What's not to love about Zendaya? Well, like most 23-year-olds, Zendaya is not exempt from the horror that is hormonal acne. You may be under the impression that her skin is flawlessly glowing 365 days of the year, but in true Zendaya fashion, she kept it real when she told her millions of Twitter followers she's so over it.
"My hormonal breakouts popping up every month [are] unwelcome, just when I think I got my skin on lock," she tweeted along with one of the internet's favorite America's Next Top Model GIFs. Celebs, they're just like us.
This is how the hormonal acne story unfolds: Just when we think puberty's passing took unsightly teenage acne with it, we're introduced to a new wave of pimples in our 20s. Right around the time of our periods, acne flares up along our jawline, cheeks, forehead, and between the eyebrows (okay, everywhere), adding insult to injury. "Fluctuating hormones (including pregnancy), stress, family history, and pore-clogging beauty products can be to blame for pimples that always pop up at the most inconvenient times, particularly before big events or job interviews," says Michelle Henry, MD a Harvard-trained, board-certified dermatologist.
Looking on the bright side, though, hormonal acne is, indeed, preventable, and it's possible to get rid of hormonal acne once it starts. But back to the downside: It requires some lifestyle changes. These breakouts are coming from excess buildup of testosterone in the body, so you need to get to the root of the cause to determine the right hormonal acne treatment.
Below, dermatologists share their best tips for hormonal acne and how to get rid of it.
What Is Hormonal Acne?
If you're dealing with hormonal acne, there are two main indicators: Your breakouts happen along the lower third of your face, and they get worse before your period, according to Joshua Zeichner, MD, the director of cosmetic and clinical research in dermatology and assistant professor of dermatology at Mt. Sinai Medical Center in New York City.
Causes and Prevention of Hormonal Acne
- Pregnancy: Fluctuating hormones that take place during pregnancy can result in hormonal acne.
- Menstruation: The excess buildup of testosterone that takes place during your period can lead to hormonal breakouts.
- Menopause: The decline in reproductive hormones can cause hormonal acne due to your body adjusting to fluctuating levels.
- PCOS: Polycystic ovary syndrome, which can occur in women at a reproductive age, causes a fluctuation in hormones that can increase the length of your menstrual cycle, cause obesity, and result in breakouts.
We recommend this at-home hormone level test to monitor any hormone imbalances.
"When it comes to hormonal acne," says SkinOwl founder Annie Tevelin, "the body inhabits a strong sensitivity to androgens, more specifically testosterone. Roughly 50 percent of women aged 20 to 29 will experience adult-onset hormonal acne." To make sure hormones are the root cause, Tevelin suggests you "run an in-depth hormone panel blood test and test it throughout the month to make sure your hormone levels are stable." Because the hormonal cascade fluctuates depending on where you are in your menstrual cycle, she suggests testing several times throughout the month.
Try benzoyl peroxide.
"By far and away, the best topical medicine for acne is benzoyl peroxide," Katie Rodan, MD, dermatologist and cofounder of Proactiv, says. "Nothing, not even antibiotics, beat it when it comes to killing bacteria and clearing pores for the long-term without antibiotic resistance." Benzoyl peroxide is so powerful because it's antimicrobial, meaning it zaps acne-causing bacteria and keeps pimples from coming back, according to Henry.
Zeichner recommends using benzoyl peroxide in concentrations ranging from 2.5 to 10 percent for maximum benefits. Rodan says that it works best when left on the skin in the form of a lightweight lotion, but that some cleansers and masks containing benzoyl peroxide can remain on the skin in an effective concentration after they've been washed off—if they've been formulated to do so (she says this is a trademark of Proactiv and its sister line, X Out). Try X Out Acne Wash-In Treatment ($20)—a multi-hyphenate cleanser, mask, and spot treatment with 8.5 percent benzoyl peroxide—or Clearogen Benzoyl Peroxide Acne Lotion ($32), which contains 2.5 percent benzoyl peroxide along with soothing ingredients like green tea extract and cowslip extract.
Change your diet.
"Studies have shown that dairy can worsen acne," says Jeremy Fenton, MD, of Schweiger Dermatology Group. "Dairy has been shown to stimulate testosterone production in people who consume it, and spikes in testosterone can worsen acne. Dairy also naturally contains its own hormones, such as estrogen, which can exert their own impact on a person's hormonal balance." The worst culprit, believe it or not, is fat-free dairy. Fenton explains that removing fat from the dairy concentrates its food items and causes them to be absorbed by the body faster, meaning hormonal spikes occur more quickly.
Foods high in sugar are also to blame. "I would recommend avoiding refined flour, sweets, and processed carbohydrates," says Fenton. "The exact mechanism isn't known for certain, but we believe that these refined carbs lead to an insulin spike, which causes a hormonal cascade that can increase inflammation and oil production."
Use salicylic acid.
Zeichner says that the best concentration of salicylic acid is up to two percent when you're choosing an over-the-counter product. You want to look for a product that unclogs pores and reduces inflammation, Jeanine Downie, MD, New Jersey-based board-certified dermatologist, says. She especially likes Benzac for adult hormonal acne. In addition to pore-clearing, skin-exfoliating salicylic acid, the line also contains East Indian sandalwood oil, which Downie says has antibacterial and anti-inflammatory properties without being harsh or drying.
Try Philosophy Clear Days Ahead Acne Treatment and Moisturizer ($39), a lightweight, hydrating lotion that controls breakouts with one percent salicylic acid, or Clinique Acne Solutions Clinical Clearing Gel ($27), which can be used all over your face or as a spot treatment.
Find time to relax.
Ever heard of a stress zit? Being on edge is not only bad for your mindset but also aggravates your skin. "Stress triggers the release of a variety of hormones that can trigger an inflammatory response in the body," says Fenton. "Inflammation is a major part of acne—that's what leads to those large and deep red cystic pimples. Anything you can do to reduce inflammation will be helpful for your acne."
Staying hydrated and reducing stress are things that are often overlooked in regards to skincare, Henry adds. "Exercise helps nourish skin cells and keep them healthy," she explains, because it increases blood flow.
When it comes to lifestyle adjustments, Kimberly Snyder, holistic nutritionist, says to make sleep a priority: "Sleep fights stress and helps your body and hormonal systems function." Additionally, she recommends upping your water intake to flush out toxins, dry brushing, which is great for detoxication, exercising (she loves yoga) to help manage and relieve stress, and staying on top of gut health (which has been linked to acne) by incorporating a quality probiotic.
Try an oral contraceptive.
If you're comfortable and if a gynecologist says you're a good candidate, oral contraceptives can help balance out your hormones, including those that are responsible for acne.
Zeichner says that the best prescription options for hormonal acne are birth control pills and Spironolactone (more on that in a second). Birth control pills help regulate your hormones and decrease testosterone levels, which can mean fewer hormone-induced breakouts. Zeichner notes that there are four birth control pills currently approved for acne: Yaz, Beyaz, Ortho Tri-Cyclen, and EstroStep.
Another option is the aforementioned Spironolactone. Though not specifically designed to treat acne, it is often used for exactly that purpose because it prevents testosterone from stimulating the oil glands. "Less oil means less shine, fewer clogged pores, and less food to feed acne-causing bacteria," Zeichner explains.
"Certain oral contraceptives have even been approved by the FDA to be used in the treatment of acne," explains Fenton. "If you are already on birth control or thinking of going on it, make sure to ask your gynecologist for an oral contraceptive that will also help your acne."
Stick to a gentle routine.
"Even when your skin is doing well, you should continue your preventative skincare routine," says Melissa Kanchanapoomi Levin, MD, board-certified NYC dermatologist and clinical instructor at Mount Sinai Hospital. "That means in addition to regular daily sunscreen or sun protection, continue using your topical retinoid, such as Differin Gel. And if your skin is not irritated and can tolerate an exfoliator, try alpha-hydroxy acids or salicylic acid two to three times weekly.
"In addition to clearing existing acne, Differin Gel ($12) will also help to prevent future breakouts from forming by increasing skin cell turnover to minimize clogging of pores." Additionally, Fenton recommends using an OTC acne wash and non-comedogenic moisturizer regularly.
See a dermatologist.
Especially if topical treatments aren't working, seeing a skincare professional will help you approach treatment in the best way possible. "A good rule of thumb is to go to your dermatologist if your treatment regimen hasn’t improved your skin after two weeks, because it is likely that you will need a prescription treatment," Henry says.
"If you're very congested, acne extractions can be helpful midcycle as well as a steroid injection in hormonal cysts to decrease the inflammation quickly," says Levin. There are other in-office treatments available that may be helpful, including LED light therapy and chemical peels. Make sure to consult your dermatologist to determine the best treatment option for you and your acne.