What Is Hormonal Acne and How Can I Treat It? – Skin Rocks

Hormonal Acne 101

What is hormonal acne and what can you do about it? We asked Consultant Dermatologist, Dr Emma Wedgeworth, to explain all.

First things first, let’s clear up acne vs breakouts…

The word ‘acne’ may conjure up images of severe cysts and boils, however, dermatologists use the word ‘acne’ or ‘acneiform’ (acne-like) to describe the process by which breakouts occur.  So, in reality, all spots and breakouts are a form of mild acne, although the term is usually reserved for more severe cases. 

What is hormonal acne?

Dermatologists don’t routinely use the term hormonal acne because we know that hormones play a key part in the development of all spots.  True acne is very rare in children and usually starts at puberty when the hormonal axis switches on and is rare after the menopause.  

"Adult acne is more common in women and a huge proportion of women will experience breakouts at specific points in their menstrual cycles."

Acne is a disorder of oil-producing (sebaceous) glands. Sebum (oil) production from the glands becomes abnormal - either increasing production or altering it, making sebum stickier – and this leads to blocked pores.  Subsequently, other factors like shifts in the microbiome (particularly increased levels of a bacteria known as cutibacterium acnes) and inflammation lead to red, angry bumps. 

Sebaceous glands are under hormonal control, so hormonal changes profoundly affect the skin.  Having spots doesn’t necessarily mean that there is a hormonal abnormality.  We know that approximately 70-80% of women with adult acne will have a normal hormonal profile.  However, progesterone-only contraceptive pills, period delay tablets and morning-after pills can all increase the risk of acne.  Polycystic ovary syndrome (PCOS) is also associated with acne, due to raised testosterone levels.

Treatment

  1. Exclude underlying causes. If acne is caused by medication, speak to your doctor about alternatives.  If there are other signs of a hormonal abnormality (irregular periods or hirsutism), blood tests and potentially an ultrasound scan can be performed to exclude PCOS.

  1. Live right. Hormonal status and acne reflect interactions between genetics and our environment. Environmental factors previously linked with hormonal and skin changes are diet, sleep and stress.  Restrictive diets are not advised but try and minimise your consumption of high glycaemic index foods (i.e., sweet food and refined carbohydrates) which raise insulin levels and have been linked both to PCOS and spots.

  1. Sort your skincare. A healthy skin barrier is important in acne and drying the skin out can make things worse. Choose gentle gel or cream cleansers which don’t raise the skin’s pH and don’t be afraid of moisturiser. So often, people prone to blemishes avoid moisturiser, which actually exacerbates the situation.  Niacinamide-containing moisturisers are useful because as well as boosting skin barrier function, niacinamide has anti-inflammatory and sebum-regulating properties. Cleansers and moisturisers I recommend are:

You should also be mindful when using facial oils. Ingredients such as coconut oil, cocoa butter, wheatgerm oil and soybean oil can be very pore blocking (comedogenic) and exacerbate spots, particularly if you are prone to breakouts. Whilst other oils such as argan oil, shea butter and mineral oil are thought to have a low risk of blocking the pores. 

  1. Blitz blemishes with actives. Even if acne is hormonally driven, targeting the skin can be very helpful.  Actives support skin cells to work more efficiently, regulating oil production and leaving skin less reactive to circulating hormones. Helpful over-the-counter ingredients include salicylic acid, azelaic acid, retinoids and benzoyl peroxide. Start slowly, one ingredient at a time and start twice a week, then build up to daily as required.  Over time, see if you can combine 2 ingredients; one in the morning and one during the evening, if needed. Below are the products I recommend:

Blue and red LED treatments may also be helpful as they are anti-bacterial and reduce inflammation, helping to calm red angry spots.

  1. Seek a specialist. Ultimately acne is a medical condition and more severe cases need medical intervention. Prescription-grade retinoids, benzoyl peroxide and azelaic acid are all helpful but can take at least 3 months to see improvements, so perseverance is essential. Creams may also be needed on an indefinite basis, with more severe cases requiring tablets. Antibiotics can also be helpful in the short term to settle angry, red breakouts whilst creams kick in. Hormonally, the contraceptive pill is no longer routinely advised as a specific treatment for acne but may improve breakouts in people who take it for contraception. Oral spironolactone, an anti-androgen tablet, can be effective in treating adult, hormonally driven acne and Dermatologists may even sometimes use oral isotretinoin (Roaccutane) if breakouts are very severe. 

Ultimately, all acne is, to some degree, hormonal.  However, this doesn’t always mean hormones need to be changed.  Acne and breakouts are entirely treatable and if at-home measures are ineffective, please seek medical advice. 

 

Words by Consultant Dermatologist, Dr Emma Wedgeworth

Qualifications – MA MBBS FRCP UK (Derm) DCH

 Follow Emma @dremwedgeworth