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Created for Greatist by the experts at Healthline. Read more

Having acne as a teen is bad enough. But breaking out in adulthood? It feels cruel. Here’s everything you need to know about hormonal acne and how to send your pimples packing.

You’re not alone

Hormonal acne can attack at any age. Studies show about 50 percent of women in their 20s, 35 percent of women in their 30s, and 26 percent of women in their 40s deal with acne.

Hormonal acne is triggered by fluctuating hormone levels. That’s why you might get more breakouts if you have a vajayjay.

“Females are more susceptible to hormonal acne since we experience fluctuations in female sex hormones — estrogen, progesterone, and testosterone — monthly with our menses,” says Zenovia Gabriel, MD, FAAD, a board-certified dermatologist and hormonal skin care expert.

When does it happen?

PMS breakouts are super common. Period pimples usually appear on the lower part of the face and jawline. Other hormonal acne triggers include:

  • pregnancy
  • menopause
  • thyroid disease
  • polycystic ovarian syndrome (PCOS)
  • switching up hormonal birth control

A breakout can be the first sign of hormonal imbalance. The pimples are proof your body is adjusting.

“An increase in testosterone stimulates our oil glands to produce excess sebum, which is one major cause of acne,” says Zenovia.

A hormonal roller coaster can increase:

  • clogged pores
  • skin inflammation
  • oil (sebum) production
  • clogged skin cells in hair follicles
  • acne-causing bacteria Propionibacterium acnes

Hormonal acne tends to be cyclical. If you have a vagina, breakouts usually flow with your monthly crimson tide. These zits usually appear on the lower face, jawline, and parts of the neck. Regular pimples are much more random and can pop up anywhere on the face.

“Forehead and mid-cheek acne are typically not hormonal acne, while jawline acne can be indicative of hormonal origin,” says Zenovia. “This is because jawline oil glands are highly sensitive to the hormone fluctuations in your bloodstream.”

It looks different

Hormonal acne is usually more cystic or nodular than regular pimples. That means the zits are deeper and more painful than your garden variety whiteheads or blackheads.

Acne can be caused by a ton of factors. That’s why you need to diversify your skin care regimen.

“When treating hormonal acne, it is essential to use a multi-pronged clinical approach addressing the four causes of acne: follicular plugging, bacteria, excess sebum production, and inflammation,” says Zenovia.

Some folks take a prescription medication to curb their acne. There are also lots of over-the-counter (OTC) treatments to try.

1. Look for these active ingredients

Products containing benzoyl peroxide and salicylic acid have been scientifically proven to help treat acne. They kill bad bacteria associated with acne and accelerate skin cell turnover.

Pro tip: Stick to face wash if you have sensitive skin. Leave-on masks and other products might cause irritation. Wash your face daily for the best results.

What to buy

You don’t need to spend big $$$ for quality products. Check out:

2. Retinoids are all the rage

A retinoid is a synthetic derivative of vitamin A. This chemical might help your skin bounce back faster after a breakout. It may also prevent future acne flare-ups.

What it does

Research shows retinoids can help:

  • combat acne
  • even out skin tone
  • reduce inflammation
  • prevent acne scarring
  • stimulate skin cell turnover
  • improve collagen production
  • prevent hyperpigmentation (dark spots)

Differin Gel is the only FDA-approved OTC retinoid acne treatment, says Zenovia.

How to use it:

  • Apply after you cleanse.
  • Use every other night for a few weeks.
  • Work toward daily use once your skin adjusts.

FYI: Some peeling and redness may occur until your skin gets used to it. If it’s painful or burns discontinue use ASAP.

3. Tea tree oil

Keep it au naturel with tea tree essential oil. One study found that a 5 percent topical tea tree oil product relieved acne symptoms.

DIY tea tree oil solution

  • Combine 4 to 6 drops of tea tree oil with 1 teaspoon (approx 98 drops) of a carrier oil, like jojoba or grapeseed oil.
  • Apply the mixture with a cotton swab to individual pimples as a spot treatment.

If you’re not the DIY type, check out TruSkin Tea Tree Clear Skin Super Serum. It combines the acne-fighting powers of salicylic acid, niacinamide, retinol, and tea tree oil. It also has hyaluronic acid and olive oil to keep your skin hydrated.

Keep in mind: Tea tree oil can be irritating for some. Do a patch test on the inside of your forearm before putting it (or any essential oil you’ve never tried before) on your face.

4. Curb your stress

Anxiety sucks for your skin. When stressed, your body ramps up on hormones like cortisol and testosterone. This can lead to excess oil production which can trigger a breakout.

Calm your nerves, calm your skin

Dedicate some time to relaxation. Your skin will thank you for it. Try daily walks, journaling, meditation, or yoga. These activities help lower stress.

5. Tweak your diet

The relationship between food and acne isn’t fully understood. But there are some basic changes you can make that will likely help.

Excessive sugar intake can increase the release of cortisol and other hormones that may contribute to acne. Try a low-glycemic diet on for size. You’ll reduce your sugar intake which might stave off zits.

While dairy is a low-glycemic index food, some peeps claim it can spark a breakout. Pass on the fromage for a few weeks and see if that helps.

Reduce inflammation

Research shows certain foods can cause inflammation. Thankfully, there are loads of yummy anti-inflammatory foods to keep things in check. Some options include:

  • fruits
  • veggies
  • plant-based proteins
  • antioxidant-rich green tea
  • omega-3 rich foods (e.g. salmon, walnuts, and flaxseed)

6. Sun exposure PSA

Many topical and oral acne treatments can increase your sun sensitivity. This can lead to sunburn, dryness, premature aging, and hyperpigmentation.

Lather up

Avoid direct sun exposure when you can. Even if you aren’t out catching rays you should still wear sunscreen on the reg. Use a minimum of SPF 30 daily.

Check out EltaMD UV Clear Broad-Spectrum SPF 46. It’s a dermatologist-recommended brand specifically formulated for sensitive, acne-prone skin.

Hormonal acne can be stubborn AF. If at-home treatments aren’t working it’s time to call a dermatologist. They can provide you with a tailored treatment approach. They can also help identify any underlying health conditions that might be triggering your acne.

Here are some common treatments your derm may recommend.

1. Prescription retinoids

An OTC retinoid might not cut it in severe acne cases. Your derm may give you a higher potency prescription.

What will I take?

Two retinoids commonly prescribed for acne include tretinoin (Retin-A, Avita) and tazarotene (Tazorac, Fabior, Avage). They’re topical treatments.

2. Anti-androgen meds

Your doctor might prescribe Aldactone (spironolactone) if they suspect acne is caused by excessive androgen. That’s a group of sex hormones that includes testosterone.

High androgen levels can cause massive acne mayhem. It can interfere with hair follicles that regulate skin cells and increase oil production.

What the pills do

Anti-androgen drugs prevent sebaceous glands from being stimulated by hormones. It’s been known to benefit peeps with cystic acne.

3. Oral contraceptives

Some oral contraceptives are FDA-approved for treating acne. They combine ethinyl estradiol (aka estrogen) with a progestin (e.g. drospirenone, norgestimate, and norethindrone). These synthetic hormones might decrease circulating androgens and decrease acne.

Drawback

Some experts believe birth control pills only mask the symptoms of hormonal imbalances. They may not address the root cause.

4. Oral options

Isotretinoin is a type of retinoic acid you take orally. It’s often considered a last resort treatment due to its potentially severe side effects. It’s usually only prescribed in severe cases — particularly for painful nodular and cystic acne.

“I think Isotretinoin is by far the most successful drug we have available for acne,” says Zenovia. “The key is using a low dose to minimize any potential health risks and side effects.”

Typically, if your doc puts you on this drug, frequent follow-up visits are required to monitor side effects and progress.

Isotretinoin side effects

The most common side effects include:

  • dry skin
  • severely chapped lips
  • nosebleeds
  • dry eyes
  • dry mouth

One study also suggested a link between Isotretinoin and depression, especially at higher doses.

Hormonal acne is super common. But it can still knock the confidence right out of ya.

Thankfully, there are plenty of treatment options to try. If home remedies don’t work, your derm may need to bring out the big guns — like prescription retinoids and oral medications. You’ll eventually find the regime that works best for you.