Hormonal Acne: Causes, Treatment, Long-term Management 

What is acne?

Acne is one of the most common skin conditions that can affect both looks and confidence. It’s not merely an aesthetic issue, as studies have shown it directly correlates with one’s mental health in the long term. 

According to the NHS, up to 95% of people aged 11 to 30 are affected by acne to some extent. While acne is often seen as something ‘you grow out of’, about 3% of adults have acne over the age of 35. 

Acne, officially acne vulgaris, is caused by the P. acnes bacteria in the skin. It’s a chronic inflammatory condition characterised by blockages of the pores. Acne can occur on the face, chest or back. While not all acne is hormonal, hormones play a major role. 

What is hormonal acne?

Hormonal acne is triggered by fluctuations in hormone levels, particularly androgens, which cause an overproduction of oil (sebum), resulting in pore blockages, inflammation and breakouts. 

It’s most commonly seen in puberty but can occur at any age, such as during menstruation, pregnancy or menopause, or for people who have certain conditions, such as polyendocrine metabolic ovarian syndrome (PMOS, formerly PCOS), which affects hormones and can cause irregular periods.
It’s important to understand that even if your hormonal blood tests are coming back normal, you can still get hormonal acne. This is due to the sebaceous unit’s sensitivity to hormones, resulting in pimples.

What does hormonal acne look like?

Most commonly, hormonal acne presents as pimples, spots, or even deep, painful cysts on the lower face, the chin or jawline. These might be tender and resist healing. They may also show little response to standard over-the-counter solutions.

What causes hormonal acne?

Hormonal acne is directly affected and influenced by the body’s delicate hormone balance, especially androgens. These signal the sebaceous glands to produce extra oil (sebum).
At the same time, the inflammation around the sebaceous gland blocks the pores. This can result in blackheads and whiteheads forming.

Several hormones influence this:

  • Testosterone and DHT (dihydrotestosterone)
  • Estrogen fluctuations
  • Progesterone changes
  • Stress-related cortisol increases

Treatment for hormonal acne

To treat both normal and hormonal acne, a combination of medical interventions, topical treatments and lifestyle changes may be required. At present, there is no cure for acne, but the condition can be managed successfully. To see results, follow the recommended treatment plan for a minimum of 12 weeks.

Always consult a medical professional to reach the ideal treatment plan for you. Acne is a complicated condition, and a treatment is never a one-size-fits-all. 

The medical treatments we use in our clinic include:

  • Spironolactone: Spironolactone is a diuretic; however, it also blocks androgens. Women with acne usually have higher levels of androgens. While spironolactone is not licensed to treat acne, it’s been shown to be effective, and Dr Anastasia Therianou has been a principal investigator in the biggest national study, the SAFA study, which proved its efficacy. Doctors prescribe it for hormonal acne when suitable, in several countries.
  • Oral contraceptives: Combined contraceptive pills that contain cyproterone acetate may be helpful for hormonal imbalances or conditions such as PMOS (formerly PCOS). 
  • Oral antibiotics: Usually erythromycin or a type of tetracycline such as lymecycline or doxycycline, it can be prescribed for about 12 weeks.
  • Isotretinoin: The pure form of Vitamin A. Isotretinoin may only be taken under the direct supervision of a medical professional. The government’s medicine safety agency (MHRA), has strict rules for the prescription of this medicine. Isotretinoin can harm an unborn child and people who are able to get pregnant must enrol in a pregnancy prevention programme (PPP).

 

Topical

  • Clascoterone: Sold as Winlevi. This FDA-approved, topical antiandrogen medication is one of the most important recent advances in the treatment of acne. Apart from blocking androgen hormones directly in the skin, it reduces oil production, inflammation and it can be combined with both retinoids and benzoyl peroxide. It can be used twice daily for hormonal acne in both women and men.  
  • Benzoyl peroxide: A topical antimicrobial that is mildly comedolytic, meaning it breaks down existing comedones (blackheads and whiteheads) and prevents the formation of new ones. This is typically the first recommendation in the treatment of mild to moderate acne.
  • Retinoids: Such as tretinoin or adapalene. Vitamin A has been shown to target acne-causing bacteria. Retinoids are a safe and efficacious treatment of acne vulgaris. 
    • Trifarotene: Sold as Aklief. This newer, fourth-generation retinoid has been approved for face and body acne (back and chest). It helps to unclog pores and prevent new acne lesions, and it’s often less irritating than other retinoids for certain patients. 
  • Topical antibiotics: Such as erythromycin, tetracycline, clindamycin, minocycline and dapsone. These treat acne through antibacterial and anti-inflammatory effects. 
  • Salicylic acid: A betahydroxy acid (BHA) that targets the sebum in the pores. Chemical peels with salicylic acid can be performed in-clinic, depending on the severity of your acne.

TREATMENT

TYPE

BEST FOR

RESULTS

Spironolactone

Oral

Adult women with hormonal acne

3–6 months

Combined pill

Oral

PCOS, hormonal imbalance

3-6 months

Isotretinoin

Oral

Severe or resistant acne 

4-6 months

Clascoterone

Topical

Mild to moderate acne

12 weeks

Benzoyl peroxide

Topical

Mild to moderate acne

12 weeks

Retinoids

Topical

Moderate acne, maintenance

12 weeks

Salicylic acid

Topical

Oily skin, blackheads

4-8 weeks

Frequently Asked Questions

How do I know if my acne is hormonal?
Take note of when your breakout appears, if in sync with the menstrual cycle or other major hormonal shifts (such as pregnancy or menopause), it is likely hormonal. Hormonal acne typically appears in clusters along the jawline, chin, and neck.
Yes, PMOS, causing imbalanced hormones, is often linked to hormonal acne, hair thinning and irregular periods, as well as increase in facial hair.

Depending on the severity of your acne and the treatment plan chosen by Dr. Therianou and her team, results can take a minimum of 12 weeks. 

Although typically seen in women, men can also get hormonal acne, especially during puberty or due to testosterone treatment.

The combined pill can aid hormonal acne, especially for people with conditions such as PMOS, by balancing hormones. Stopping or switching hormonal contraceptives may trigger breakouts. Also, it is very important to know that some contraceptive pills can have bind to androgen receptors, causing side effects like acne.

About 50% of women in their 20s and 25% of women in their 40s experience hormonal acne. It doesn’t automatically go away with age.

These are often confused as they both start in the hair follicles, but have different causes. Fungal acne is due to excess yeast and can present itself as whiteheads, itchiness, redness and inflammation.

While lifestyle changes, like avoiding picking spots, stress reduction, changing bedsheets and pillowcases and a balanced diet can support the condition, they are rarely sufficient in the treatment of moderate to severe acne. 

Further Information

Dr. Therianou and her team have treated hundreds of patients suffering from acne. Get in touch with us today to discuss the most suitable treatment for you.

info@drtherianou.com 

134 Harley St, Marylebone, London, W1G 7JY

+44 (0) 2034684884

+44 (0) 2038695134

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