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Wondering what hormonal acne is, which hormones trigger it, and how to treat it? You are in the right place. I am a doctor (M.D.) and beauty therapist who spent years in skin therapy. In this article, I will share my experience.

What is Hormonal Acne?

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Hormonal acne is a type of acne caused by a change in hormone levels. It looks like whiteheads, blackheads, papules, pustules, and sometimes cysts or nodules. Usually, breakouts are located along the jawline, on the chin, neck (the lower face is targeted by hormonal acne) but can spread to the upper face or the back and chest.

Hormonal acne affects both men and women. Let’s talk about female hormonal acne.

For men’s acne, check this article.

Which Hormones Trigger Hormonal Acne?

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The short answer to what hormonal acne causes is the imbalance of sex hormones. Reproductive hormones are produced by the ovaries and in low quantities by the adrenal glands. There are three main types of sex hormones – androgens, estrogens, and progesterone. Women produce all three of them only in different amounts. Read on to understand hormonal fluctuations in women.

FEMALE HORMONE CYCLE AND ACNE BREAKOUTS

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Three main hormones play roles in hormonal acne caused during a woman’s cycle are:

• Testosterone;

• Progesterone;

• Cortisol.

Women’s cycle starts with menstruation or period, and the levels of all hormones are very low. Estrogen, which gives shine to the skin and lessens acne, is at its lowest.

Testosterone

At the beginning of the woman’s cycle, all hormones drop to their lowest concentrations. Although not very high, testosterone becomes the dominant hormone at the beginning of the women’s cycle.

The ovaries and adrenal glands produce testosterone in small amounts. Testosterone is an essential hormone for women, gives good health, and is responsible for bone density and sex drive.

It is an androgen, has many receptors on the sebaceous glands, and stimulates the growth and secretion of those oil glands (1, 2). Most of them 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).

Many teenagers experience teenage acne because testosterone levels suddenly increase during puberty.

That’s why many women face period acne (whiteheads, papules, pustules, and other forms of acne) during their period.

Before ovulation, estrogen spikes to the highest. The woman becomes most attractive, skin is glowing, is the healthiest, with no or minimal pimples.

Also, there is a peak in the level of testosterone before ovulation. It increases the woman’s libido before and during ovulation (the most fertile days). It can also cause hormonal breakouts for some women in the middle of the cycle, especially if they experience hormonal imbalances and have lower levels of estrogen or higher levels of testosterone.

Higher Levels of Testosterone

Women may have higher levels of testosterone (or other androgens, such as DHT, DHEA, androstenedione) if they are diagnosed (or not yet diagnosed) with polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia, ovarian or adrenal tumors, insulin resistance, have high prolactin levels, take corticosteroids or anabolic steroids which lead to drug-induced acne. Read this comprehensive article on the 10 causes of high testosterone in women.

You may suspect you have high testosterone levels if you are obese, have acne and hair growth on the face or men type hair on the body, do not menstruate, experience infertility.

Sometimes women have normal levels of testosterone or DHT (dihydrotestosterone), but they have increased sensitivity of their hair follicles to androgens. And oil glands open up into the hair follicle through the duct. Mutations in genes cause increased sensitivity to androgens.

Cortisol

It was estimated that women have higher cortisol – the stress hormone – levels in the first half of the cycle (in the follicular phase) (3). It peaks during ovulation because of the elevated sex steroid levels (4).

Cortisol increases oil production, which can lead to clogged pores. High cortisol lowers estrogen levels, resulting in relatively higher androgens and more secreted sebum. So, higher levels of cortisol also may contribute to ovulation acne. It is not very common to break out during ovulation, but occasionally it happens.

Progesterone

In the second half of the woman’s cycle, progesterone peaks. It is produced by the ovaries, the corpus luteum, and the adrenal glands. Progesterone becomes the dominant hormone in the second half of the cycle and helps the uterus prepare for the fertilized egg.

Progesterone also stimulates the secretion of sebum in the oil glands. In addition, it can cause the skin to swell, and this swelling may compress the pores. Compressed, excessively secreting oil glands may become inflamed. This is the reason for acne flares just before your period.

And when the period starts, progesterone and estrogen levels drop, testosterone becomes the dominant hormone, and acne breakouts worsen, resulting in period acne.

THYROID HORMONE IMBALANCES MAY CAUSE HORMONAL ACNE

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According to the American Thyroid Association, 20 million Americans have some form of thyroid disease, and up to 60% are undiagnosed. Scientists found a link between hypothyroidism and acne (5).

Hypothyroidism is a condition where the thyroid is underactive and produces too low levels of thyroid hormones. An underactive thyroid may cause fatigue, weight gain, constipation, depression, and the list goes on.

The thyroid produces hormones that help to convert cholesterol into progesterone. If thyroid hormones are insufficient, progesterone levels get too low, and estrogen becomes the dominant hormone. Progesterone can block DHT (dihydrotestosterone, a type of androgen) associated with hormonal acne.

When progesterone levels get low, and a woman has estrogen dominance, DHT triggers acne (because low progesterone can’t block DHT). Usually, this type of acne is seen in the second phase of the menstrual cycle because progesterone is typically the dominant hormone in the second half of the cycle. Acne may worsen at the end of the cycle and lead to period acne (Again!).

There are many causes of estrogen dominance, such as perimenopause, obesity, xenoestrogens found in pesticides, plastics, environmental toxins, and chronic stress.

You may suspect low progesterone if you experience infertility, spotting in the second phase of the menstrual cycle or before your period, have irregular periods or short cycles, and become irritated or depressed. Because of estrogen dominance, you may have hot flashes and gain weight.

Hypothyroidism is caused by a slow thyroid and causes the body to slow down. Body metabolism slows down, which is why you may experience weight gain or constipation.

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. Natural moisturizing factors include urea, lactate, and amino acids, which mix with the oil on the skin’s surface and hydrate the skin.

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. That’s another cause of hormonal acne! Unhealthy skin with damaged skin barrier and a lack of antimicrobial peptides from sweat may lead to acne flares.

OTHER HORMONAL IMBALANCES AND ACNE

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Insulin

Insulin stimulates the growth of the oil glands and affects the production of androgens by the ovaries and adrenal glands. It explains why highly glycemic index foods result in high insulin levels, which lead to higher levels of androgens and acne (6).

Overweight women or those with polycystic ovary syndrome tend to have higher levels of insulin and acne symptoms.

Prolactin

One more hormonal acne cause is prolactin. Prolactin is a hormone secreted by the pituitary gland, a small gland in the brain. It stimulates the growth of the breasts and milk production when breastfeeding. Adrenal glands express prolactin receptors.

In the case of excess prolactin, adrenal glands secrete androgens, and acne pimples form (7). Higher prolactin levels than usual may indicate a prolactinoma, a type of tumor of the pituitary gland. It is benign, but excess prolactin levels may result in acne and infertility, irregular periods, premature menopause, and a slow, underactive thyroid (hypothyroidism).

For other female hormonal changes and hormonal acne causes, read these related articles on acne during pregnancy and menopausal acne.

Intrauterine Device

Sometimes intrauterine devices (IUD) can cause hormonal acne because most of them release hormones progestins, which have androgenic activity. Many questions about IUDs and acne are answered in this article.

Vitamin Deficiency

Sometimes your hormones may mess up if you lack some vitamins. Also, some vitamins may help you regulate your hormonal balance. Read more about vitamin deficiency acne and get to know which vitamins you might be lacking and what supplements would be helpful.

Acne is a multifactorial disease; many factors can affect your hormones and trigger hormonal acne. Also, other environmental factors (such as the sun), bad habits (smoking), wrong cosmetics, and other surprising acne causes may contribute to hormonal acne.

Note! If nothing helps, if acne treatment or antibiotics do not help, you might have fungal acne caused by Candida or Malassezia fungi, not bacteria. Or you might not have acne at all. Instead, you might have a very similar condition called rosacea.

Testing for Hormonal Imbalances

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Suppose you want to know whether you have hormonal imbalances, such as high testosterone, high cortisol, estrogen dominance, thyroid imbalances, and are experiencing hormonal acne. In that case, you should perform a blood test. You may perform these tests in a lab or clinic. However, booking an appointment and visiting the lab takes time and effort.

Would you like to get a lab test at your home and at a convenient time?? Wouldn’t that be great?

I would recommend home tests for those who are very busy and do not have time or cannot visit the lab or clinic. Home tests are delivered to your home; you just need to follow simple instructions and get accurate results. It is a safe, convenient, and less expensive test and requires no waiting time.

Look for the tests that check the levels of androgens (testosterone, DHT, DHEA), progesterone, cortisol, thyroid hormones (TSH, T3, T4), prolactin, and insulin.

How to Know if You Have Hormonal Acne or Bacterial acne?

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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 bacteria Cutibacterium acnes (formerly Propionibacterium acnes) caused inflammation. Only the underlying conditions of the increased oil secretion differ.

How to Treat Hormonal Acne in Women?

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1. BALANCE YOUR HORMONES

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Oral Contraceptives for Treating Hormonal Acne

One of the most common treatments for hormonal acne is oral contraceptives, containing high doses of estrogen and progestin. Estrogen becomes the dominant hormone in the body and decreases the productivity of the oil glands. Birth control pills also increase sex hormone-binding globulin, which binds testosterone, lowers its levels, and reduces hormonal acne (8, 9).

However, I would not recommend taking oral contraceptives for hormonal acne treatment only. The primary purpose of contraceptives is… contraception. These pills disturb the natural reproduction system, suppress the activity of the ovaries, cause infertility and accelerate the beginning of menopause.

Too high levels of estrogen cause headache, raised blood pressure, dark spots, weight gain, and even thrombosis, especially for older (above 35), smoking, and obese women.

It is not a cure for hormonal imbalances. The pills only mask the real problem but do not solve it. After weaning off oral contraceptives, the former problem will show up again (because it was not treated!), the skin may break out even more, and you may experience post-pill acne. The body may take years to recover after birth control pills.

2. Androgen Blockers

You may try medications or supplements that block androgens if you have high testosterone levels.

Spironolactone for treating hormonal acne

Spironolactone is an oral prescription medication that reduces the activity of androgens. Therefore, acne breakouts clear out, especially cysts and nodules, or the rate of acne reduces.  It may take 3 to 6 months to see the result, but it may be worth waiting because spironolactone gives significant results.

It is also used to treat high blood pressure and heart failure combined with other medications.

But spironolactone does not help every woman. About one-third of women may not see any results. Others may see a reduction in acne flares but not a complete clearing of acne. So, these women with a reduced rate of acne may still need other treatments simultaneously or after treatment with spironolactone.

Spironolactone is unsuitable for pregnant women or those who intend to get pregnant because it may affect male babies by blocking androgens, and boys become feminized. My advice for all women taking spironolactone to treat their hormonal acne is to be on contraception.

I also do not recommend taking spironolactone for women with low or normal blood pressure because it may get reduced even more.

Other side effects of spironolactone include irregular periods, spotting or disappearing periods, breast tenderness or swelling, headache, fatigue, dryness of the skin, and others.

Would I recommend taking spironolactone? Well, it is not my first choice. Nor the second one. I would recommend taking spironolactone for women in menopause or postmenopausal women if they have high blood pressure and severe acne, such as cysts and nodules. For younger women, I recommend considering other hormonal acne-treating options.

Cyproterone acetate for treating hormonal acne

Cyproterone acetate blocks androgen receptors and decreases adrenal androgen production. It also increases linoleate concentration in sebum, reducing comedones indirectly. This treatment is usually combined with oral contraceptives but can be used alone (10).

The side effects include liver toxicity, inhibition of ovulation, irregular period, and fluid retention. Women on cyproterone acetate should test their liver function regularly.

Flutamide for treating hormonal acne

Flutamide is used in prostate cancer and alopecia (hair loss) treatment. It inhibits the androgen receptors and increases androgen breakdown. This medication can effectively treat acne, especially in women with polycystic ovary syndrome. Several studies have found improvement in acne after treatment with flutamide (10).

Although flutamide might effectively treat hormonal acne, it damages the liver severely. Regular liver tests are needed if treated with flutamide.

Natural androgen blockers

Below I review some of the best natural antiandrogens for women. Note that natural remedies take time to show the result and be patient. It may take 3-6 months to notice the effect. Natural blockers work best when combined with a skincare regimen.

1. 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 (11). Soybean isoflavones are phytoestrogens (plant estrogens) and can bind to estrogen receptors and regulate the balance of estrogens – whether they reduce the estrogens or increase them (12). But anyway, it decreases the levels of androgens. Try edamame, tofu, soy milk, miso.

2. Another natural androgen blocker is licorice (Glycyrrhiza glabra), the “sweet root.” It is a phytoestrogen, mimics the effects of natural estrogen in the body, and reduces testosterone levels. It is also known for its antioxidant, antibacterial, and calming effect. Licorice works best when taken along with White Peony (13).

3. White Peony (Paeonia lactiflora) works as an antiandrogen in a supporting role with licorice. It promotes the activity of aromatase, an enzyme that converts testosterone into estrogen.

4. Spearmint, usually taken in the form of tea, reduces the level of testosterone in the blood. One study found that drinking spearmint tea for 30 days significantly reduced levels of blood androgens (14).

5. Garden Angelica (Angelica archangelica), also known as Wild Celery, Holy Ghost, and Norwegian angelica, normalizes hormone balance and liver work and helps to eliminate the excess hormones.

6. Zinc is a strong antiandrogen that restricts the metabolism of androgens. It inhibits the conversion of testosterone to DHT, even more potent androgen. It has an anti-inflammatory effect which also contributes to clearing acne. Zinc also helps wound healing, reducing the possibility of getting acne scars (15). Zinc may be labeled zinc acetate, zinc sulfate, or zinc gluconate. It is thought that our bodies absorb zinc sulfate the easiest. It is especially effective when taken along with vitamin B6. You may also look for topical cosmetic products containing zinc, such as creams, masks, or sunscreens.

7. Vitamin B6 is a good androgen blocker and reduces the skin’s oiliness. It also decreases the levels of cortisol. Vitamin B6 helps to absorb and utilize zinc. I would recommend taking it as a vitamin B complex along with zinc. But do not overdose since doses higher than 250 mg/day cause acne breakouts.

It is best to alternate plant extracts with each other to avoid habituation.

Saw Palmetto (Serenoa repens) was studied as an antiandrogen for treating androgen-caused conditions, such as prostate hyperplasia, androgenic alopecia, and PCOS. But the efficacy was not confirmed in several trials. So, I do not recommend taking it for treating hormonal acne (16).

A healthy lifestyle to balance female 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 HORMONAL ACNE

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Isotretinoin for Treating Hormonal Acne

One of the most common acne treatments is isotretinoin. It is a prescription medication sold under the brand names Accutane (Accutane is discontinued in the US, but isotretinoin is still available), Claravis, Absorica, and others. It is a retinoid, a synthetic vitamin A analog, prescribed for severe, recurrent nodular or cystic acne.

Isotretinoin works very well in decreasing the oil glands’ size and stopping acne breakouts. However, at the beginning of taking isotretinoin, your acne may worsen. It is called purging – dead skin cells and sebum are pushed out from underneath the skin. But when this purging completes, acne will get better.

Would I recommend taking isotretinoin for hormonal acne? Take it ONLY if you have severe nodular acne and nothing else helps.

Because isotretinoin works very well in minimizing the size and production of the oil glands, your skin may become dry, itchy, flaky, and peeling. It also affects your lips, which become chapped and may bleed, and your eyes also become dry and inflamed. 

While taking this retinoid medication, it is recommended to use broad-spectrum sunscreens because it increases the skin’s sensitivity to sunlight and may cause hyperpigmentation.

Sometimes isotretinoin may cause retinoid dermatitis, characterized by itching or burning sensation, redness of the skin, and scaling. It was also associated with increased levels of blood cholesterol and body fat. One study found that isotretinoin had side effects on sexual function, causing erectile dysfunction and loss of libido (17).

Isotretinoin is very teratogenic and dangerous for pregnancy and unborn babies. It can cause severe congenital disabilities (missing ears, missing eyes, heart defects, etc.), miscarriage, or death of the baby. Therefore, women should always stay on two forms of birth control while taking isotretinoin and take pregnancy tests before, during, and after treatment. 

Long-term side effects include depression, psychosis, pancreatic, bowel, or liver damage. It may affect bones and muscles and stop growth in teenagers (18).

Tretinoin for Treating Hormonal Acne

Tretinoin is also a retinoid derived from vitamin A. Despite having a similar molecular structure as isotretinoin, it is not the same medication. While isotretinoin is an oral medication, tretinoin is a topical cream (Retin A, Renova, Refissa, Avita) or gel (Retin-A, Atralin, Avita) or lotion (Altreno). It is also prescribed for moderate and severe acne, age spots, and wrinkles. Isotretinoin is prescribed only for severe acne.

Tretinoin speeds up the cell turnover rate, which results in unclogged pores and reduced acne lesions. If you were prescribed tretinoin, be cautious and do not use it with salicylic acid, resorcinol, diuretics, antibiotics, and some other medications.

Possible side effects include dryness of the skin, peeling, itching, burning, red or swollen skin, sometimes even blisters, and a change of skin color.

Is tretinoin safe to use during pregnancy? The evidence about the safety of this medication is still lacking, so I would definitely not recommend using it for pregnant women or for those who intend to become pregnant. If you got pregnant while using tretinoin, don’t worry. It is not an oral medication like isotretinoin, and only small amounts of it may be absorbed, and it has a very low chance of affecting the baby (19).

Other topical retinoids include adapalene (Differin) and tazarotene (Tazorac) and have similar effects as tretinoin.

Antibiotics for Treating Hormonal Acne

Another widespread treatment option for acne is antibiotics. They are prescription medications available as oral medications or topical creams and ointments. Antibiotics are usually prescribed for moderate and severe acne. They reduce bacteria that cause inflammation. The most common oral antibiotics are tetracyclines (doxycycline) or macrolides (erythromycin, azithromycin).

Be aware that antibiotics may cause allergies (especially trimethoprim or cotrimoxazole), photosensitivity (doxycycline), thrush caused by the spreading of Candida albicans, digestive problems, and sometimes even bacterial resistance (topical antibiotics).

Always remember to wear sunscreens to avoid sunburn and dark spots, and take probiotics to prevent thrush.

Cutibacterium acnes (formerly Propionibacterium acnes) may become resistant and spread resistance genes to other bacteria like Staphylococcus aureus. Combine topical antibiotics with benzoyl peroxide or topical retinoids to avoid bacterial resistance.

What is my opinion about antibiotics for treating hormonal acne? Take them if you have severe acne, nodules, or cysts, but only at the beginning of the treatment. Antibiotics will reduce the inflammation, and you can switch to other acne treatments then because acne requires long treatment and constant skincare. Look for different treatments and skincare for acne after you are done with antibiotics.

3. FACIAL CLEANSING

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Extraction of Comedones

This is a supportive procedure, along with other acne treatments performed by a dermatologist or cosmetologist. It is usually done by pressure around the pore opening or by incision. Sometimes metal loops or hooks are used.

This procedure is safe when performed by trained professionals. But do not try to extract comedones (whiteheads and blackheads) this way at home. Extracting comedos incorrectly may cause infection, inflammation, and scarring. Moreover, your acne may worsen. Read more about blackheads and how to remove them here.

Vacuum extractors may be used to extract comedones. It sucks out the oil and dead cells of the skin and extracts blackheads. For the best results, skin preparation is needed.  Use a facial steamer to exfoliate your skin (salicylic acid is the best exfoliator and has an anti-inflammatory and antimicrobial effect) or soften your comedones, applying softener gel (e.g., aloe vera gel).

But vacuum extractor is not suitable for everyone. Do not use this device if you have sensitive skin, facial capillaries, rosacea, inflamed acne (papules, pustules, nodules), or fragile skin. It may damage sensitive or delicate skin, break facial capillaries, spread inflammation, and cause facial skin ptosis (drooping of the skin). Vacuum extractors are most suitable for thick oily skin.

Ultrasonic Facial Cleansing

It is a safe and approved way to cleanse your face. Ultrasonic cleansing is usually performed with an ultrasonic face spatula (whether by an esthetician or at home). It is safe to use on many skins, even on sensitive skin, but it is unsuitable for inflamed acne (inflammation may spread). If you count less than ten inflamed acne lesions (papules, pustules, cysts, nodules) on your face and can bypass them with a spatula, you can give it a try!

Ultrasonic facial cleansing has many advantages and is very easy to use at home. There is no risk of damaging your skin, but skin cleansing is deep. The spatula is activated by ultrasonic sound waves (26,000 – 28,000 vibrations per second) and removes debris, oil, bacteria, dead skin cells, makeup residues, and blackheads and whiteheads.

Three ways ultrasonic spatulas work:

• Mechanical exfoliation – vibrations affect skin cells; they start vibrating and push dirt upwards, which also works as a micro-massage. It is a very gentle exfoliation and does not damage the skin.

• Chemical effect – ultrasound reaches even the deepest skin layers, activates skin renewal, and improves the supply of skin nutrients.

• Thermal effect – ultrasound increases the skin’s temperature, microcirculation, and skin metabolism increases.

It is an excellent tool for preventing pimples since it reduces skin oiliness, opens pores, cleans whiteheads and blackheads, removes dead skin cells, and increases skin renewal.

Some spatulas have a cleansing function only, but some are double-sided and have two functions – cleansing and sonophoresis. Sonophoresis enhances skin absorption of nutrients. Using such a spatula, you may lead serums or ampoules in (except for the oil-based products, ultrasound does not lead them in), and those nutrients will reach deeper layers of the skin and get better results than just applying them on the skin.

If you are wondering which ultrasonic spatula to buy, my advice is – do not buy the cheapest ones. Cheap spatulas may only have mechanical vibration, not ultrasonic vibration, which should be 26,000 – 28,000 vibrations per second. Also, look for double-sided spatulas – one side leads out the dirt, and the other side leads in the nutrients.

Since it is a gentle cleansing of the face, it may take several procedures to see the results. But the results are worth waiting for. After the procedure, combine spatula with sebum control serums, anti-acne ampoules, and apply face masks.

Microdermabrasion

It is another skin cleansing method that exfoliates the outer layer of the skin. This procedure uses crystals that remove the cells from the skin’s surface. The result is smooth and soft skin.

Since it exfoliates the outer layer of the skin, it works best on acne scars, decreases pore size, and minimizes dark spots and wrinkles. It is an excellent method to prevent pimples but does not help if you already have acne lesions. Microdermabrasion will be too aggressive for those with sensitive skin and rosacea (or any other face redness).

Chemical peels

Yes, chemical peels are also considered face cleansing. It is the best way to treat acne, and I am a big fan of them.

A chemical peel is controlled skin destruction when a chemical substance – acid – of a defined strength 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 skin peels off after treatment.

Treatments can be individualized according to the skin type, skin state, and problems.

Suitable results may be achieved just after one treatment, but a course of treatments is required for the best result. Maintenance of achieved results is often offered.

What is the best chemical peel for treating hormonal acne?

Salicylic acid peel is a golden standard. It exfoliates the skin very well and dissolves lipids around keratinized cells. It is a lipophilic (oil-loving) acid that works well on oil glands and reduces comedones. Salicylic acid has the strongest anti-inflammatory and antimicrobial properties of all acids. That is why it is the best acid for treating hormonal acne.

If you have mild acne, mostly whiteheads or blackheads, several papules, you may try mandelic acid peel. This peel is very superficial, does not hurt, and the skin does not peel after treatment but has some anti-inflammatory and antimicrobial effects. Mandelic acid is suitable for sensitive skin, either.

Azelaic acid peels are best for rosacea.

Do chemical peels hurt?

It depends on the person’s tolerance level and the type of acid. Salicylic acid peels cause some discomfort, tingling, or mild burning, but they are temporary. Salicylic acid is alcohol-based, and the alcohol evaporates from the skin very quickly. When it disappears, the action of an acid stops, and the discomfort is gone.

Mandelic acid has a very mild discomfort or no discomfort at all.

4. NOVEL TREATMENTS

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Light therapy, laser therapy, and photodynamic therapy are also used to treat acne. These devices target Cutibacterium acnes, sebum production, and inflammation. However, these procedures are pretty pricy and require time.

LED light therapy will be it if you look for something you could try at home. LED light devices allow lights of different wavelengths (and colors) to penetrate the skin but do not burn it and do not cause pain. It is suitable for sensitive skin and those with darker skin.

Several studies (20) have found that blue light is effective for treating acne due to the destruction of the bacteria membrane.

These devices work best for mild and moderate acne. Like all treatments, LED light therapy also requires time. The research found the reduction of acne breakouts by 25% in 5 weeks, 53% in 8 weeks, and 60% in 12 weeks (21). It also reduces acne scars.

Note! Do not use this device if you are using anything that makes your skin sensitive to sunlight, such as isotretinoin (Accutane) and acids (salicylic, mandelic, glycolic).

Which LED light device to buy?

There are a lot of devices on the market. Do not hook up with the simplest ones because they may only spread the colored light due to the colored glass, but not the different wavelengths of light. The best choices would be wands or masks. Wands have benefits because they may be used all over the body (especially if you have acne breakouts on your body, such as your back and chest). Look if the device has blue light mode.

5. SKINCARE

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As with the treatments, acids are among the best and most potent ingredients in home care cosmetics. You may try products including salicylic acid or mandelic acid. Both acids have anti-inflammatory and antibacterial properties, reduce keratosis (the excess of keratin that sticks the dead skin cells together and clogs the pores) of the outer layer of the skin, and remove dead skin cells.

Salicylic acid has stronger antibacterial properties and works better on keratosis than any other acid. Since it is a strong acid, it may sometimes irritate your skin and will not be suitable for very sensitive or very thin skin. The option for sensitive or irritated skin is to look for natural sources of salicylic acids, such as willow bark extract (Salix alba or Salix nigra), which contains salicin (the natural form of salicylic acid). Natural salicin will be milder on the skin, suit irritated skin and calm down the inflammation.

Mandelic acid is an excellent option for sensitive, irritated skin with hormonal acne. It is also a good acid to start with if you have never tried acids products and do not know how your skin reacts to acids. You do not need any stronger ingredients if you have mild acne, blackheads, or whiteheads and do not have inflammatory lesions. Mandelic acid will do the work just fine.

Homecare products that contain acids usually do not cause a tingling or burning sensation because concentrations of acids are much lower than those used in chemical peels. Look for cleansers, creams, serums, and masks that contain these acids.

If you are not interested in acids or have any hesitations, you may try other ingredients, such as tea tree oil (Melaleuca Alternafolia), sulfur, zinc, turmeric/curcumin, clay, papaya enzyme, neem.

The best choice for the spot treatment is benzoyl peroxide. It has a powerful anti-inflammatory and antimicrobial effect. You may find benzoyl peroxide at lower concentrations without prescription.

While treating your acne flares, do not forget to control sebum production. Niacinamide, vitamin B3, prevents the oil glands from overproducing sebum and significantly reduces skin greasiness (22). It will also help treat acne lesions, such as papules or pustules.

Another ingredient in cosmetics known for reduction of sebum production is green tea. In addition, green tea is a strong antioxidant, fights inflammation, and has antimicrobial and anti-androgenic activity (23, 24).

A new emerging ingredient in decreasing sebum production is L-carnitine. It is an amino acid produced in the body, breaking down fatty acids. Usually used in fat burning, L-carnitine significantly breaks down fatty acids in skin oil glands. You may look for topical cosmeceuticals or oral supplements containing L-carnitine (25).

6. HYDRATE SKIN

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There is no life without water, and your skin needs hydration too. Even if you have oily or combinations skin, it still needs hydration. If your skin gets dehydrated, it may produce even more oil to moisturize your skin. More oil leads to more acne breakouts. Dry skin cells may clog your pores which results in acne flares.

Moisturizers will also prevent your skin from side effects and dehydration due to the acne treatment, especially if you are using products that contain acids, such as salicylic acid or mandelic acid (or any other harsh ingredients (isotretinoin) or any other acids).

Best moisturizers for hormonal acne-affected skin should be non-comedogenic and oil-free. Look for non-comedogenic moisturizing ingredients best for oily or combination skin, such as Aloe vera, hyaluronic acid, sodium PCA, sorbitol, niacinamide (Vitamin B3), Vitamin C, argan oil, glycerin, hemp seed oil, propylene glycol, shea butter.

Avoid comedogenic products, such as algae extracts, carrageenans, coconut oil, flaxseed oil, hexadecyl alcohol, isocetyl stearate, octyl stearate, sodium lauryl sulfate, wheat germ oil.

7. AVOID UV RAYS

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If you have acne, always wear sunscreen. Inflamed skin is susceptible to sunlight, and you may get dark spots in 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 a ton of products every day.

Do sunscreens clog pores?

Yes, some sunscreens, such as water-resistant sunscreens containing oil, may clog your pores. Non-water-resistant sunscreens usually do not clog pores but choose a water-resistant mineral powder if you still want to use a water-resistant product. Apply it on top of your non-water-resistant sunscreen. Since it is a powder, it is easy to apply and reapply when needed. Powders contain physical blockers (titanium dioxide and zinc oxide), which are water-resistant.

Note! Wash your skin carefully after sunscreens, especially if you are using water-resistant sunscreens. For proper removal of water-resistant sunscreen, use cleansers containing some emollients (oils) because those sunscreens also contain water-repelling emollients. Water-based cleansers will not do the job properly, and you may end up with clogged pores.

Takeaway

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Hormonal acne is a complex disease, and many hormones play roles in sebum production and inflammation. The key hormones to look at are androgens (testosterone, DHT, DHEA), progesterone, the stress hormone cortisol, thyroid hormones, prolactin, and insulin. They increase sebum production and lead to hormonal acne symptoms.

Hormonal acne looks like whiteheads, blackheads, papules, pustules, and sometimes cysts or nodules. Usually, breakouts are located on the lower face (along the jawline, chin, neck) but can spread to the upper face or the back and chest.

If you want to treat your hormonal acne properly, you need to treat the causes first. Balancing your hormones should be a priority. Try natural androgen blockers like soybean isoflavones, licorice, white peony, zinc, spearmint, and vitamin B6. If you suspect other hormonal imbalances or diseases, consult your doctor.

No matter which hormones are in excess, bacteria are always involved in the inflammation. Using salicylic acid products is a golden standard in skincare. This acid has potent anti-inflammatory, antimicrobial, and keratolytic properties and works best for treating hormonal acne, especially when combined with androgen blockers.

If you have mild acne or sensitive skin, use products that contain mandelic acid, niacinamide, green tea, and clay.

Always hydrate your skin, and use non-comedogenic moisturizers. To avoid UV rays, use sunscreens that do not clog your pores to prevent dark spots.

Remember that hormonal acne is a disease and can be cured!

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