How to Treat Hormonal Acne, According to Dermatologists

Even celebs have to deal with it.


@zendaya / Design by Dion Mills

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 excess build-up of testosterone 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.

01 of 09

Monitor Your Hormone Imbalances With a Test

EverlyWell Women's Health Test
EverlyWell Women's Health Test $199

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. "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.

02 of 09

Clear Pores With Benzoyl Peroxide

Acne Spot Treatment Gel
Humane Acne Spot Treatment Gel $17

"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.

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 (Rodan 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 this pick from Humane, which contains five percent benzoyl peroxide along with soothing ingredients like aloe vera gel and cucumber extract.

03 of 09

Consider Your Diet to Avoid a Hormonal Imbalance

Healthy diet
We Are / Getty Images

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 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."

04 of 09

Exfoliate With Salicylic Acid

First Aid Beauty FAB Pharma White Clay Acne Treatment Pads 2% Salicylic Acid
First Aid Beauty FAB Pharma White Clay Acne Treatment Pads $30

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 to minimize inflammation in existing acne flare-ups and also keep new ones at bay.

05 of 09

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 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. 

06 of 09

Try an Oral Contraceptive to Balance Hormones

Birth control
dvoevnore / Getty Images

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."

07 of 09

Maintain a Preventative Skincare Routine

Differin Acne Treatment Gel $12

"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.

08 of 09

See a Dermatologist For a Prescription Treatment

"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."

Woman with hormonal acne
Rochelle Brock / Getty Images

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.

09 of 09

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."

Article Sources
Byrdie takes every opportunity to use high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial guidelines to learn more about how we keep our content accurate, reliable and trustworthy.
  1. Bagatin E, Freitas THP de, Rivitti-Machado MC, et al. Adult female acne: a guide to clinical practiceAn Bras Dermatol. 2019;94(1):62-75. doi:10.1590/abd1806-4841.20198203

  2. Zeichner JA, Baldwin HE, Cook-Bolden FE, Eichenfield LF, Fallon-Friedlander S, Rodriguez DA. Emerging Issues in Adult Female AcneJ Clin Aesthet Dermatol. 2017;10(1):37-46.

  3. Katta R, Desai SP. Diet and Dermatology: The Role of Dietary Intervention in Skin DiseaseJ Clin Aesthet Dermatol. 2014;7(7):46-51.

  4. Kober M-M, Bowe WP. The effect of probiotics on immune regulation, acne, and photoagingInternational Journal of Women’s Dermatology. 2015;1(2):85-89. doi:10.1016/j.ijwd.2015.02.001

Related Stories