Breakouts as an adult are no fun. But just because your hormonal acne is flaring up doesn’t mean you can’t get it under control. Is it hard? Yes. Is it impossible? No.
Although hormonal acne is challenging to remedy, there are tried-and-true solutions for getting the skin on the path to clear. Just remember that while you can treat acne, there isn’t an actual cure, and once you find something that works for you, it’s imperative to stick with it.
Why Adults are Breaking Out Now More Than Ever
Dr. Estee Williams, MD, a board-certified dermatologist, says the perceived increase in hormonal acne is just perception. “More women are reporting their acne to their doctors, but there is no evidence that it is actually on the rise,” she says.
Another reason women experience acne as adults is that once they go off birth control, which masks acne, breakouts breakthrough, explains Dr. Doris Day, MD, a board-certified dermatologist. Every time you adjust, go on or stop taking birth control with hormones, the body reacts positively or negatively to the change — skin either clears up or erupts like Mount Vesuvius — since hormonal fluctuations can cause more-than-normal amounts of oil production.
Hormones 101
Several factors can lead to a hormonal imbalance. Birth control, pregnancy, stress, menopause, and polycystic ovary syndrome (PCOS) are equal contenders for consistent breakouts. In addition, as female hormones, such as estrogen and progesterone, rise from the reasons above, testosterone levels, which contribute to more-than-normal amounts of oil production, are also affected. “It is not so much about the absolute hormone levels as much as it is the relative ratio of androgens and estrogens that contributes to hormonal imbalances,” adds Dr. Williams. “Anything that upsets the delicate balance between androgens and estrogens can cause acne.”
The only way to determine if hormones are the cause of acne is by testing them. “A lot of times, I’ll test a patient’s hormone levels, and while the levels read as normal, the patient displays patterns of hormonal acne,” says Dr. Day. “When we treat them with solutions for hormonal acne, their skin improves. So, either we (as doctors) are testing the wrong hormones, or the scales are off,” she notes.
Additionally, if breakouts occur at least once a month, if not more, it is probably hormone-related. It’s also normal to see acne around the menstrual cycle because progesterone and testosterone (both contribute to oil production) levels peak during the second half of the cycle. “Hormonal acne ebbs and flows in tandem with a woman’s menstrual cycle or acne in a female patient with other signs of hormonal imbalance like excess facial hair or irregular periods, which is known as hyperandrogenism,” notes Dr. Williams. And like other types of acne, the hormonal variety easily scars and can cause post-inflammatory hyperpigmentation, especially if picked.
What Hormonal Acne Looks Like
For the most part, hormonal acne tends to mirror the inflammatory acne that teenagers experience. “But the pattern of acne in adults is different, and it primarily occurs on the lower face, jawline, and neck,” says Dr. Day. “It’s also cystic and not commedonal, so there are stubborn large, red, painful, inflamed cysts that are hard to treat — but little to no whiteheads or blackheads,” she clarifies. The acne tends to appear as clusters and often takes a long time to resolve.
And then there’s menopausal acne, which Dr. Williams says refers to acne that onsets during perimenopause (the period before the final menses, plus one year afterward). However, hormonally-induced adult acne and rosacea can be confused in menopausal skin. “Rosacea, which is common in menopausal skin, often looks like adult acne, but it’s not, which is why you need to see a dermatologist for an accurate diagnosis,” explains Dr. Day.
The Solutions
A multi-pronged approach consisting of oral medication and topical products is necessary to get the skin on the path to clear. But chances are, you’re going to need to pull out the big guns with medical intervention (accessible only via a dermatologist) to control the pimples.
Good skin hygiene is essential. For starters, wash twice daily with a cleanser containing proven acne-busting ingredients such as salicylic acid in Dr. Doris Day MD Skincare Medicated Cleanser and Neutrogena Oil-Free Acne Wash. Clay-based cleansers, like Sunday Riley Ceramic Slip Cleanser, are also good since they keep the pores clean and the skin balanced, which is vital since some anti-acne ingredients are drying. Lastly, toners and gentle exfoliators will help limit oil, bacteria, and dead skin buildup.
Incorporating topical retinol, like Sunday Riley A+ High-Dose Retinoid, or a retinoid (the stronger, prescription-version of its cousin, retinol) are musts to keep the pores free of acne-causing dead skin cells. “Patients who already incorporate a retinoid in their skincare routine have the upper hand in combating acne because retinoids help reduce breakouts,” says Dr. Williams. However, if retinoids and retinol are too strong for your skin, try ‘sandwiching’ the product with hyaluronic acid — PCA Skin Hyaluronic Acid Boosting Serum is a good one to try.
Gentle facials and light chemical peels help speed up the rate of exfoliation by lifting away pore-clogging dead skin.
Other tricks of the trade in the dermatologist’s toolbox include Intense Pulsed Light (IPL) and lasers like Fotona. “It has an active acne treatment option, which is like a miracle to knock out the redness and inflammation,” says Dr. Day.
Finally, don’t pass over the skin-transformative powers of oral medication like spironolactone, a diuretic medication for blood pressure used off-label to treat hormonal acne. Dr. Day says spironolactone blocks hormonal receptors to control acne. “It takes a few months to kick in, but it’s a good treatment,” she says. Some doctors also prescribe antibiotics, birth control, and isotretinoin (Accutane) to help.
Once you find what works for you, stick with it. “A lot of patients think that once they see improvement, they can stop all treatment, but they can’t because the acne will come back,” advises Dr. Day. “That’s why a maintenance program, which usually consists of a good cleanser, a retinoid, and a low dose of spironolactone, is necessary to keep the skin clear for the long term.”
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