Hormonal acne: what causes it and what helps

Key takeaways

• “Hormonal acne” usually means acne in adults, most often women, that’s linked to hormone changes. Hormones called androgens make the skin produce more oil.

• It often shows up on the lower face, like the jaw, chin and around the mouth, and many women notice flares before their period.

• Over-the-counter options include adapalene, benzoyl peroxide, azelaic acid and salicylic acid. Give one six to eight weeks.

• A dermatologist can prescribe hormonal treatments, such as certain birth control pills or spironolactone, which work on the hormone side.

• See a doctor if acne comes with irregular periods or extra hair growth, which can be signs of polycystic ovary syndrome (PCOS).

What is hormonal acne?

Hormonal acne is acne tied to changes in hormone levels. Cleveland Clinic describes it as developing “when hormonal changes increase the amount of oil your skin produces,” and calls it another name for adult acne. Doctors often use the term adult female acne, which a 2019 clinical guide defines as acne in women over 25 that either continues from the teen years or starts for the first time in adulthood.

The American Academy of Dermatology (AAD) says women tend to get adult acne more often than men. It explains that androgens, a type of hormone, “stimulate the oil glands and hair follicles in the skin, which can lead to acne.” Hormone levels don’t have to be abnormal, though. The 2019 guide notes that hormonal treatments can work even in women whose hormone levels test normal.

Where does hormonal acne show up?

It’s often on the lower face. The 2019 guide says adult female acne tends to appear on the jaw, chin and around the mouth, in a U-shape, along with the front of the neck. That pattern isn’t a rule: Harvard Health notes adult acne “can appear on any part of the face or trunk.”

It can include deep, tender bumps. The AAD mentions deep-seated, tender acne on the lower face, jawline or neck as the kind a hormonal treatment can help.

The same 2019 guide says 60% to 70% of women with adult acne notice it gets worse before their period.

What triggers hormonal acne?

The AAD lists several times when hormones shift:

• Around your period.

• During pregnancy, perimenopause and menopause.

• After stopping, or starting, birth control pills.

• Stress, which the AAD says causes the body to make more androgens.

Other things can play a part too. The AAD also lists family history, hair and skin care products and side effects of some medicines. And the American College of Obstetricians and Gynecologists (ACOG) notes that the high androgen levels in PCOS can cause acne.

Over-the-counter treatments

The AAD’s guide to adult acne treatment lists these active ingredients for mild to moderate acne:

• Adapalene. A retinoid that helps clear blackheads, whiteheads and pimples. It’s been sold without a prescription in the US since 2016. Our guide to retinal vs retinol explains how retinoids compare.

• Benzoyl peroxide. The AAD suggests starting with 2.5% to avoid dryness and burning. Our list of face washes for acne covers benzoyl peroxide and salicylic acid washes.

• Azelaic acid. The AAD says it fights acne and can also fade the dark spots acne leaves behind. Products you can buy without a prescription use lower strengths than the 15% and 20% prescription versions. Our list of azelaic acid products compares options.

• Salicylic acid. It helps unclog pores.

For individual pimples, our list of acne spot treatments covers creams and patches. The AAD says to use a product for six to eight weeks, and to expect fewer breakouts in four to eight weeks and clearing around 16 weeks after starting.

Prescription treatments

If over-the-counter products don’t help, a dermatologist can work on the hormone side. The AAD’s page on hormonal therapy covers the main options:

• Birth control pills. The FDA has approved some combined oral contraceptives for treating acne, for women who also want birth control. The AAD says it can take two to three months to see results.

• Spironolactone. It isn’t FDA-approved for acne, but dermatologists often prescribe it off-label. In one group of 85 women, a third had complete clearing and another third had noticeably less acne. If you can get pregnant, you need to use birth control while taking it, because it can cause serious birth defects.

• Clascoterone cream. A prescription cream approved in 2020 that blocks androgens in the skin, for people 12 and older.

A 2024 AAD guideline gives conditional recommendations to birth control pills, spironolactone and clascoterone, and strong recommendations to benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline.

Does diet cause hormonal acne?

The evidence is limited. The AAD’s page on diet and acne says small studies suggest a low-glycemic diet may reduce acne, but that other studies haven’t found a link and more research is needed. One large study found women who drank two or more glasses of skim milk a day were 44% more likely to have acne, but the AAD notes no studies have found that yogurt or cheese lead to more breakouts.

When to see a doctor

• Signs of PCOS. ACOG lists irregular periods, excess hair growth on the face, chest, belly or upper thighs, and severe acne or acne after adolescence that doesn’t respond to usual treatments.

• Deep or scarring acne. The AAD says that large, painful pimples deep in the skin, or acne that leaves scars, need a dermatologist.

• No improvement. The AAD suggests making an appointment if your skin isn’t clear within a few months.

• Pregnancy. The AAD advises talking to a dermatologist before treating acne on your own if you’re pregnant or trying to get pregnant.

Not every jawline breakout is hormonal. Small, itchy, same-sized bumps may be fungal acne, and a rash around the mouth could be perioral dermatitis, which each need different care.

Frequently asked questions

What does hormonal acne look like?

It can appear as pimples or deep, tender bumps on the lower face, like the jawline, chin and around the mouth, and tends to flare before periods. It can appear elsewhere on the face and body too.

How do I know if my acne is hormonal?

Clues include acne that started or continued into your 20s or later, flares that follow your menstrual cycle, and breakouts on the lower face. A dermatologist can confirm it and check for conditions like PCOS.

Does birth control help hormonal acne?

Some combined birth control pills are FDA-approved to treat acne. The AAD says they can take two to three months to work. Talk to a doctor about whether they’re right for you.

Can hormonal acne go away on its own?

It can come and go with hormone changes, like during pregnancy or around menopause, but it often needs treatment to clear. The AAD says to expect fewer breakouts four to eight weeks after starting a treatment.

What is the best treatment for hormonal acne?

It depends on how severe it is. Over-the-counter adapalene, benzoyl peroxide or azelaic acid help many people. For stubborn cases, a dermatologist may suggest birth control pills, spironolactone or clascoterone.