Hormonal acne in adulthood

The term ‘hormonal acne’ will probably make you think of the school years plagued by pesky pimples. Unfortunately, zapping zits isn’t always a thing of the past for many women. In fact, you might be surprised to learn that hormonal acne often rears its head later in life, affecting most adult women between the ages of 20 and 40.
 
Adult acne is a real pain, especially if you’ve never dealt with troublesome skin before. Even though narratives around beauty standards are changing for the better, skin conditions and acne still have the potential to impact body image and self-esteem (1).
 
So, what is hormonal acne in adulthood, and how can you best manage it?
 

What is hormonal acne?

 
Hormonal acne is linked to, well, hormones. Although ‘hormonal acne’ isn’t recognised as a medical term, when women experience acne around the time of menstruation or at significant hormonal shifts, many people would describe it as such.
 

What does hormonal acne look like?

 
Firstly, it’s worth understanding the difference between the odd pesky spot and hormonal acne. One major giveaway is where you tend to break out. If you get pimples on the lower half of your face, particularly around your jawline, chin, and neck, or have acne flare-ups before or during your period, then hormones are most likely to be the culprit. Acne can also occur during other significant hormonal changes, such as around menopause and postpartum.
 
Cystic acne is most common in women with hormonal imbalances. It occurs when bacteria get trapped and form a cyst deep underneath the skin. Cystic acne often resembles boils. They tend to be red, inflamed, filled with pus, and painful to touch.
 

What causes hormonal acne?

 

Women are subjected to far more complex hormonal patterns than men. Not only do they deal with male hormones (yes, women have small amounts of male hormones, like testosterone), but they also have to navigate the ups and downs of the female hormones, oestrogen and progesterone.
 
Women experience fluctuations in hormones throughout their monthly cycle, as well as across their lifetime; pregnancy, postpartum, perimenopause, and post-menopause can affect the skin and lead to breakouts in adulthood.
 

The role of male hormones (androgens) in acne

Male sex (androgen) hormones, like testosterone, are the primary drivers of acne (2). Androgens activate the sebaceous glands, making them produce more sebum, which clogs pores.
 
Levels of male hormones tend to remain the same during a woman’s monthly cycle. But the female hormones fluctuate. In a textbook 28-day cycle (side note: not every woman is a textbook; normal cycles vary between 21 and 38 days), oestrogen increases across days 1 and 14 and progesterone rises from days 14 and 28.
 
Just before menstruation, oestrogen and progesterone drop sharply, while testosterone stays the same. As a result, relatively speaking, the ratio of male hormones tends to be higher, which is why a lot of women – especially those with sensitivities to androgens – tend to break out before menstruation (3). For the most part, more testosterone means more sebum production.
 
Some women also find their skin gets worse during the second half of their cycle onwards. This is because progesterone, which spikes around day 21, has slightly similar effects to testosterone. Therefore, women who are progesterone-sensitive can find their skin breaks out at this time (4).
 
The same goes for menopause. As women approach menopause, oestrogen falls. Again, relatively speaking, this leads to an oestrogen deficiency – and the same issue prevails: female hormones drop, while male hormones remain unchanged. That’s why it’s common to get spots and excessive hair growth at this time.
 

Treatments for hormonal acne

 

What is the best skincare routine for hormonal acne? 

A good basic skincare routine consists of a cleanser, exfoliator, moisturiser, and sunscreen. You may also wish to use targeted treatments for active acne. With natural antiseptic properties, tea tree oil is an excellent choice. In a 2015 review of 35 studies, researchers found topical tea tree oil may improve the appearance of mild to moderate breakouts (5).
 

Exfoliate 

When it comes to exfoliation, there are two main exfoliants: chemical exfoliation – which uses glycolic acid, salicylic acid, and lactic acid to slough off the top layer of dead skin cells and brighten your complexion – and mechanical exfoliation – which uses physical devices, such as scrubs and brushes, to exfoliate the skin.
 
Chemical exfoliation is generally better for decongesting acne-prone skin. Moreover, if you’re prone to breakouts, harsh mechanical exfoliation may be too abrasive on the skin and could even spread bacteria across your face.  For a healthy complexion, consider exfoliating once or twice a week.
 

Double-cleanse

Falling asleep with your makeup on, once in a blue moon, probably won’t affect your skin. But if you consistently fail to cleanse your skin each night, there’s every chance you’ll experience breakouts. Try to get into the habit of cleansing your skin thoroughly before bed and every morning.
 
In its simplest form, double-cleansing means cleansing your skin twice. Most women will benefit from double-cleansing at night: the first, a superficial wash to remove skincare, make-up, sweat, and pollution; the second, to thoroughly cleanse the skin. 
 
You might, for instance, use micellar water to remove your makeup, and then follow with a foaming cleanser to ensure your face is squeaky clean.
 
Double-cleansing will be particularly helpful for women who wear makeup and cosmetic products during the day or live in a polluted city.
 
If you’re prone to acne, try to avoid oil cleansers, as they can block pores.
 

Topical treatments

Topical treatments for cystic acne can help reduce swelling, oil production, or a bacterial infection. It’s worth noting that you may not see results for four to eight weeks. 

 

Benzoyl peroxide

Benzoyl peroxide is a powerful acid known for its anti-inflammatory and antiseptic properties. When used as a cream or gel, it can help kill bacteria on the skin, which may prevent the development of whiteheads, blackheads, and cystic acne.
 
Although you can find many over-the-counter products with benzoyl peroxide, some stronger versions are available with a prescription from your GP.
 

Topical retinoids 

A topical vitamin A, retinol works on a cellular level to reduce inflammation, decrease oil production, and activate your cell turnover rate (6). Retinols used to treat acne can be harsh on the skin, so you need to build up a tolerance. Always introduce it into your routine gradually.
 

Tretinoin

Tretinoin falls in the same camp as retinol. Like retinol, it exfoliates the skin and stimulates collagen. But, unlike retinol, it’s a much stronger synthetic version of vitamin A and only available on prescription. If retinol hasn’t worked for you, you may wish to have a chat with your doctor about tretinoin.
 

Oral contraceptives 

The combined pill, which contains synthetic oestrogen and progesterone, is often recommended to women who experience cystic acne.
 

Don’t squeeze!

As tempting (and satisfying) as it is, don’t squeeze your spots. By extracting the contents of your pimples, you risk scarring the skin and spreading bacteria. If you want to decongest your spots, always consult a professional aesthetician, who can do so safely.
 

How do you treat hormonal acne naturally?

Although genetics and hormones are the most likely causes of acne, lifestyle and environmental factors can also contribute to and exacerbate breakouts. 
 

Diet for hormonal acne     

The understanding of the role nutrition plays in dermatology is relatively new. And the science points to two things to consider when using food to support the skin. Firstly, there are certain nutrients needed for normal, healthy skin function. Secondly, some components of food may aggravate skin conditions, like acne.
 

Which vitamins help with hormonal acne?

Aside from packing your diet with plenty of plant foods, fibre, protein, and omega-3 healthy fats, try to include more sources of zinc, selenium, vitamin A, and vitamin C, all of which contribute to the normal function of the skin.
 
Vitamin D3 is another important nutrient for skin health. It’s not only made in the skin; it’s vital for maintaining the skin barrier.
 
Found in walnuts, bananas, whole grains, nuts and legumes, vitamin B6 contributes to the regulation of hormonal activity, which may be another useful addition for your skin. You can find generous levels of vitamin B6 in our specialist multi, Multi-Max® Woman, designed for menstruating women.
 

Dairy and sugar 

Some research suggests low-fat dairy products and high glycaemic index diets – or those rich in refined sugar – may contribute to or aggravate cystic acne (7). Though it’s not the case for everyone, cutting out dairy and sugar may help manage breakouts.
 

Gut health and acne

Gut health is also believed to play a role in skin function. Alongside eating a variety of fibrous plant foods (around 30 per week), adding more sources of fermented foods to your diet, like kimchi, kefir, and kombucha, taking a high-quality live bacteria supplement may be a helpful way to support your gut.
 

Stick to a 12-week routine 

Skin and hormones work in 12-week cycles. This means you should aim to follow any dietary changes, implement new supplement regimes, and use different skincare products for at least 3 months to see the best results.
 

Get enough sleep 

There’s a great deal of truth behind the notion of ‘beauty sleep’. Every one of our skin cells has a 24-hour circadian rhythm (internal body clock). Your skin cells turnover and repair at night, so getting 7-9 hours of sleep is vital for your overall complexion.
 

Think about how you exercise 

In a perfect world, you wouldn’t exercise with any makeup on. However, in practicality, if you’re conscious of a breakout, it’s only natural to want to conceal it when you work out – and that’s fine! Just ensure that you shower and cleanse your face as soon as you can. If it’s impossible to do this after exercise, the next best thing is wiping your face down with salicylic or glycolic pads.
 

Relax

Studies suggest mental health conditions and psychological stress can impact the way skin behaves and aggravate chronic inflammatory skin conditions, like acne (8). Making the time to prioritise self-care is one of the best things you can do for skin health, not least for your overall wellbeing.
 

Watch the alcohol 

Drinking heavily and consistently will deplete your body of vital nutrients, including vitamin A, vitamin C, zinc, and selenium, all of which contribute to healthy skin. Try to moderate your alcohol consumption where possible.
 

Acceptance

It may sound counterintuitive, but some women take comfort in the knowledge that getting a few spots around their period is completely normal. You could even call it a positive sign that your body and hormones are functioning optimally; the physiological processes that occur in the skin can occasionally cause breakouts – and that’s perfectly normal.
 

Does hormonal acne go away?

Hormonal acne can be extremely challenging. It can affect your self-confidence, body image, and sense of wellbeing. Plus, it can be awfully painful. Don’t give up; there’s plenty you can do at home to support your skin health. Many women even choose to work with a dermatologist – and there’s no shame in that.     
 

Want to learn more?

 

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References

1. Gallitano. SM., Berson DS., How Acne Bumps Cause the Blues: The Influence of Acne Vulgaris on Self-Esteem. Int J Womens Dermatol. 2017 Dec 6;4(1):12-17.

2. Ebede. TL, Arch. EL, Berson. D. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology.2(12):16-22.

3. Elsaie ML., Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 9: 241-8.

4. Elsaie ML., Hormonal treatment of acne vulgaris. 241-8.

5. Cao H. et al., Complementary therapies for acne vulgaris. Cochrane Database Syst Rev. 2015;19;1:CD009436.

6. Leyden. J, Stein-Gold. L, Weiss. J. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatol Ther (Heidelb). 2017;7(3): 293-304.

7. High GI-Diet And Dairy Intake Linked To Acne (2022). Available online: https://www.medicalnewstoday.com/articles/256664#1

8. Chiu. A, Chon. S, Kimball. A. The Response of Skin Disease to Stress. Archives Of Dermatology. 2003;139(7).

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

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