Those pesky, painful, and unpleasant pimples that seem to pop up at the worst times imaginable—right before a long-awaited vacation or just before your sister’s wedding for all your family to see—are downright difficult to deal with. Weren’t you supposed to shake off acne in your teen years? Sadly, not—especially if you’re battling bouts of hormonal acne, which most commonly appears in adult women ages 20 to 40. And even the post-40 crowd is not in the clear, as New York City-based dermatologist Cherise M. Levi, M.D., tells SELF. There can be a resurgence of acne breakouts around menopause due to hormonal fluctuations in the body.
The key word here is “hormonal,” as this very obnoxious type of acne is intrinsically linked to (you guessed it) your hormones. “The hormones that cause this type of acne are fluctuations of estrogen and progesterone, which both vary widely throughout the menstrual cycle month,” explains S. Manjula Jegasothy, M.D., board-certified dermatologist and founder of Miami Skin Institute. “In addition, the ratio of each of these hormones to each other can also affect women’s testosterone levels, and can also be causative in hormonal acne.” Lastly, cortisol, the stress hormone, can affect all of these hormones, too.
“It is believed that hormonal fluctuations, which can be menstrual or cyclical (or both) in women do cause increased oil production in the pore,” says Jegasothy. This is how skincare experts believe hormonal acne starts, although the actual cause has yet to be determined.
How can you tell a hormonal breakout from just run-of-the-mill acne? Dermatologists use a few key characteristics to pinpoint if a pimple is hormonal. Keep reading to learn how to spot hormonal breakouts, plus six expert-approved solutions for treating them.
It’s probably hormonal acne if…
1. You’re no longer in your teen years.
While we’d love to leave acne behind (along with our braces and boy band posters) once we enter our 20s, the reality is flare-ups are possible at any time. Hormonal acne is the type that’s most likely to attack in your 20-something years. That because those are the years when women are most hormonally active, says Jegasothy. “Your 20s is often peak childbearing age, making women more prone to the intense hormonal fluctuations of pregnancy, childbirth, and lactation (breastfeeding).”
But age alone won’t determine whether or not you’ll break out. Genetics can dictate when hormonal breakouts start and stop. “Throughout my professional career I’ve found that nearly half of women in their 20s experience acne—and menopause can cause a resurgence of breakouts,” says Peredo.
2. It’s happening around your chin and jawline.
One of the telltale signs of a hormonal breakout is its location on the face. If you’re noticing inflamed cysts around your lower face—especially your chin and jawline area—you can bet your bottom dollar that it’s probably hormonal. Derms don’t exactly know why this beard of acne is a thing in women, but it comes down to too much oil production clogging up your pores. “This is because these excess hormones in your body stimulate the oil glands—many of which are around your chin area,” says Marina Peredo, M.D., cosmetic and medical board-certified dermatologist and associate clinical professor of dermatology at Mount Sinai Hospital. “These excess oil glands make your skin a prime spot for these types of breakouts.” Though the chin and jawline are extremely common places for hormonal acne, it might arise up along the side of your face or down your neck as well—or instead.
3. It’s recurring once a month.
“Hormonal acne often manifests in a cyclical pattern, much like women’s menstrual cycles,” Jegasothy explains. “This is true even in postmenopausal women, because these women still experience monthly fluctuations in their estrogen and progesterone levels, albeit lower than pre-menopausal women.” Hormonal breakouts tend to pop up in the same place each month as well. This is usually the result of a particular pore being enlarged in size by a previous pimple. However, Jegasothy tells SELF that it could be that the actual pore opening happens to trap oil naturally. This can vary person to person and pore to pore.
4. You’re seriously stressed.
Cortisol, the stress hormone, can affect all of your other hormones, too, causing them to be all out of whack. “Women who are prone to monthly hormonal fluctuations, which are quite steep, and have periods of acute stress, are setting up a ‘perfect storm’ for themselves to get a hormonal acne flare,” explains Jegasothy.
5. It’s not blackheads and whiteheads, but more painful cysts.
Those surface-level brownish spots that typically yield more gunk than you expected (aka blackheads) and those tiny white dots of bacteria stuck in your pores are not in the same category as hormonal acne. “These painful cysts manifest as deeper bumps that are under the skin’s surface and cannot be extracted with normal manual extraction either by an individual or an esthetician,” says Jegasothy. “These bumps are usually tender to the touch because they’ve accumulated oil over a period of days or weeks that then causes an inflammatory reaction.” These painful cysts tend to pop up in the same place over and over again, becoming subacute or chronic. Because they have an inflammatory component, they require a more clinical approach to treatment that starts from the inside out rather than treating topically.
So, think you’ve got hormonal acne? Here’s how to treat it.
Before you get downtrodden about the finicky nature of hormonal acne, know first that it’s pesky, but perfectly normal. So normal, in fact, that there are many methods to help treat it. Most patients with hormonal acne have usually tried over-the-counter treatments to no avail. Therefore, many of them are seeking the help of a board-certified dermatologist because they do need one or two prescription treatments. In general, it is good to see your board-certified dermatologist if you have deep or cystic pimples, because they could be a marker of something more serious, such as a thyroid condition or abnormal hormone levels, adds Jegasothy. Here are a few common treatments to know about:
The hormonal acne treatment pyramid starts with good over-the-counter cleansers. Choose an option with salicylic or glycolic acid to help exfoliate the skin. Both Aveeno Clear Complexion Foaming Wash ($7) and La Roche-Posay Effaclar Medicated Gel Cleanser ($15) are derm-approved picks for acne-prone skin.
Jegasothy recommends a probiotic cleanser, such as Glowbiotics MD Probiotic Acne Treatment Cleanser ($30). “It’s very effective in controlling the microbiome, or bacterial and yeast environment, in the skin,” she says. “This keeps the skin in normal pH balance for optimal penetration of stronger prescription topical treatments.” Research suggests that some microbial strains in topical probiotics can improve the skin’s protective mechanisms, impede inflammation, and inhibit the P. acnes bacteria that causes breakouts.
In acne patients of any age, most dermatologists will consider topical retinoids as the first step for treatment of mild to moderate acne, especially when it’s hormonal. “Retinoids help your skin slough off dead skin cells at a more normal rate so the dead skin cells don’t bind together and clog your pores,” explains Peredo. “They are the preferred avenue for long-term treatment because of the limited severe side effects and are known for preventing new acne in the long term.” While you can get retinol-containing products like Differin Gel ($27) over the counter, your dermatologist can prescribe you much higher concentrations, which is likely the level of strength you’ll need to fight hormonal acne.
If you’ve ever been on birth control, and then gotten off of it, you probably noticed your skin go into total panic mode—leaving breakouts behind. But before you go cursing your sensitive skin, know that this type of reaction is totally normal, as oral contraceptives can do a great job of clearing acne in women. In fact, some, like Ortho Tri-Cyclen and YAZ, are approved by the U.S. Food and Drug Administration for the treatment of hormonal acne. “These oral contraceptives are composed of ethinyl estradiol plus either the progestin norgestimate, norethindrone acetate, or drospirenone, which work together to alter levels and activity of hormones that can trigger acne,” explains Peredo. If you’re not on the Pill, you might want to ask your doctor if he or she recommends it to help stabilize your hormones.
“These oral therapies help reduce the amount of excess androgens (primarily male hormones) that can cause hormonal acne,” says Peredo. Antiandrogen drugs, such as the Spironolactone pill, work by blocking androgen receptors to decrease the actions and effects of testosterone in the body. “When given at low doses, Spironolactone works very well to improve cystic acne and decrease overall oil production in the skin,” says Levi.
A much stronger defense mechanism against breakouts is Accutane, a form of oral vitamin A that reduces the amount of oil released by oil glands in your skin and helps your skin renew itself more quickly. “It’s used in the treatment of severe acne, and is usually given after other acne medicines or antibiotics have been tried without success,” Peredo explains. “Due to its strength and potential side effects, however, this treatment isn’t typically considered as a first solution, but it can be quite effective when other remedies aren’t working.” Your doctor will likely ask whether or not you’re pregnant or trying to conceive in the near future before writing you a prescription for Accutane, as it’s been shown to cause birth defects. Peredo tells SELF, however, that taking Accutane in general will not affect your child-bearing potential for the future.