yes, testosterone and acne are connected. Hormonal acne usually occurs in response to a rise in certain hormones, especially testosterone. During puberty, the production of testosterone increases and can prompt hormonal acne in teenagers. Rising testosterone may stimulate more sebum production from glands in the skin. Then, excessive sebum combines with dirt and dead skin cells, clogging the skin pores. The infection of these clogged pores by acne-causing bacteria may lead to pimples. Your body’s immune system may react to the bacteria and its metabolites and produce inflammation, which looks like redness alongside acne lesions.

How to treat hormonal acne?

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

Anti-androgen drugs

Other drugs work by reducing the androgen hormone. Most people have natural levels of androgen, but excessive androgen may cause acne by increasing the production of sebum. 

Anti-androgen drugs keep the body from producing excessive androgen and stabilize the levels of this hormone. 

They are not appropriate for everyone; be sure to discuss the risks and benefits with a health care provider.

Retinoids 

Some people may need topical retinoids to treat mild hormonal acne. These derivatives of vitamin A are available as over-the-counter gels, lotions, and creams. A dermatologist can also suggest a prescription-strength product to keep your acne at bay. 

Oral contraceptives

Combined oral contraceptives can normalize testosterone production, helping clear away acne. When acne is severe and other treatment methods are ineffective, your health care provider can prescribe combined oral contraceptives, after discussing the benefits and risks.

Oral contraceptives

Combined oral contraceptives can normalize testosterone production, helping clear away acne. When acne is severe and other treatment methods are ineffective, your health care provider can prescribe combined oral contraceptives, after discussing the benefits and risks.

Takeaway

Acne affects more than just teenagers. Adult acne is particularly present among women. Acne can result in inflammation, scarring, and redness. It can be caused by a number of factors including genetics, bacteria, irritation, stress, and medications.

Home remedies and medical treatments are both an option. A dermatologist can also point you in the right direction.