50% Of Women In Their 20s Have Hormonal Acne — How To Finally Get Clear Skin

Do you know anyone who takes spironolactone? If you’re a woman in your mid-20s, chances are you probably do. This medication is used off-label to treat hormonal acne in women, a skin condition 50.9% of women in their 20s and 25% of women in their 40s struggle with—plus, research shows this kind of “adult acne” can persist even after the age of 501. Men can experience hormonal acne as well, but it’s much more common in women, especially in adulthood.

But has hormonal acne always been a major part of the female experience? Given the increased stress levels, hustle culture, hormonal birth control, and hormone disrupters found in the world today, it’s safe to say probably not. 

This kind of acne is particularly frustrating because you simply cannot completely control the root trigger—imbalanced hormones. Not to mention, getting acne in your adult years can make you feel insecure, as if you don’t give off a mature, professional appearance when you need to. 

However, dermatologists have been treating this form of acne for decades, with more trusted options available now than ever before. If you’ve been going through it with hormonal breakouts, we hear you. We asked dermatologists for help, so you can feel more in control of what’s happening underneath your skin and learn how to ease these pesky breakouts.

To come, the 101 on hormonal acne—from root causes to a full skin care routine and how to support hormonal health from within. 

Not-so-fun fact: Sebum production is controlled by hormones, specifically androgens, board-certified dermatologist and founder of NicholsMD of Greenwhich Kim Nichols, M.D., FAAD tells mbg. Androgens cause the enlargement and overstimulation of the sebaceous glands found in the hair follicles, she explains. Then, this sebum snatches up dead skin cells and clogs the pore, resulting in a breakout. 

Estrogens have the opposite effect, meaning they inhibit the secretion of androgens, modulate genes involved in the growth of the sebaceous gland and inhibit their function. The activity of the sebaceous gland, therefore, depends on the estrogen and androgen ratio1—which is why many people consider birth control pills containing estrogen as a possible form of treatment. 

You’ll generally find hormonal breakouts on the chin and along the jawline, often going down onto the neck as well. Back and chest acne can also be linked to hormone imbalances. Some breakouts can be pustules and papules (inflamed zits with a white head), while others can be cystic and under the skin. 

“Cystic pimples are deeper, larger, and can occur when the bacteria, sebum, and dead skin cells become trapped beneath the surface of the skin and can cause a large and painful bump,” Nichols explains. And yes, you can have a combination of both. 

1.

Figure out what type of breakouts you’re dealing with. 

2.

Put together your topical routine.

If you have a combination of any of the following, you’ll want to focus on the most severe type of pimple you have and treat it from there. Before we get into that, you should know that many of these treatments can take anywhere from a few weeks to a few months for the best results to show—so don’t switch it up too early and give each method at least three months to show you what it can do. 

Here, the best active ingredients for each form of acne.

3.

In the meantime, tend to your hormones internally. 

As mentioned before, you can support healthy hormones from within. This includes lifestyle choices surrounding diet, exercise, sleep, and mental health. 

Diet wise, do your best to craft up balanced plates. This means getting your leafy greens, protein, healthy fats, and carbohydrates. Include other foods like those rich in probiotics and fiber as well—here’s more ideas if you want to dive deeper. 

A lack of high-quality sleep will increase cortisol levels, which, as you now know, can manifest into more sebum production and more breakouts. Do your best to get a full night's rest as often as you can (helpful tips here if you struggle catching Z’s).  

If at all possible, try to manage your stress levels, too. Stress can cause an increase in sebum production—which you don’t need on top of a hormonal uptick. Experiment with meditation, breathwork, yoga, journaling, or any other activity that makes you feel calm. 

Lastly, exercise! Exercise produces endorphins2—chemicals in the brain that make you feel good—which help decrease tension, elevate mood, improve sleep, and boost self-esteem. Plus, it may double as a stress management technique.

It can be tempting to deploy all of your acne fighters at once, but here’s the thing—you don’t need to “fight” your acne, you need to heal it. This means selecting those targeted treatments (like retinoids, exfoliants, benzoyl peroxide, etc.) and sandwiching them in a barrier-supporting skin care routine. 

Be sure to keep the rest of your products (like serums and moisturizers) solely focused on replenishing hydration—but be sure to scan them for pore-clogging ingredients first. Apart from your cleanser and treatment, look for hydrating serums, nourishing moisturizers, and of course, SPF. 

You’ll know you’ve overdone it if your skin becomes red, itchy, and sensitized. This means you have a damaged skin barrier, and you’ll need to lay off the actives for a few days and repair it (here’s how). 

5.

Know your prescription options. 

Unfortunately, there is a stigma surrounding acne medication, but let us be very clear: If your acne is causing you psychological stress and your dermatologist thinks you’re a great candidate for oral medication, you shouldn’t feel shame for following their suggestion. 

As we mentioned before, acne is a very complex skin condition, and it’s equally as personal. While the steps above will help many people struggling with hormonal breakouts, plenty of other folks may need something stronger to fully clear their acne and keep it at bay. 

For hormonal, you have four main oral prescription options: 

Last but not least, don’t hesitate to see your dermatologist. Many people are under the impression that anything less than cystic acne should just be treated at home, but every kind of breakout can benefit from a derm visit, if you have access to one. 

What’s more, prescription-grade retinoids can be cheaper than OTC options, depending on your medical insurance. If you visit the derm, they can help you assess the most affordable options for your financial situation. 

Every person has unique skin, even if they experience similar breakouts. A dermatologist can help you figure out which products will work best for your skin type and give you some peace of mind that what you’re doing right now is the best path to take.