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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. Looking on the bright side, though, you have options when it comes to helping quell hormonal acne. But let's first dive into how to identify them.
What Is Hormonal Acne?
“The term hormonal acne is typically used to describe adult-onset female acne, as there tends to be a strong hormonal component to this type,” explains Elyse M. Love, board-certified dermatologist. She goes on to say that this acne can can present in your 20s, 30s, and 40s, and impact both those who have experienced cystic breakouts before and those who haven’t.
What Does Hormonal Acne Look Like?
"Hormonal acne is almost always cystic and inflammatory in nature,” says Love. “It presents with painful red papules, pustules, and deep cysts on the lower face, and it can create long-term scarring (especially if you attempt to pop it). At its mildest form, hormonal acne presents with a breakout or two near menstruation, but for many, it can persist all month long.”
She explains that hormonal acne most commonly occurs on the lower face (on the lower cheeks, jawline, chin) and body (across the chest, back, and shoulders), but can also present between the brows.
Causes of Hormonal Acne
There are two main indicators: Your breakouts happen along the lower third of your face, and they get worse before your period when there is an excess build-up of testosterone, according to Joshua Zeichner, MD, the director of cosmetic and clinical research in dermatology and assistant professor of dermatology at Mount Sinai Medical Center in New York City.
Besides Aunt Flow, there are a few other hormonal acne causes. Pregnancy and the fluctuating hormones that come along with it, for one. Also, the decline in reproductive hormones (aka menopause) can cause hormonal acne due to your body adjusting to fluctuating levels. Polycystic ovary syndrome (PCOS) is another culprit. It can occur in women at a reproductive age and causes a fluctuation in hormones that can increase the length of your menstrual cycle, cause obesity, and result in breakouts.
How to Treat Hormonal Acne
"Preventing hormonal acne might seem like a tall order—it is caused by your hormones, after all— but there are a few things you can do,” says Love. It requires some lifestyle changes. These breakouts are coming from an imbalance of hormones in the body, so you need to get to the root of the cause to determine the right hormonal acne treatment. Ahead, dermatologists share their best tips for how to help treat hormonal acne.
Monitor Your Hormone Imbalances With a Test
We recommend this at-home hormone level test to monitor any hormone imbalances.
"When it comes to hormonal acne, the body inhabits a strong sensitivity to androgens, more specifically testosterone," says SkinOwl founder Annie Tevelin. Studies estimate that approximately 50 percent women aged 20 to 29 experience 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.
Clear Pores With Benzoyl Peroxide
"By far and away, the best topical medicine for acne is benzoyl peroxide," says dermatologist Dr. Katie Rodan. "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.
Zeichner recommends using benzoyl peroxide in concentrations ranging from 2.5 to 10 percent for maximum benefits. It works best when left on the skin in the form of a lightweight lotion, but 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. Try this pick from Humane, which contains five percent benzoyl peroxide along with soothing ingredients like aloe vera gel and cucumber extract.
Consider Your Diet to Avoid a Hormonal Imbalance
How to treat hormonal acne has a lot to do with your diet, namely the consumption of dairy. "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 skim milk and 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 another culprit 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."
Exfoliate With Salicylic Acid
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 has antibacterial and anti-inflammatory properties without being harsh or drying.
Try these acne treatment pads from First Aid Beauty—they contain maximum strength two percent salicylic acid meant to minimize inflammation in existing acne flare-ups and also keep new ones at bay.
Limit Stress to Reduce Inflammation
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, a 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; dry brushing; 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 to Balance Hormones
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 the 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."
Maintain a Preventative Skincare 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 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 For a Prescription Treatment
Especially if topical treatments aren't working, seeing a skin care 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.
Consider Zinc Supplements
"Zinc is anti-inflammatory and can provide natural benefits for acne," says Love. "Most studies have been performed with oral zinc supplements, but topical zinc is likely also helpful."
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