Introduction

Acne can be irritating and frustrating for women. Sometimes, the cause of these breakouts stems from hormonal issues. Curious to know more? Read on to find out.

What is hormonal acne

Hormonal acne, also known as adult acne, is a type of acne (breakouts) that occurs due to fluctuations in hormone levels. It commonly starts during adolescence, affecting about 50% of women in their 20s, and can persist into their 30s, 40s, and even 50s. While it is less common, it also affects men, especially during puberty or due to testosterone treatment.

Role of hormones in triggering acne

The oil present on the surface of skin is called sebum, which is controlled by hormones called androgens, such as testosterone. Girls have much lower levels of testosterone, stimulating the growth of underarm and pubic hair. It also increases bone mass and muscle in girls, but testosterone also stimulates the production of sebum in the hair follicles. 

When these hormones rise above usual levels compared to other hormones, such as progesterone and estrogen, your skin produces more sebum.

Although the other hormones, such as progesterone and estrogen, play a role, androgens are considered the main drivers of acne development.

As women get older, their estrogen levels often decline. At the same time, the male hormone will increase.

Hormonal acne occurs due to the overproduction of sebum in the oil glands of the skin, often triggered by hormonal imbalance, stimulating excess sebum production and leading to oily skin.

Pores become clogged due to excess sebum and dead cells, creating the perfect environment for a type of bacteria that lives on skin—P. acnes—to multiply, triggering the immune response in the skin, resulting in inflammation, leaving the red spots.

What are the different types of hormonal acne?

Types of acne include:

• Whiteheads or cysts
• Blackheads
• Nodules
• Papules
• Pustules

Causes and risk factors

Hormonal acne can be caused by

• Increase in androgens (male hormones)
• Testosterone treatment
• Use of medications such as steroids and birth control)
• Family history of adult acne
• Conditions that affect hormonal levels (such as PCOS and hypothyroidism)

Women experience fluctuations in hormones:

• During their periods
• During pregnancy, menopause, and peri-menopause
• During the initiation of or after stopping the use of birth control pills.

Other reasons include:

• Stress
• Family history
• Using certain hair and skin care products
• Due to the side effects of some medications
• Undiagnosed medical condition

Symptoms and patterns (jawline, chin)

Hormonal acne may appear as common forms of acne, such as whiteheads, or more severe types of acne, such as nodules and cysts. Pimples may look like mild, non-inflammatory forms or severe inflammatory forms of acne, including: 

• Blackheads: Small, dark spots
• Cysts & nodules: Painful and large lumps deep under the skin
• Whiteheads: Small blemishes with white-coloured heads
• Papules & pustules: Reddish, tender bumps that may have a white-coloured head.

Hormonal acne breakouts usually appear on the lower part of the face, including cheeks and jawline, or on your chest, shoulders, neck, and back. These breakouts could last for a few weeks in some people or even months for some people and leave scars. Hormonal cystic acne is the persistent and most severe type that requires more advanced treatments. 

Effects

Hormonal acne in women affects a greater number of adult females, impairing their quality of life, with significant negative psychological effects and social impact.

Diagnosis

A dermatologist diagnoses this condition by 

• Examining the skin of the patient
• Reviewing the medical history
• Discussing the symptoms
• Understanding the lifestyle habits
• Blood tests to check the hormone levels

Treatment: topical, oral, and hormonal therapy

Treatment approaches include topical creams, oral medications, and sometimes hormonal therapy. The goal of treatment is to manage the abnormal levels of hormones and prevent future breakouts.

• Topical creams: Prescription-strength gels or creams with salicylic acid, benzoyl peroxide, retinoids, or antibiotics
• Oral medications and hormonal therapy: Oral medications such as antibiotics will be recommended to reduce inflammation, or hormonal treatments like birth control pills are also suggested to reduce the effects of androgens for regulating sebum production, or spironolactone for acne control.
• Cortisone injections: These injections can be given to reduce the inflammation and pain, persistent nodules, and cysts.

Dietary and lifestyle changes

To manage or control the hormonal acne, one should follow the following tips:

• Managing stress
• Limiting dairy products
• Reducing refined carbs and sugars
• Staying hydrated
• Exercising regularly
• Using mild, non-comedogenic, gentle skincare
• Eating foods that are rich in antioxidants

When to see a dermatologist

A woman can consult a doctor if her hormonal acne is severe, painful, or causing psychological distress, or has not improved even after making lifestyle changes and using over-the-counter treatments, or if a person has confusion that acne might be due to some underlying diagnosis.

Conclusion

Hormonal acne is a common yet frustrating condition, especially among women, often triggered by hormonal imbalances. While it can affect people well into adulthood, effective treatments and lifestyle changes can help manage it. If your acne is persistent, painful, or affecting your well-being, it’s best to consult a dermatologist for proper diagnosis and care.