Being a woman, the fight against acne can be a bit more complicated than it is for men. Hormonal acne can often be considered a chronic condition that requires long-term management. In this article, we’ll explore its causes and the best ways to treat it.
What is hormonal acne?
In fact, this is not the term we usually use in medical language; we more precisely refer to it as “adult female acne.” This diagnosis applies to women who develop acne or continue to have it beyond the age of 25. However, this age limit is somewhat arbitrary, as the approach for a 23- or 24-year-old woman would likely be the same.
Although breakouts can appear anywhere on the face, hormonal acne typically affects the chin and jawline. The spots may be small (like blackheads or whiteheads), more inflammatory with a white tip (pustules), or even deep and painful (nodules).
In some cases, breakouts are related to the menstrual cycle and worsen a few days before the period. In others, there’s no clear connection.
Why does hormonal acne appear?
Hormonal acne can appear in women who never had it before or persist from adolescence. In either case, it tends to become less frequent over time. It is estimated that half of women in their 20s have acne, a quarter of women in their 30s, and more than 10% of women over 40 also experience it.
The main causes of adult female acne are the same as in teenage acne:
- Hyperkeratinization of the hair follicle
- Excess sebum production
- Presence of the bacteria Cutibacterium acnes in the pore
- Inflammation
What makes this condition “hormonal” is that it tends to worsen in situations where androgen levels (male hormones) increase — whether due to medications (such as certain birth control pills) or medical conditions (such as polycystic ovary syndrome). Androgens, which are also naturally present in women (produced by the ovaries or adrenal glands), stimulate sebum production, which can trigger breakouts.
However, interestingly, most women over the age of 25 with acne have normal hormone levels. In fact, we usually don’t order blood tests. This has led to the hypothesis that in many cases, the sebaceous glands are simply more sensitive to normal androgen levels, producing more sebum and leading to acne.
Other contributing factors may include stress, pollution, the menstrual cycle, smoking, and the use of greasy or comedogenic cosmetics.
Does diet affect hormonal acne?
Until a few years ago, dermatologists generally denied that diet had any influence on acne. However, we now know that diets with a high glycemic load and those rich in dairy products can worsen acne.
Does this mean eating well will cure your acne? Probably not — in most cases, medical treatment is needed. However, a healthy diet rich in fruits, vegetables, legumes, and fish can reduce the inflammatory nature of acne and prevent flare-ups. For that reason, a healthy diet is an excellent complement to treatment.
How to treat hormonal acne
When acne is hormonal in origin, the first step is to establish a proper skincare routine, including thorough cleansing and the use of exfoliating agents as a complement. You can use physical or chemical exfoliants (like salicylic acid or alpha-hydroxy acids).
Depending on the severity and extent of the inflammation, medical treatment will vary. In cases where the acne is mild and non-inflammatory, topical treatment may be sufficient, combining retinoids, benzoyl peroxide, and a good skincare routine. Topical antibiotics should be used only for short periods (no longer than 3 months).
However, when lesions are more inflamed or affect a large area of the face or neck, we may recommend oral treatments, such as hormonal contraceptives, spironolactone, isotretinoin, or antibiotics.
The treatment strategy should be long-term, as adult female acne is often chronic. Short-term treatments usually bring initial improvement, but acne tends to return afterward.
Taking a long-term approach and having strategies in place to control flare-ups and maintain clear skin has proven, in my experience, to be very effective. In any case, treatment should always be personalized, taking into account each woman’s needs, preferences, and individual response.
