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 not to be ashamed of breakouts. To be honest, they still get to me. Acne isn’t 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.
What Is Hormonal Acne?
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, an associate professor of dermatology at the George Washington University School of Medicine and Health Sciences. “This form of acne tends to be more cyst-like or cystic and feels deeper than a whitehead or blackhead.”
Meet the Expert
Adam Friedman, MD, FAAD is an associate professor of dermatology and serves as residency program director and director of translational research in the department of dermatology at The George Washington University School of Medicine and Health Sciences. He has published more than 120 papers and three textbooks on topics like acne and eczema and on his research using nanotechnologies he developed to treat many of these conditions.
The most important thing is to first determine whether you have hormonal acne and, if so, whether it's mild, moderate, or severe, says Dr. Dennis Gross, founder of an eponymous skincare brand. It’s also key to rule out other causes including wrong product selection, genetics, stress, and medication. Once you’ve done that, check out these two plans for how to treat hormonal acne below, courtesy of Drs. Gross and Friedman. It’s time to get clear skin once and for all.
Gross's Skincare Plan
“While breakouts may seem totally random, they actually often are ‘scheduled,’” says Gross, who is based in Manhattan. “For example, they may routinely get worse the week before your period.”
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. Dennis Gross Skincare 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 gentle on your 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. Dennis Gross Skincare Hyaluronic Marine Oil-Free Moisture Cushion. Any external oil from products contributes to blockage, so make sure the product you are using specifically says it's 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, says Friedman. 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 broad-spectrum SPF. “Apply the moisturizer to damp skin so it locks in the moisture,” says Friedman. Cleanse at night as well.
- Supplement: Friedman suggests taking spironolactone (a water pill) with breakfast and dinner, with a dose between 25 mg and 50 mg. This androgen receptor blocker has actually been used for more than 30 years to treat acne because it reduces sebum (oil) production in the skin, says Friedman. However, it comes with serious side effects, so talk to your healthcare provider about them and check in with them to monitor your health. Before starting spironolactone, you must make sure you're not pregnant, because the drug affects your hormones and can cause major fetal defects. Be sure you're on an effective method of birth control while taking spironolactone. And you’ll need blood tests every three months, since the drug makes you retain potassium. Your provider will counsel you on your levels and which potassium-rich foods to avoid, like coconut water, fruit smoothies, bananas, and supplements.
- 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 unpleasant reactions ranging from redness and severe dryness to discoloration and even scarring.
If neither plan works for you, consult a dermatologist to get a custom skincare regimen based on your specific needs.