Most males experience acne during their teenage years, but it exists long after they have finished high school for some men. In this article, I look at what men’s acne is, what causes it, and how to treat it based on my experience as a doctor and skin therapist.
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Causes of Men’s Acne
The main reasons for acne and other breakouts in men are:
- Hormonal acne;
- Razor bumps;
- Workout-induced acne.
Men’s Hormonal Acne
The fluctuations of hormones cause hormonal acne. Let’s discuss the main hormones triggering male hormonal acne.
Testosterone is the dominant sex hormone in men. Testosterone and other androgens regulate masculine muscle and bone mass, sex drive, fertility, and other male features. It is produced in the testes and adrenal glands.
As an androgen, it has many receptors on the sebaceous glands. Androgens bind those receptors and stimulate the growth and secretion of the oil glands (1).
Men secrete more oil than women because they produce more testosterone. Most of the androgen receptors are located on the face near hair follicles. When the oil glands become clogged with dead skin cells and inflammation starts, we can see hormonal acne breakouts on the face (or elsewhere).
Testosterone levels suddenly increase during puberty. Testosterone levels are at their highest during teenage years and early adulthood. Boys become men, and breakouts on the face may appear.
Later in life, the testosterone decreases a little bit, and acne usually goes away. After 30, testosterone levels drop by 0,5 – 2% percent each year (2).
Higher Testosterone Levels
Some men may have higher than usual testosterone levels. Causes of high testosterone include testicular or adrenal tumors (even benign, not cancerous), congenital adrenal hyperplasia, steroid use (corticosteroids, anabolic steroids), testosterone supplements, or gels.
Men with high testosterone may experience more severe acne and skin oiliness. You may suspect you have high testosterone if you experience infertility (yes, high testosterone may cause infertility due to the low sperm count), high blood pressure, increased sex drive, increased appetite, prostate enlargement, insomnia, or sleep apnea, weight gain.
Some men may experience a temporary increase in testosterone. Stress, exercise, sexual intercourse, and young age may increase testosterone levels and worsen acne.
Higher Susceptibility to Androgens
Some men have normal testosterone levels but have a higher density of testosterone receptors in the skin or receptors more susceptible to androgens.
Genetics plays a significant role here. If your father or mother had severe acne, you might have acne too. All genetically related family members having acne most likely will not have high testosterone. It is most possible they will have a high density of androgen receptors or receptors more susceptible to androgens.
Therefore, some men may have normal testosterone levels, but their oil glands are genetically determined to be more susceptible to androgens and produce more sebum.
In addition, sebaceous (oil) glands contain enzymes called 5α-reductase, which convert testosterone precursor DHEA into testosterone and DHT (dihydrotestosterone, a more powerful hormone than testosterone) (3). This means that DHT may be produced locally in the skin and enhance sebum production. Oil glands are more sensitive to DHT, even to a small amount of DHT.
However, scientists think that testosterone, rather than DHT, is more important in regulating sebum production (4). So, blocking the enzyme 5α-reductase will not give good results in acne.
Another hormone related to acne is cortisol. It is known as a stress hormone and is produced in the adrenal glands. Your body does not need to feel actual stress; any trigger or work overload may exacerbate the release of cortisol. Cortisol increases sebum production and can lead to or worsen acne.
Cortisol can also decrease the immune system (we know that stress reduces our immunity), and the skin may become more susceptible to inflammation. Inflammation can cause acne or worsen existing skin conditions, such as rosacea.
Hypothyroidism is caused by a slow thyroid and causes the body to slow down. Body metabolism slows down.
Slow thyroid also decreases secretion of the sweat glands. Although sweat is mostly water and salt, these glands secrete natural moisturizing factors and antimicrobial peptides.
If sweat glands are slowed down, the skin becomes dry and cracked and may clog the pores. Dry skin may lead to increased oil production. Unhealthy skin with a damaged skin barrier and a lack of antimicrobial peptides from sweat may lead to hormonal acne (5).
Sometimes the lack of some vitamins might imbalance your hormones and make you break out. I have answered many questions about the deficiency of vitamins and how it is related to hormones and acne in this article.
What does Men’s Hormonal Acne Look Like?
Hormonal acne in men looks like any other type of acne. It may include whiteheads, blackheads, papules, pustules, sometimes even cysts.
Hormonal acne involves the lower face – jawline, cheeks, chin, neck. It is also common for men to experience body acne because the density of sebaceous (oil) glands on the chest, shoulders, and back is higher in men.
Do You Have Hormonal or Bacterial Acne?
No matter which type of acne you have, bacteria are always involved. Pimples result from the overproduction of sebum in the oil glands, the dead skin cells, which clog the pores, and the inflammation caused by bacteria Cutibacterium acnes (formerly Propionibacterium acnes). Only the underlying conditions of the increased oil secretion differ.
How to Treat Men’s Hormonal Acne?
1. BALANCE YOUR HORMONES
If you have high testosterone or DHT levels, you may try medications or supplements that block androgens. Synthetic antiandrogens for men are prescribed only in the case of prostate cancer or enlargement but not for acne. But you can try some natural antiandrogens that balance the levels of testosterone:
One of the best natural androgen blockers is soybean isoflavone. It restricts the enzymes involved in androgen metabolism and significantly reduces acne lesions. It also has an anti-inflammatory effect that lowers acne flares (6). Scientists have found that men who consumed soy protein isolate for 54 days resulted in decreased testosterone levels (7). Other scientists found that soy foods have no effect on androgen levels in men (8). So, further investigations are needed.
Another natural androgen blocker is licorice (Glycyrrhiza glabra), the “sweet root.” It is also known for its antioxidant, antibacterial, and calming effects. One study found that men consuming licorice root daily had reduced testosterone levels after one week (9). Note that only natural licorice root works, not sweets that may not contain any licorice root.
Some other natural foods, such as flaxseed, nuts, mint (spearmint and peppermint), vegetable oils, have shown the ability to decrease testosterone, but the research was mainly performed on women.
A healthy lifestyle to balance male hormones:
- Regular physical exercise helps to regulate hormone imbalances and reduce insulin levels.
- Try reducing stress and lowering your stress hormones (read about stress-induced acne).
- Healthy diet – more fibers help eliminate the excess of sex hormones from the body. Avoid refined sugar and carbs because they increase insulin levels and imbalance other hormones.
- Eat enough proteins. Proteins provide essential amino acids. Some hormones are composed of peptides.
- Add enough healthy fats to your diet. Fish, avocados, nuts, eggs provide essential fatty acids. Sex hormones are produced from fatty acids. Fatty acids also regulate the concentration of some hormones and their receptors, reducing insulin resistance.
2. TREAT MALE HORMONAL ACNE
Isotretinoin for Treating Men’s Hormonal Acne
Isotretinoin is one of the most popular acne treatments, especially in men. It is a synthetic vitamin A form known as Accutane. Isotretinoin decreases oil glands, sebum production also slows down, and acne goes away.
Although it combats acne very well, isotretinoin has a downside too. Because it shrinks the oil glands, the skin does not get hydration and becomes dry and flaky. Not only the skin but also the lips become chapped, and the eyes get dry and irritated.
Sometimes isotretinoin may cause retinoid dermatitis; the skin may become red and scale. One study found that isotretinoin had side effects on sexual function, causing erectile dysfunction and loss of libido (10).
It may damage the liver and pancreas and even cause depression. Therefore, take isotretinoin ONLY if you have severe nodular or cystic acne.
Isotretinoin is retinoic acid, and acids are known to increase sensitivity to UV rays and cause pigmentation. Always use broad-spectrum sunscreens to avoid this.
Isotretinoin is sold under brand names Claravis, Absorica, and others.
Tretinoin for Treating Men’s Acne
Tretinoin is also a retinoic acid derived from vitamin A and requires a prescription. It has a similar chemical structure as isotretinoin. Only isotretinoin is an oral medication prescribed only for severe acne; tretinoin is a topical medication prescribed for moderate and severe acne, age spots.
Tretinoin accelerates cell turnover. Therefore, there are fewer dead cells on the surface of the skin, they do not clog the pores, and the skin results in fewer acne breakouts.
Tretinoin also has side effects, such as drying, scaling, red skin, sometimes even blisters, and skin color changes.
Do not use tretinoin along with some medications, such as antibiotics, diuretics, and some cosmetic ingredients, such as salicylic acid or resorcinol, because it might be too much for your skin or increase sensitivity to sunlight and cause pigmentation.
Tretinoin is sold under the brand names Retin A, Renova, Refissa, Avita (creams), Retin-A, Avita (gels), Altreno (lotion).
Third Generation Retinoids
They are effective as other retinoids, only causing less irritation, and are used to treat mild and moderate acne. Some of them do not require a prescription.
Some examples of these third-generation retinoids are adapalene sold under the brand name Differin and tazarotene sold as Tazorac. Differin does not require a prescription, is FDA approved, and is safe to use.
Antibiotics for Treating Men’s Hormonal Acne
Antibiotics are a very widespread treatment for acne. They require a prescription and are used to treat moderate and severe acne.
The most widely used antibiotics for treating acne are tetracyclines (doxycycline) or macrolides (erythromycin, azithromycin). They are prescribed as oral medications or topical creams.
Antibiotics cannot reduce sebum production or increase cell turnover to avoid clogged pores, so I would recommend taking them ONLY at the beginning of the treatment and ONLY if you have inflammatory acne (papules, pustules, nodules, cysts).
Antibiotics will reduce inflammation, but acne is a chronic disease and requires constant care. After your inflammation is reduced, you can switch to other acne treatment options.
Switching to other acne treatments is important because antibiotics have many side effects, such as allergy, thrush caused by Candida, increased sensitivity to sunlight, and bacterial resistance (especially, topical antibiotics tend to cause resistance). It is advised to combine topical antibiotic creams with benzoyl peroxide or topical retinoids if you want to avoid resistance.
While taking antibiotics, remember to take probiotics as well to avoid thrush.
Wear sunscreen to prevent pigmentation, because antibiotics increase sensitivity to UV rays.
3. CHEMICAL PEELS
Chemical peels are an in-office procedure performed by a doctor or an esthetician. It is controlled skin destruction when acid is applied to the skin and is followed by regeneration, remodeling, and improvement of the skin and skin abnormalities. Skin damage is controlled at the required depth, and remodeling ends without scaring. It is called “peel” because the skin may peel off after some treatments.
Suitable results may be achieved just after one treatment, but the course of treatment is required for the best results. Maintenance of achieved results is often offered.
What is the best chemical peel for treating hormonal acne in men?
Salicylic acid peel is a golden standard. It exfoliates the skin, opens the clogged pores, reduces inflammation, has antimicrobial properties, and shrinks pores and oil glands.
The salicylic peel may cause discomfort or a burning sensation during the procedure, but these feelings are temporary and will not damage your skin. The acid solution evaporates very quickly, and the pain disappears.
Mandelic acid peel would be beneficial if you have mild acne, whiteheads, or blackheads. This peel is very superficial, does not hurt, cause discomfort, or irritate the skin, and the skin does not peel after treatment but has some anti-inflammatory and antimicrobial effects. Mandelic acid is suitable for sensitive skin, either.
If you suspect you have rosacea, azelaic acid would be best.
4. SKINCARE FOR MEN’S HORMONAL ACNE
Skincare at home is a must even for men. Especially if they have oily, acne-prone skin. Look for the products that contain acids – the same ingredient used in chemical peels. Only the strength of the acids will be much lower and safe to use at home.
Best products to combat acne should include salicylic or mandelic acid. These acids reduce inflammation and remove dead cells from the skin’s surface. Moreover, salicylic and mandelic acids have strong antibacterial properties, contributing to clearing acne.
Salicylic acid is a golden standard in treating acne and has the strongest antibacterial properties. But if you overuse it or use too high concentrations, or your skin is sensitive, it may irritate your skin.
In this case, natural salicylic acid, such as willow bark extract, may help. Natural ingredients work more gently and may be used on sensitive skin but still reduce acne lesions. Look for the Salix alba or Salix nigra or simply willow bark extract in the ingredient list.
Mandelic acid is also suitable for irritated skin. If you have never tried any acids, you may start with mandelic acid. It also works very well on blackheads and whiteheads.
What products contain acids? Almost all types of cosmetic products may contain acids. Cleansers, washes, creams, gels, ointments, masks, serums, and ampoules may contain acids. Do not worry; homecare products do not cause any pain or discomfort. You may notice only a slight scaling, if any at all. Usually, homecare products do not have any strong side effects.
Benzoyl peroxide is another very potent ingredient that is an OTC product (lower concentrations). It has very, very strong antimicrobial properties and reduces inflammation instantly. But it is not suitable for the whole face. Use it only for the spot treatment.
Niacinamide (vitamin B3) is another good choice. It reduces oil production, helps to clear acne, and hydrates your skin (12).
You can also try to remove blackheads. Read more in this guide:
5. HYDRATE YOUR SKIN
Hydrating your skin is one of the four fundamental skincare steps, no matter your skin type. Oily, acne-prone skin also needs hydration because it may also become dehydrated. Oil glands may produce more sebum to hydrate the skin when it gets dehydrated. More sebum results in enlarged oil glands, clogged pores, and acne breakouts.
It is essential to moisturize your skin, especially if you use acne treatments containing retinoids (isotretinoin and others) or acids (salicylic, glycolic, etc.). Moisturizers will help you prevent side effects from harsh treatments and restore your skin faster.
Best moisturizers for acne-prone skin should be oil-free and non-comedogenic that do not clog your pores. Usually, skincare products claim this on the label. Some ingredients to look for are hyaluronic acid, glycerin, Aloe Vera, sodium PCA, sorbitol, niacinamide (Vitamin B3), and vitamin C.
6. AVOID UV RAYS
Inflamed skin is susceptible to sunlight, and you may get dark spots in a place of a pimple. People with skin of color are more at risk of developing post-acne hyperpigmentation.
Another reason to avoid UV rays is that many active anti-acne ingredients and prescription medications, such as isotretinoin or acids make the skin very sensitive to UV rays, and it burns faster.
Best sunscreens for oily or acne-prone skin should be non-comedogenic and ideally provide hydration or give a mattifying effect. Some sunscreens will also include anti-acne ingredients, so you won’t need many products every day.
It is a skin disease in which hair follicles become inflamed and look like small red zits or white-headed pimples. A bacterial infection usually causes it; sometimes, viruses or fungi may cause it (13).
The infection may be spread in the whole body or can be located only in one part of the body.
Usually, folliculitis is a mild infection and clears in a few days with basic hygiene, but sometimes it may become severe, be painful, have a burning sensation, bumps may be swollen, pus or crust may be seen.
Why does the Infection Get Trapped in Hair Follicles?
Sometimes it happens because of a decreased immune system (cancer, diabetes, HIV), tight clothing, damaged hair follicles (shaving, waxing), hot tub (some bacteria can survive in hot and chlorinated water).
Sometimes folliculitis is caused by fungus, not bacteria, often mistaken for acne and even called fungal acne.
How to Get Rid of Folliculitis?
Mild infections may resolve on their own with basic antimicrobial hygiene. Sometimes antibiotic creams, lotions, or gels may be prescribed. For severe folliculitis, the doctor may prescribe oral antibiotics.
The Herpes simplex virus usually causes viral folliculitis, and treatment is the same way as with herpes outbreaks on the lips (Acyclovir).
If folliculitis tends to recur, laser hair removal may be indicated. It removes hair follicles, and the infection clears up.
Razor bumps, also called pseudofolliculitis barbae or barber’s itch, are caused by ingrown hair. They are not caused by a bacterial, fungal, or viral infection, but sometimes secondary infection may be present in the lesions (14).
Razor bumps occur when the hair is shaved, and the dead skin cells prevent new hair from growing straight, or pores are angled. The hair stays inside the pore.
African – American, Hispanic men and those with curly hair tend to develop razor bumps more frequently (15).
Razor bumps may affect any part of the body that is shaved:
- Face and neck,
Sometimes waxing or chemical removal of the hair may cause pseudofolliculitis.
Razor bumps look like rounded papules or pustules (a bump that contains fluid or pus), usually are itchy.
How to Treat Razor Bumps?
Because dead skin cells prevent the hair from growing outside the pore, exfoliating the dead skin is a golden standard. Use glycolic acid lotion. It will remove the dead cells, and hairs will grow out.
Do not use a scrub to exfoliate your skin. Razor bumps are itchy and sometimes might be painful. Scrubs may irritate your skin even more.
Another good piece of advice is to let your hair grow. Avoid shaving for 3 – 4 weeks, and the hair will grow out.
To reduce itching and inflammation, use moisturizing and soothing aloe vera gel. Aloe vera also has antimicrobial properties and will prevent secondary infection.
Tea tree oil is also effective. It has antibacterial and anti-inflammatory properties and opens up the pores.
How to Avoid Razor Bumps?
- Shave less frequently; shave every other day rather than daily.
- Wash your skin with an antibacterial cleanser before shaving.
- Use lubricating shaving gel.
- Use only one stroke over each area.
- Shave in the direction of hair growth.
- Leave the hair ends longer – use an electric razor or guarded blade.
- Do not stretch the skin.
- Apply moisturizing lotion after you shave.
Exercising does not induce acne for all working out persons. In fact, exercising can reduce stress, lower stress hormones like cortisol, epinephrine (adrenaline), and improve acne. But sometimes, it may worsen acne breakouts for those with acne-prone skin.
Exercising induces acne in three ways:
- By trapping sweat and bacteria (or yeast) in the pores,
- By increasing androgen levels,
- By using anabolic steroids for bodybuilding.
During exercise, body heat and oil production increase. Pores dilate, and bacteria, yeast, and toxins may enter the oil glands, causing inflammation and acne breakouts. Also, excessive sweat, if it stays on the skin for too long, may cause inflammation. Sweat changes the skin’s pH, creating an environment for the bacteria to build up and cause pimples.
When the body cools off, pores close, and bacteria, sweat, toxins get trapped in the pores. There you have workout-induced acne, especially if you have acne-prone skin.
Other factors that worsen acne are tight closing, causing friction, headbands, hats because they keep the bacteria in place.
What does Sweat-Trapped Acne Look Like?
Trapped sweat and bacteria cause inflammatory red or pink acne lesions. It is uncommon to experience blackheads or whiteheads as workout-induced acne breakouts.
How to Avoid Sweat-Trapped Acne?
- Always wear clean (washed every time) and loose-fitting clothing to minimize friction and let the air circulate.
- Avoid hats and headbands because they keep sweat and bacteria in place.
- Avoid pre-workout supplements containing creatine and caffeine because they dehydrate the skin and increase acne.
- Use a clean thin towel to wipe off sweat. Try an antimicrobial towel that has silver strands. Do not rub your skin.
- Avoid touching your face with your hands to prevent the transfer of bacteria, oils, and toxins.
- Clean your gym bag. Since it holds your sweaty gear and is often kept on the ground and may pick up some microbes, your acne may worsen. Clean your bag with disinfecting wipes at least once a week.
- If you can, avoid shared equipment, like helmets and shoulder pads.
- Clean every shared equipment like treadmills, weights, etc. Shared equipment could be full of bacteria, oil, and dirt. If you use the equipment, touch the handles or bars, then touch your face, you can transfer bacteria and oil to your face.
- Clean your headphones because they collect sweat and bacteria.
- Shower right after your workout.
- Use a body wash and face cleanser that contains 2% salicylic acid (or beta-hydroxy acids).
- If you cannot take a shower right away, use salicylic acid pads to wipe your face, neck, and shoulders.
- If you exercise outside, always wear sunscreen. The sun dries out the skin. Then oil secretion increases. Increased oil production and dry, dead skin cells clog pores and worsen acne. You should also apply sunscreen if you use strong antiacne products containing hydroxy acids, like salicylic or glycolic acids, benzoyl peroxide. These products increase skin’s sensitivity to UV rays and may cause dark spots. Sunscreen should be used to avoid dark spots resulting from acne lesions too.
- Do not forget to moisturize your skin daily. Dehydrated skin increases oil secretion to hydrate your skin and contribute to acne breakouts. Use lightweight oil-free, non-comedogenic moisturizer.
Exercising Can Increase Androgens
Another cause of workout-induced acne is increased androgens. Scientists found that exercise increases the levels of testosterone and DHT (dihydrotestosterone, a more potent androgen than testosterone) (16, 17). Increased testosterone and DHT cause acne the same way as hormonal acne in men. Read above how to deal with it.
The Use of Anabolic Steroids Can Cause Acne
The third possible cause of acne because of exercising is using anabolic steroids in large doses for bodybuilding. Researchers found that 50% of anabolic steroids users have developed acne (18).
Anabolic steroids are synthetic derivates of natural androgens (male sex hormones). We talked about androgens above (read HORMONAL ACNE above). Steroids enlarge sebaceous glands and increase acne bacteria production, leading to acne breakouts.
Steroid acne usually looks like pustules, sometimes papules, located on the chest. Sometimes it can be found on the face, neck, shoulders, and elsewhere. Steroid acne may become severe, resulting in cysts, nodules that grow together under the skin (acne conglobata, acne fulminans).
To avoid steroid acne, men should stop using anabolic steroids.
If you have already developed steroid acne, treat it the same way as hormonal acne (read above).
Male acne differs. Four different conditions affect men: hormonal acne, folliculitis, razor bumps, and workout-induced acne.
Male hormonal acne is strongly influenced by androgens, mainly testosterone and DHT, and sometimes by thyroid hormones.
Folliculitis is an infection of the hair follicles, and the condition should be cleared.
Razor bumps are caused by ingrown hair, and measures to grow your hair or leave them longer while shaving should be taken.
Exercising may induce acne because of sweat, dirt, bacteria, or yeast entrapment. Sometimes workouts may increase androgens and cause hormonal acne.
Try to balance your hormones and take care of your skin. Salicylic acid has the strongest antimicrobial and anti-inflammatory properties.
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