As an adult, you may have thought acne was a thing of the past, associating it with puberty and adolescence. However, adult acne is very real and often occurs as a result of hormone changes.

Depending on the severity of your hormonal acne, treatment options to manage breakouts include lifestyle changes—like diet adjustments or using different skin care products—to in-office procedures like laser treatments or corticosteroid injections.

1. Lifestyle Changes

Some lifestyle changes that may help reduce acne include:

• Use noncomedogenic products: Certain hair and skin care products can clog pores and cause acne or worsen. Use products identified as noncomedogenic, non-acnegenic, oil-free, and “won’t clog pores” to reduce the risk of clogged pores and acne.
• Change your diet: Foods with a high glycemic index (those that spike your blood sugar, like bread, rice, and potatoes) have been shown to increase androgen levels and exacerbate acne.
• Manage stress: Stress can cause androgen levels to increase, causing acne.

2. Over-the-Counter (OTC) Treatments

Some over-the-counter (OTC) at-home medications that are safe to try with acne include:

• Differin (adapalene): This OTC vitamin A gel can help with whiteheads, blackheads, and pimples.
• Azelex (azelaic acid): This topical treatment fights acne and fades dark spots that occur once the acne spots clear.
• Clearasil (benzoyl peroxide): This cream or gel effectively manages mild pimples. However, it can dry the skin, so experts recommend starting with a product containing 2.5% benzoyl peroxide and slowly increasing to products containing up to 10% benzoyl peroxide over time.
• PanOxyl 2% (salicylic acid): This topical treatment helps unclog pores and works best on white and blackheads. It also exfoliates the skin and removes dead skin cells, which can prevent acne.

3. Complementary Therapies

Complementary therapies are intended to provide other options for use in combination with or in place of conventional acne treatment. Talk to a healthcare provider before trying complementary therapies to ensure they don’t interact with your current medications.

Some complementary therapies that have shown successful in treating acne include:

• Topical tea tree oil and bee venom: There is weak evidence that topical tea tree oil and bee venom reduce adult acne, though it may irritate the skin or trigger allergies in some people.
• Oral barberry extract: Liquid barberry extract may help treat moderate-to-severe acne.
• Oral zinc: The evidence to support oral zinc supplements for adult acne treatment is mixed.
• Oral gugulipid: Gugulipid is an extract of gum guggul. When taken orally twice a day, it was shown to be as effective as systemic antibiotics in treating nodular acne.
• Topical or oral probiotics: Probiotics effectively minimize the growth of bacteria and control the inflammation associated with acne.

4. Prescription Options

A healthcare provider or dermatologist (medical skin specialist) can prescribe various medications for hormonal acne, including:

• Birth control pills: The U.S. Food and Drug Administration (FDA) has approved these medications to treat acne because they help regulate hormones to allow for the androgen-to-estrogen ratio to stay balanced.
• Spironolactone: A prescription medication primarily taken for high blood pressure. It can help regulate hormone levels and decrease the incidence of adult acne, mainly in women.
• Retinoids: Retinoids are compounds derived from vitamin A that help prevent pores from clogging and thus decrease acne outbreaks.
• Clascoterone: An FDA-approved medication taken specifically for hormone-related adult acne. It works by helping control androgen production.
• Isotretinoin: Commonly known as Absorica, Claravis, or Zenatane, this is often prescribed to treat nodular acne, a severe type of acne that frequently causes scarring. Accutane is a type of isotretinoin that is no longer available.
• Dapsone topical: A prescription medication sold under the brand name Aczone, which is applied directly to the affected skin to help slow or stop bacterial growth and reduce inflammation.

Sometimes, healthcare providers combine these prescription therapies to achieve the best results. Follow your healthcare provider’s instructions to prevent unexpected side effects or complications.

5. In-Office Treatments

A healthcare provider treating hormonal acne might recommend the following in-office treatments:

• Corticosteroid injections: Corticosteroids can relieve swelling and pain associated with severe, painful acne outbreaks. Providers use them sparingly because they inhibit the body’s immune system from functioning fully.
• Chemical peels: A chemical peel can effectively remove dead skin cells, which can clog pores, and excess oil, both of which can prevent acne.
• Laser light therapy: A dermatologist may recommend laser therapy for mild-to-moderate acne. The therapy uses a combination of lasers and light treatments to penetrate the skin based on the severity of the acne.
• Acne surgery: This procedure physically removes acne. It should be performed by someone trained in performing acne extractions, such as a dermatologist.

What Is the Link Between Hormones and Acne?

The skin requires sebum, an oil produced from the sebaceous glands, to keep skin hydrated. Androgens (a dominant male hormone) cause the sebaceous glands to produce more sebum. Estrogen (a dominant female hormone) minimizes the production of androgens and thus reduces the amount of sebum produced.

When these hormone levels fluctuate—due to things like menstruation, menopause, pregnancy, and birth control—it can cause an overproduction of sebum, resulting in clogged pores and acne.

Common Breakout Locations

Older studies have suggested that hormonal acne appears on the lower third of the face, typically around the mouth, chin, and jawline. However, more recent studies have observed hormonal acne in other areas, including:

• Along the cheekbone
• Along the temples (on both sides of the head)
• Forehead
• Lower jawline

Acne can also appear in other areas, such as around the eyes or on the neck, chest, back, and buttocks.

Types and Severity of Hormonal Acne

There are different types of acne that can occur in any of the above areas, including:

• Whiteheads: Blocked hair follicles that remain under the top layer of skin and appear to be a white bump on the skin surface
• Blackheads: Blocked hair follicles that are open on the skin’s surface. The sebum becomes discolored when exposed to air, not necessarily because the follicle contains dirt.
• Papules: Small, pink, inflamed bumps that can be tender to touch
• Pustules or pimples: Papules with white or yellow pus-containing spots that are usually red at the base
• Nodules: Often painful, large, and solid sacs deep within the skin structure
• Severe nodular acne or cystic acne: Deep and painful sacs (similar to nodules) that contain pus

Acne can range from mild to severe.

• Mild: A few spots of whiteheads or blackheads
• Moderate: Many breakout locations that also include pustules
• Severe: Many breakout locations that also include nodule and/or cystic acne

When to Ask a Provider

Many adults can safely and effectively treat mild-to-moderate acne at home. Be patient and consistently take your at-home medication as directed. The number of acne breakouts should decrease within four to eight weeks, with clearing occurring around 16 weeks.

Contact a healthcare provider if you do not see results or you notice dark spots on your skin after the acne clears up.

If your adult acne is moderate to severe, you may benefit from prescription treatment. Many at-home medication options are not strong enough to treat deep adult acne.

Summary

Hormonal acne, often called “adult acne,” results from hormone imbalances. An imbalance of androgen and estrogen levels can cause an overproduction of sebum, leading to clogged pores and acne.

People with mild to moderate acne can treat it at home with lifestyle changes, OTC medications, and complementary treatments. Those with more severe cases can benefit from prescription medications and therapies.