“Hormonal acne” isn’t a particular type of acne—it’s just plain old acne. Some refer to the skin condition as “hormonal” because it is caused by hormonal changes manifested in your skin.
Although acne often occurs during puberty, some adults experience it as well: as occasional break-outs, monthly explosions, or chronic patches. Severe acne can affect self-image and self-esteem, which have negative psychological consequences.
What Causes Acne
Acne—not an occasional pimple or bump—occurs when the level of androgens (male sex hormones) increases, causing glands in the skin to secrete extra oil (sebum) around hair follicles. This results in clogged pores. Dead skin cells that would normally rise to the surface of the skin to be washed away accumulate under the plugged pores and cause a breakout (1).
Once the hair follicles are stopped up, bacteria can accumulate; the immune system responds to the bacteria and areas around the follicles become inflamed. Not all forms of acne cause inflammation.
There are five types of acne lesions that can form:
- Comedones – plugs that form at the base of hairs in the follicles; they can be open or closed and are non-inflammatory. Whiteheads and blackheads are comedones.
- Cysts – an infection that occurs under the surface of the skin. These contain pus and appear as bumps on the skin. Cysts don’t come to a head like pimples. They can be sore and linger for a long time.
- Nodules – similar to cysts in that they appear as sore bumps under the skin, different in that they don’t contain pus
- Papules – swollen, raised, red bumps (with no head) on the skin
- Pustules – papules filled with pus; the heads appear white or yellow
Other causes of acne include:
- Medications – corticosteroids, and drugs containing androgens, lithium, or tuberculosis drugs (2)
- Diet – dairy, wheat, and refined sugar
- Stress
- Household cleaners
- Personal care products
- Internal inflammation
The Role of Hormones
The increase in testosterone and other androgen production naturally occurs at puberty for both sexes, when children develop into young adults. These hormones stimulate the glands that produce sebum. Some areas of the body are covered with the kind of skin whose pores produce more sebum than others. These locations are therefore where acne is more likely to erupt: the face, back, chest, and buttocks. Acne on the cheeks is also very common.
In women, hormonal changes also naturally occur during menstruation and pregnancy. If you find break-outs occur around your monthly cycle, these changes are most likely the culprit. Additionally, Polycystic Ovary Syndrome (PCOS) can throw hormones out of whack and cause acne. (3)
The area of your body on which acne occurs can indicate its cause:
- Acne around the mouth can be caused by lip and mouth products (e.g., lip balm, mouthwash), certain foods, or saliva while sleeping (drooling).
- Scalp acne can be caused by hair products or styling methods (curling or flat irons, hot hair dryers) that irritate the skin.
- Acne on the back is common because there are lots of hair follicles there. Add friction from clothing and backpacks and this area can become irritated, opening the door for the bacteria that cause acne.
- Pimples on the arm can occur in an allergic response or other irritants.
- Thighs, legs, and pelvic area: type of underwear (cotton is best), shaving or waxing, and irritation caused by damp or tight clothing can all cause break-outs that may not be acne. (4)
Managing Hormonal Acne
Here are a few unwritten rules of managing your acne:
- Rule Number One: Don’t squeeze or pick! Doing so can spread the bacteria that cause acne and cause permanent scarring.
- Don’t touch your face unnecessarily, especially with unwashed hands.
- Avoid irritants and behaviors known to trigger breakouts.
- Use natural personal care and household products to avoid endocrine disrupting chemicals and irritating and pore-clogging ingredients.
- Vitamins A and D are significant contributors to skin health. (5) Make sure you get enough of both.
Plus, according to the Natural Acne Clinic:
“The typical American diet that is highly acidic and high in saturated fats, processed grains, meat fats, refined sugar and low in fresh vegetables, fruit, fish, fiber, antioxidants and seaweed has been shown in many studies to either increase or decrease testosterone and androgen levels, respectively. Therefore, a healthy diet is one form of natural treatment for hormonal acne.” (6)