Follow this expert-approved guide so it doesn’t have to be a total headache anymore.
Alix’s hormonal acne journey is far from a secret ever since she took to her social platforms to share her skin struggles. From complexion closeups and insight into the ups and downs of managing her acne—physically and emotionally—she was totally real with millions of viewers a BTS glimpse of how she was caring for her real skin. And she is clearly not alone with her acne: According to the Cleveland Clinic, up to 50 percent of 20-somethings say hormonal acne is an issue; and approximately 25 percent of 40 year old females say they suffer from it, too. And because hormonal acne can strike basically anytime from early adulthood, to mid life especially during pregnancy or post-pregnancy, plus pop up during peri- or true menopause, it’s a skin concern that nearly every woman has faced or will face at some point in their life.
Frustrated with figuring out your hormonal acne? Find out why it’s happening and the at-home and in-office treatments, proven to help prevent, treat and heal hormonal acne breakouts.
What is Hormonal Acne?
According to Kiran Mian, MD, Director of Clinical Innovation at Real Actives and a cosmetic dermatologist at Hudson Dermatology and Laser Center in New York City, if you’re experiencing adult acne, there is one hundred percent a hormonal component to it. “What happens, and I see this mainly with my female patients including Alix, is that women go through fluctuations in hormones,” she says. “And because of those fluctuations, oil glands can start to overproduce oil and lead to clogged pores.” Hormonal fluctuations, Dr. Mian explains, can be triggered by what our body is going through at that time, even if you never experienced hormonal acne before. “It’s often during late 20s-early 30s, during or post pregnancy, perimenopause and when taking certain medications like those used in IVF can also trigger hormonal acne,” she adds.
Where hormonally charged pimples primarily pop up: along the jawline, chin and the lower face area in general all the way down to the neck. Why? Why? Why? “The oil glands in that area are more susceptible to hormonal fluctuations, to the androgens that are being secreted,” Dr. Mian explains. “So once you have this increase in oil production, hormonal acne tends to also be deeper and often painful.”
What Hormonal Acne Looks—And Feels—Like
If you’re dealing with hormonal acne you know the drill: your breakouts are typically red, raised, deep and painful. “The reason hormonal lesions tend to be deeper is that hormones are targeting the hormone receptors on the oil gland, which sits deeper in the skin at the base of the pore,” explains Dr. Mian. “Once that oil is produced, oil is food for bacteria and can trigger inflammation—so you have an increased amount of cytokines and therefore more inflammation, which leads to increased swelling and increased pain.”
The Complete Guide to Controlling Hormonal Acne
Hormonal acne is easy to spot but often a total pain to treat. Pros agree that it’s crucial to stay consistent with a solid acne-centric skincare routine that focuses on balancing skin and keeping pores clear. Equally as important is incorporating a 360-approach that factors in lifestyle changes and pro-approved treatments to halt hormonal acne.
Daily Skincare Routine:
“Because inflammation is a big component of hormonal acne, you want to make sure that your skincare regimen is very balanced and nourishing for the skin,” says Dr. Mian. “And that's why Real Actives is great for hormonal acne because it helps address all of the issues that are happening in terms of excess oil production and inflammation plus a compromised skin barrier while making sure to hydrate and soothe the skin.”
Cleanse
Reale Actives Get Bare Makeup Melting Cleansing Balm, $29
“Get Bare uses noncomedogenic oils high in anti-inflammatory linoleic acid to emulsify and remove oil based makeup, skincare and the day's sebum,” explains Dr. Mian.
Reale Actives Pore Power Exfoliating LHA + BHA Gel Cleanser, $27
“This gel cleanser is ideal for acne because it uses a balanced blend of BHA+LHA to clear out congested pores, while fermented rice and glycerin condition and hydrate the skin,” says Dr. Mian.
Treat
Reale Actives Go Deep 8% Mandelic Acid Serum Concentrate, $39
“This gentle but effective liquid exfoliant uses a powerful blend of exfoliating mandelic acid and acne-fighting SynactinAC,” Dr. Mian says. “Then squalane and centella asiatica strengthen and stabilize the skin barrier.”
Moisturize
Reale Actives Dew More Barrier Boosting Moisturizer, $35
“These lightweight hydrators have a quad-ceramide blend, water attracting hyaluronic acid and glycerin, plus nourishing shea butter to destress the skin and reinforce the skin barrier while providing long lasting hydration,” says Dr. Mian.
In-Office Derm Treatments:
Oral Rx’s
“An effective method to treat hormonal acne is to block the hormone receptor at the base of pores from interacting with hormones,” explains Dr. Mian. “One way we can do that is using a prescription medication called spironolactone, which can also go by the brand name Aldactone.” Spironolactone, which is actually a water pill or diuretic, is used to treat medical conditions including high blood pressure, fluid retention and even heart failure. But it has a surprising off label usage that targets hormonal acne (along with PCOS, too) because of its anti-androgen properties and ability to physically block the androgen receptors that are instigating the over production of oil. But not everyone can—or wants to— take spironolactone (like if you’re trying to get pregnant or have kidney issues). Another way to balance hormones from the inside out is with oral contraceptives. “Oral contraceptives can help regulate the fluctuation of hormones that triggers hormonal acne in some patients,” notes Dr. Mian.
Cortisol Injections
“Because hormonal acne is typically deep within the skin, some people try to pop their pimples or get them extracted but that's not necessarily going to be beneficial with hormonal acne because it's not a comedogenic problem where your pores are blocked,” says Dr. Mian. “It's more so a sebum problem and an oil gland problem where the process is happening underneath.”
That’s why when you have an acute acne flareup that’s deep, red and painful to the touch, a cortisol injection, essentially a steroid injection, from a dermatologist can be the quickest and most effective way to get it down. “A cortisol injection is an anti-inflammatory injection that will help to get to the base of a lesion where the swelling is happening to help flatten it, soothe it and decrease that inflammation,” explains Dr. Mian.
Here’s what to expect if you opt for a cortisol injection to help with a hormonal acne flareup: First, your practitioner will clean the area with an alcohol pad then inject the inflamed lesion using a small needle syringe with a small amount of the diluted steroid solution. “You may have some pinpoint bleeding after the injection and the lesion may be sore and possibly appear bigger due to the injected liquid,” Dr. Mian explains. “But after a few days, the inflamed cyst will calm down, reduce in size and you’ll experience not only a reduction in pain but the lesion will heal.”
Topical Prescriptions
Along with sticking to a stellar at-home skincare routine, if your hormonal acne is out of control, your dermatologist may prescribe topical acne treatments that can help. These include high-strength retinoids (such as Tretinoin or Tazorac), as well as azelaic acid (like Finacea) or clascoterone (known as Winlevi) plus topical antibiotics like clindamycin (aka Clindagel or Cleocin T) and benzoyl peroxide creams. Retinoids are shown to help accelerate skin cell turnover, which helps prevent pores from being blocked. Clascoterone is considered to be a topical androgen receptor blocker, so it works similar to spironolactone but topically. Azelaic acid has several benefits for hormonal acne including reducing bacteria and inflammation on the skin. Clindamycin is a topical antibiotic; and benzoyl peroxide spot treatments (go-tos include Duac or Benzaclin) has been shown to help kill bacteria in skin, lessen inflammation and reduce clogs. The bottom line: find the combo that not only treats your hormonal acne specifically but also finds a solution that your skin can tolerate.
Lifestyle Hacks:
Swap out sugar
“Controlling the amount of sugar that’s in your diet and therefore avoiding elevated sugar spikes has been shown to help with hormonal acne,” says Dr. Mian. “Focusing on incorporating foods that are low on glycemic index as opposed to high glycemic index will help to control hormonal acne.” This means ditching tons of refined sugars and processed foods whenever possible. Some studies have even shown that altering your diet in this way can significantly reduce hormonal acne and improve skin in as little as eight to 12 weeks. “When you have high amounts of sugar in your body, it increases insulin and insulin-like growth factor is something in the skin that then triggers inflammation as well and contributes to hormonal acne, which contributes to that overproduction of oil,” explains Dr. Mian.
Chillax
There are countless scientific studies that showcase the direct correlation between increased stress and acne. “Another thing that can contribute to hormonal acne is stress, and that's because of cortisol, a hormone that triggers inflammation in the skin,” shares Dr. Mian. You also want to be sure to get quality sleep regularly. “Skin cells are constantly regenerating—about every 28 days or so, we have new skin cells that push up to the surface and then the old skin cells, they get decimated off,” says Dr. Mian. “This process of regeneration happens predominantly at night so you want to make sure that not only are you getting enough sleep so this can happen but also that your skin is clean before you go to sleep so all those old skin cells are able to get shed off and won’t stay behind to clog pores.”
