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Acne isn’t just for teenagers—studies show that hormonal acne plagues about 50% of women ages 20 to 29 and about 25% of women ages 40 to 49. And no matter how old you are, breakouts can still ruin your day. So we thought we’d ask two leading dermatologists for their advice on hormonal acne treatment—and how to know whether you have this kind of acne in the first place.
Hormonal acne isn’t the same for everyone. “The most important thing is to first determine whether you have hormonal acne and, if so, whether it’s mild, moderate, or severe,” says Dr. Dennis Gross, founder of his famed eponymous skin care brand. It’s also key to rule out other causes, including wrong product selection, genetics, stress, and medication.
Below, check out two plans for how to treat hormonal acne, courtesy of Dr. Gross and Dr. Adam Friedman, MD, FAAD. It’s time to get clear skin once and for all.
What Is Hormonal Acne?
Hormonal acne forms as a result of fluctuations in hormones (often associated with your menstrual cycle) and usually occurs on the lower half of the face, particularly along the jaw or on the chin. It’s a form of acne that produces more cystic blemishes and is deeper in the skin than an average whitehead or blackhead.
Causes & Prevention of Hormonal Acne
- Hormones: Hormonal changes, such as an increase in testosterone, can cause oil glands in our skin to overproduce sebum.
- Clogged Pores: Excess oil, dirt, bacteria, and dead skin cells then clog the pores, causing whiteheads.
- Bacterial infection: From there, the bacteria gets trapped underneath the whitehead and causes an infection, which results in a (sometimes) painful pimple.
Dr. Gross’s Treatment Plan
“While breakouts may seem totally random, they actually often are ‘scheduled,’” says Gross, who is based in Manhattan. “For example, they may routinely get worse the week before your period.”
You have to make sure you’re being consistent with your treatment for it to really work. “Prevention is really the best treatment because it is important to realize that a blemish can begin to form up to two to three weeks before it appears on the surface of the skin,” Gross says.
Properly cleanse the skin, since all acne starts with a blocked oil gland. Make sure you also remove all makeup before bed. Double cleansing is key here—start with an oil or balm makeup remover to remove all traces of your makeup, dirt, sunscreen, etc., then follow up with a gentle foaming cleanser to make sure your skin is super clean.
Follow with an at-home chemical peel, such as Dr. Dennis Gross Skincare Alpha Beta Extra Strength Daily Peel, to remove dead skin and debris and to decongest pores to remove oil-gland blockage. “This preps pores and skin to better receive ingredients that may follow,” says Gross.
Next, reach for a retinol serum—it’s excellent for pores and tolerated well by many people (though it can be irritating for some). Retinol works by encouraging cell turnover, so all of those dead skin cells, dirt, and bacteria are gently whisked away. Bonus points—it also helps improve those post-inflammatory hyperpigmentation spots around the chin and jawline (two major areas for hormonal acne).
To combat acne the effective-yet-gentle way, start by using over-the-counter anti-acne remedies that contain pore-clearing salicylic acid or bacteria-banishing benzoyl peroxide. “If neither works well enough independently, try using them both together,” suggests Gross. (Heads-up: Sulfur is also a fantastic spot treatment to draw out the oil and kill bacteria.)
Lastly, apply an oil-free moisturizer, such as Dr. Dennis Gross Skincare Hyaluronic Marine Oil-Free Moisture Cushion. Many external oils from products contribute to blockage, so make sure the product you are using specifically says it’s oil-free. “You have no room for an additional source of oil from an outside product,” warns Gross. “Even if a product suggests it’s oil-free by saying things like ‘won’t clog pores’ or ‘dermatologist-tested,’ it can still contain oil.”
Dr. Friedman’s Treatment Plan
Friedman is an associate professor of dermatology and serves as residency program director and director of translational research in the department of dermatology at the George Washington University School of Medicine and Health Sciences. He has published more than 120 papers and three textbooks on topics like acne and eczema and on his research using nanotechnologies that he developed to treat many of these conditions.
According to Friedman, treating hormonal acne is straightforward, as long as you address the underlying issue: the hormonal influence. And when it comes to a regimen, simplicity is key. “The largest percentage of women who suffer from hormonal acne are juggling way too much—jobs, parenthood, etc.—to do a complex regimen,” he says.
Cleanse and Moisturize
In the morning, wash with a mild cleanser and apply an oil-free moisturizer with a broad-spectrum SPF of at least 30. “Apply the moisturizer to damp skin so it locks in the moisture,” says Friedman. Cleanse at night as well.
Friedman suggests taking a dose of between 25 mg and 50 mg of spironolactone (a water pill) with breakfast and dinner. This androgen receptor blocker has actually been used for more than 30 years to treat acne because it reduces sebum production in the skin, explains Friedman.
However, this medication has some known potential side effects, so be sure to talk to your health care provider about it first, and check in with them to monitor your health. Before starting spironolactone, you must make sure you’re not pregnant because the drug affects your hormones and can potentially cause fetal defects (though the risk profile is considered to be mild by health care professionals). It’s also worth noting that this drug can affect your potassium levels, causing your body to retain potassium. So your provider may counsel you to avoid potassium-rich foods like coconut water, fruit smoothies, bananas, and certain supplements.
Apply a topical retinoid at night after cleansing. Retinoids do a lot of wonderful things for acne: They inhibit inflammation, regulate skin turnover, and increase collagen and elastin production. To make it easy on you (and your bank account), you can now get Differin Gel over the counter—it’s the only FDA-approved OTC retinoid for acne treatment. Friedman advises beginning by applying the retinoid every other day for a few weeks to avoid irritation. Gradually, begin applying it every night. “Use a small, pea-size amount for the entire face (do not spot-treat) after washing skin and drying—wait a couple of minutes after cleansing,” instructs Friedman.
Note: Don’t wax your face if you’re using a retinoid; it can cause unpleasant reactions ranging from redness and severe dryness to discoloration and even scarring.
If neither of these plans works for you, consult a dermatologist to get a custom skin care regimen based on your specific needs.
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