As a preteen, I struggled with acne that made me so, so self-conscious, but I always assumed that as I got older, I’d have enough confidence to not be ashamed of breakouts. To be honest, they still get to me. Acne is not just for teenagers—studies show hormonal acne plagues about 50% of women ages 20 to 29 and about 25% of women ages 40 to 49. So we thought we’d ask two leading dermatologists how to treat stubborn hormonal acne–and how to know whether you have that kind in the first place.
Hormonal acne isn't the same for everyone. “That said, hormonal acne typically occurs on the lower half of the face, particularly along the jawline,” says Adam Friedman, associate professor of dermatology at the George Washington University School of Medicine & Health Sciences. “This form of acne tends to be more cyst-like or cystic and feels deeper than a whitehead or blackhead.”
Just because you didn’t have acne when you were younger doesn’t mean you can’t get it now. Adolescent hormonal acne is often related to puberty. “While breakouts may seem totally random, they actually often are ‘scheduled,’” says Manhattan-based dermatologist Dennis Gross, founder of an eponymous skincare brand. “For example, they may routinely get worse the week before your period.”
The most important thing is to first determine whether you have hormonal acne and, if so, whether it's mild, moderate, or severe, Gross says. It’s also key to rule out other causes including wrong product selection, genetics, stress, and medication. Once you’ve done that, check out the two plans for how to treat hormonal acne below, courtesy of doctors Gross and Friedman. It’s time to get clear skin once and for all.
Gross's Skincare Plan
You have to make sure you’re being consistent with your treatment for it to really work. “Prevention is really the best treatment because it is important to realize that a blemish can begin to form up to two to three weeks before it appears on the surface of the skin,” Gross says.
- Cleanse: Properly cleanse the skin, since all acne starts with a blocked oil gland. Make sure you also remove all makeup before bed.
- Steam: Steam your face two to three times a week after washing to further decongest pores.
- Peel: Follow with an at-home chemical peel such as Dr. Gross Alpha Beta Extra Strength Daily Peel to remove dead skin and debris and to decongest pores to remove oil gland blockage. “This preps pores and skin to better receive ingredients that may follow,” says Gross.
- Serum: Reach for a retinol serum—it’s excellent for pores and still fairly sensitive to skin.
- Treat: To combat acne the effective-yet-gentle way, start by using over-the-counter anti-acne remedies that contain pore-clearing salicylic acid or bacteria-banishing benzoyl peroxide. “If neither works well enough independently, try using them both together,” suggests Gross. (Heads-up: Sulfur is also a fantastic spot treatment to draw out the oil and kill bacteria.)
- Hydrate: Apply an oil-free moisturizer, such as Dr. Gross Hyaluronic Marine Oil-Free Moisture Cushion. Any external oil from products contributes to blockage, so make sure the product you are using specifically says “oil-free.” “You have no room for an additional source of oil from an outside product,” warns Gross. “Even if a product suggests it’s oil-free by saying things like ‘won’t clog pores’ or ‘dermatologist-tested,’ it can still contain oil.”
Friedman's Skincare Plan
Treating hormonal acne is straightforward as long as you address the underlying issue—the hormonal influence. And when it comes to a regimen, simplicity is key. “The largest percentage of women who suffer from hormonal acne are juggling way too much—jobs, parenthood, etc.—to do a complex regimen,” explains Friedman.
- Cleanse: In the morning, wash with a mild cleanser and apply an oil-free moisturizer with at least 30 SPF broad-spectrum sun protection. “You want to apply the moisturizer to damp skin so it locks in the moisture,” explains Friedman. You’ll need to cleanse at night as well.
- Supplement: Take spironolactone (a water pill) with breakfast and dinner, usually between 25 mg and 50 mg tablet. This androgen receptor blocker has actually been used for more than 30 years to treat acne. It works to reduce sebum (oil) production in the skin, says Friedman. Two things to keep in mind while taking it: Don't use it if you're trying to get pregnant since it affects your hormones, and avoid potassium-rich foods (like coconut water, fruit smoothies, bananas, and supplements), because it the pill makes your body to hold onto more potassium.
- Treat: Apply a topical retinoid at night after cleansing. Retinoids do a lot of wonderful things for acne: inhibit inflammation, regulate skin turnover, and increase collagen and elastin production. To make it easy on you (and your bank account), you can actually get Differin Gel over the counter—it's the only FDA-approved OTC retinoid for acne treatment. Friedman advises beginning by applying the retinoid every other day for a few weeks to avoid irritation. Gradually, begin applying it every night. “Use a small, pea-size amount for the entire face (do not spot-treat) after washing skin and drying—wait a couple of minutes after cleansing,” instructs Friedman.
- Note: Don't wax your face if you’re using a retinoid, because it can cause a pretty unpleasant reaction.
If neither plan works for you, consult a dermatologist to get a custom skincare regimen based on your specific needs.