Anyone with adult acne knows it can be frustrating. If breakouts have followed you into your 20s and beyond, you’re probably wondering what to do about hormonal acne. It turns out acne can be caused no matter how great your skin care routine is.
“Hormonal acne is a term used to refer to breakouts in adult women,” says Joshua Zeichner, MD, associate professor of dermatology at Mount Sinai Hospital in New York City. “This is a bit of a misnomer because the reality is that all acne is determined by your hormones. Hormones like testosterone stimulate activity of the oil glands, leading to increased sebum production and inflammation.”
According to Dr. Zeichner, breakouts tend to be cyclical and occur around the time of the menstrual cycle due to higher and lower hormone levels. Hormonal acne is also much more common than you think: Anywhere between 12% and 22% of women ages 26 through 44 experience acne in their everyday lives.
Ahead, Dr. Zeichner explains what to do about hormonal acne and some recommended options for clearer skin.
What is hormonal acne?
Adult acne is characterized by red, angry pimples that typically occur along the lower third of the face around the jawline. “As hormone levels rise in the middle of the menstrual cycle, oil glands are activated, which translates into breakouts a week or two later when a woman gets her period,” Dr. Zeichner explains.
How do I know if my acne is hormonal?
There are some key differences between hormonal acne and the acne found in teenagers. According to Dr. Zeichner, teen acne is characterized by pimples all over the face, including blackheads and whiteheads.
Adult acne is much more inflammatory. “It shows up as papules and deeper, painful cysts under the skin,” says Dr. Zeichner. “It’s important to note that the pimples seen in adult hormonal acne typically are not ones that are pickable. Especially in this group of patients, picking the skin can lead to more harm than good, causing breaks in the outer skin layer with potential infections and scars.”
What causes hormonal acne?
There’s no definitive answer to this question, since every body is unique. Aside from hormones, Dr. Zeichner cites stress and diet as potential causes. “Foods that have a high sugar load as well as cow’s milk have been shown to worsen acne breakouts, so try to stick to a low glycemic index and consider milk substitutes like almond milk,” he says. “Whey protein and vitamin B12 have also been associated with acne breakouts.”
Lastly, stress can be a trigger. “Emotional stress can also increase activity of the oil glands, leading to breakouts,” Dr. Zeichner says. “This is well established. Studies have shown that in college-age individuals, there is an increase in breakouts around testing periods. So if you’re acne prone, do whatever you can to minimize stress, be it yoga or even meditation.”
How can I treat hormonal acne?
Teenage acne and hormonal acne may be different, but both can be treated with the same ingredients. “It’s important to find formulas that are ultra gentle on the skin as some of the ingredients are potentially irritating,” says Dr. Zeichner. “What’s challenging in adult women is that they frequently have dry and sensitive skin, despite being oily and acne prone. So you can layer a moisturizer along with your acne treatments.”
Some ingredients to look out for? “For red angry pimples, there’s no better topical treatment than benzoyl peroxide,” says Dr. Zeichner. “It lowers levels of acne-causing bacteria and reduces inflammation. Stick to lower formulations that contain 2.5% to minimize the likelihood of irritation.”
Dr. Zeichner also recommends salicylic acid, a beta hydroxy acid that removes excess oil from the skin to clear pores, and sulfur, which is antimicrobial, anti-inflammatory, and gentle for sensitive skin. If you also want to minimize fine lines and wrinkles, Dr. Zeichner suggests using topical retinoids to address both skin concerns at the same time.
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Lastly, if over-the-counter products are not helping with consistent use, you’ll want to visit a board-certified dermatologist. “Not only are there prescription-strength topical options, but also medications by mouth,” says Dr. Zeichner. “Depending on your particular need, treatment options include oral contraceptive pills, spironolactone, oral antibiotics, or even Accutane.”
