There are certain times in our lives when we are dictated to by our hormones. In our teenage years, hormones are fluctuating to a level that our bodies struggle to keep up with.
This is why we experience heavy mood swings and significant physical changes including hair growth, breast and hips growth, growth spurts and, of course, acne.
With all these bodily changes happening, it can be difficult, painful and overwhelming to also contend with acne. Hormonal breakouts, also known as acne vulgaris or simply just "acne", are extremely common.
The internet is saturated with information on how best to treat hormonal acne, and there's a lot of good and not-so-good information to wade through.
Luckily there is an abundance of clinical, peer-reviewed research on acne — how it happens, why it happens and how best to treat it. Let's dive in.
What do hormones actually do?
All bodies have hormones; they are a crucial part of how we function. Hormones coordinate our body's metabolism, energy levels, reproductive processes and physical growth.
Hormones can have surges and drops which have varying impacts on our mood, stress levels, sleep, energy levels and physicality. By understanding what your hormones are doing, you can better understand what your bodies are going through and what they need.
Hormones are, essentially, chemical messages that send signals through your blood to different organs, muscles and other tissues. Over 50 hormones exist in your body, making up what is known as the endocrine system.
Throughout different stages of life, our bodies will react to a rise in hormones known as androgens, which includes testosterone. Take note: testosterone is usually associated with male traits but exists in women too.
For women, testosterone is produced in the ovaries, adrenal glands and fat cells. Androgen excess and deficiency are among the more common hormonal disorders in women.
Androgens play a key role in the major hormonal shift that is puberty, stimulating hair growth in the pubic and underarm areas. They also pump up the body's oil production, known as sebum, on the face, neck, chest, back and buttocks.
What is hormonal acne?
Hormonal acne is a reaction to the increase of androgens that come with significant hormonal changes in the body. The excess of sebum production creates a reaction with a harmless skin bacteria known as Propionibacterium acnes. This turns sebum into fatty acids that activate inflammation in nearby skin cells.
When dirt, dead skin cells, or cosmetics clog skin pores, the extra sebum gets locked in hair follicles. This is why it's vital your skincare routine uses a gentle but effective cleanser to help clear away oil, dirt and dead skin cells. However, cleanser alone won't help reduce inflammation or the appearance of acne.
We know acne is common in teenagers, but this also explains why acne is common for people using other hormone therapies, those taking prescribed steroids, people going through menopause, pregnant women and women with polycystic ovary syndrome.
All of these result in significant hormonal fluctuations that will lead to sebaceous gland secretion, leading to clogged pores, leading to acne.
It's important to remember that acne doesn't necessarily mean there's something wrong with your hormones. Everyone will experience hormonal imbalances in their lives, and acne is a common side effect.
Acne symptoms can include:
While hormonal acne usually goes away after the body's hormones balance out, it can leave acne scars, pigmentation and dark spots on the skin.
Does progesterone cause acne?
The jury is still out on progesterone's role in hormonal acne. Progesterone regulates testosterone levels very effectively; it lowers sebum production, therefore decreasing the presence of inflammatory acne.
This is why acne breakouts are common at the beginning of the menstrual cycle, as progesterone levels are at their lowest.
However, there is evidence to show that more progesterone or synthetic progestin, particularly from IUDs, can trigger acne. More research needs to be done on the role of progesterone and acne vulgaris before anything conclusive can be said.
Can males get hormonal acne?
Absolutely. Men have hormones too! High levels of testosterone in men will lead to an increase in sebum production, therefore creating higher risks for hormonal acne.
Young men are most likely to experience hormonal acne during puberty as their reproductive hormones kick in, but it can certainly happen throughout adulthood too. If you think you might have a hormone imbalance or are worried about your adult acne, speak to your doctor.
How to treat hormonal acne
It may feel like our bodies are at the whim of our hormones, rendering us powerless against acne. They may give us grief, but hormones are vital to a body's functioning and we need them to survive.
To make things even harder, most over-the-counter products at your local pharmacy don't work on hormonal acne. Luckily, there are specialised, targeted products out there that can help with hormonal acne, but getting the right balance can be a minefield.
Hormonal therapies are usually recommended in severe, resistant-to-treatment cases, but you may find you're already taking certain medications for other purposes (e.g. the pill).
The combined oral contraceptive pill or "the pill" is a highly effective treatment not just for birth control, but for treating acne in women.
The pill contains estrogen and progestin, the synthetic form of progesterone. Together, they lower and ultimately block the effect androgens have on the skin, limiting sebum production.
If there's less sebum, there's less chance of acne. Evidence shows that any kind of contraceptive pill can help with acne.
Topical prescription treatment
We cannot stress this enough: the wrong topical treatments for hormonal acne will either do nothing, or worsen acne. Even natural remedies can be harmful.
The world is oversaturated with skincare products promising clear skin, but only a handful of treatments have cosmetic and clinical evidence behind them that show effective, safe and long-term results for minimising hormonal acne.
The most important thing to remember is that skin, hormones and bodies are different for everyone and there is no single silver bullet for curing hormonal acne. What works for someone else may not work for you.
Working with a doctor is the best way to target hormonal acne. Your GP can run you through the pros and cons of different treatments and you can come up with a plan to battle your acne together safely and effectively.
This is what Software is all about: using clinical-level treatment options that are tailored to suit your skin's needs, based on the recommendations of our dermatologists and GPs.
Some of the go-to products we know will work include:
- Salicylic acid
- Benzoyl peroxide
- Topical retinoids
- Azelaic acid
All these ingredients listed here are scientifically proven to work against acne, but they are more effective on the skin when used in higher quantities in prescription products.
They all need to be customised to your skin, as not all of these will work for you. This is where we come in.
Software brings prescription-grade skincare to your door, with tailored formulas that are more effective than anything off the shelf.
Simply answer a text-based online questionnaire, upload selfies and share your skin goals with your doctor. From here, your doctor will formulate a personalised skincare prescription, which is then compounded by our partner pharmacy and delivered straight to you.
You can track your skin results with Software and check in with your doctor at any time.
Antibiotics are an effective, safe method for reducing inflammation and controlling bacteria. Propionibacterium acnes bacteria is present on our face all the time and is not only harmless, but it's also a part of having normal, healthy skin.
Antibiotics that clear up acne work to control this bacteria, not to get rid of it. Antibiotics will usually only be prescribed for a few months to help reduce inflammation, and it's recommended that people suffering from severe acne continue using a gentle, targeted skincare routine on top of this.
Software's doctors can also prescribe oral antibiotics if they are right for you. Generally, they are used for more severe cases of acne, or cases where the acne has spread across areas of the body that would be impractical or inconvenient to apply a topical treatment.
While acne stickers won't prevent further breakouts, they are an effective way of treating active zits.
Software's AHA/BHA Pimple Patches target newly forming breakouts above and below the skin. The microdarts embedded in every patch penetrate pimples and kill off bacteria deep within the follicle, which helps contain the spread.
The combination of AHAs and BHAs helps unclog pores by removing dead skin cells, while also working to dry out excess oil. Simply pop a patch on the affected area and remove after two hours to reveal a pimple that is less inflamed and visibly reduced.
Plus, these handy patches prevent you from touching or squeezing the zit, allowing the AHAs and BHAs to tackle the breakout, head-on.
Is my acne hormonal?
Hormonal fluctuations can certainly trigger acne, but sometimes the culprit is not hormones. Here are some of the reasons why your acne may not be hormonal.
Check your hormones
The rule of thumb for determining what kind of acne you have is to check what your hormones are doing. If you are not a teenager with raging hormonal imbalances, then it's probably bacterial acne.
In the same way, if you are not pregnant, on the verge of your period, menopausal or experiencing other known hormonal imbalances, it's likely not hormonal acne.
Hormonal acne vs. fungal acne
Malassezia folliculitis, otherwise known as "fungal acne", is not technically acne, however, it presents in a similar way to hormonal acne. They both start in the hair follicles, which is why they are often confused.
Unlike hormonal acne, which develops with an increase in sebum, fungal acne is due to the presence of yeast on the face that can grow in moist environments (e.g. if you are often sweaty).
Fungal acne can result in whiteheads, and itchiness and often becomes red, irritated and inflamed. It can be hard to tell if your acne is hormonal or fungal, so if you're unsure we recommend checking with your doctor.
What else can I do to manage hormonal breakouts?
There are many reasons why acne can creep up on you, and your hormones certainly can play a huge part in this.
You can look after your acne with topical treatments as well as taking care of your hormones by maintaining a healthy weight, eating nutritious and varied foods, drinking plenty of water and getting enough sleep.
Stress hormones and acne
More and more studies are revealing the effect of psychological stress on adult acne.
Cortisol, the stress hormone, is one of the many causes of hormonal acne as it blocks the retention of water in skin tissues that keeps your skin healthy and lubricated, leaving it feeling tight and dry.
On the other hand, for those prone to oily skin, it can send your sebum production into overdrive. If you think stress may be contributing to acne, talk to your GP or mental health professional about how best to cope. Your skin will thank you for it.
Hormonal acne is a minefield and there are many wrong and right ways of managing it. Acne severity, skin type, skin sensitivity, skin condition, lifestyle, genetics and, of course, hormone levels will all play a part in how much you break out.
For optimal results, work closely with a doctor to give yourself the best chance of saying goodbye to hormonal acne.
- Makrantonaki, Evgenia; Ganceviciene, Ruta; Zouboulis, Christos. An Update on the Role of the Sebaceous Gland in the Pathogensis of Acne, Dermato Endocrinology, 2011.
- Perry, Alexandra; Lambert, Peter. Propionibacterium Acnes: Infection Beyond the Skin, National Library of Medicine, 2011.
- Coghlan, Andy. How a Lack of Oxygen Makes Bacteria Cause Acne and How to Stop It, New Scientist, 2016.
- Acne: Signs and Symptoms, American Academy of Dermatology Association, 2022.
- Felman, Adam. Everything You Need to Know About Blackheads, Medical News Today, 2017.
- What Is Progesterone, You and Your Hormones, 2021.
- Gemzell-Danielsson, Kristina; Kubba, Ali; Caetano, Cecilia; Faustmann, Thomas; Lukkari-Lax, Eeva; Heikinheimo, Oskari. Thirty Years of Mirena: A Story of Innovation and Change in Women‚Äôs Healthcare, 2021.
- Elsaie, Mohamed L. Hormonal Treatment of Acne Vulgaris: An Update, Clin Cosmet Investig Dermatol, 2016.
- Nichols, Hannah. Progesterone and Progestin: How Do They Work?, Medical News Today, 2017.
- Which Birth Control Pills Can Help Reduce Acne?, Institute for Quality and Efficiency in Health Care, 2019.
- Benzoyl Peroxide, NHS, 2022.
- How Long Can I Take an Antibiotic to Treat My Acne?, American Academy of Dermatology Association, 2022.
- A Guide to Oral Antibiotics, Software, 2022.
- Rubenstein, Richard M; Malerich, Sarah A. Malassezia (Pityrosporum) Folliculitis, The Journal of Clinical and Aesthtic Dermatology, 2014.
- Dreno, Brigitte; Bagatin, Edileia; Blume-Peytavi, Ulrike; Rocha, Marco; Gollnick, Harald. Female Type of Adult Acne, Journal of the German Society of Dermatology, 2018.