How to Get Your Hormonal Acne Under Control

Tackling the most common types of acne is quite the process as it is, but when you add hormones into the mix, it gets increasingly frustrating. Getting hit with a hormonal breakout is a major letdown; it can make you feel like you have to start from scratch to get your skin balanced again. We know we're not the only ones who know this struggle all too well. That's why we spoke to some leading experts in the skin-care industry to find out what causes hormonal acne, how to prevent it, and ways to manage it when you have a flare-up.

Dennis Gross, MD, is a dermatologist based in New York City, as well as the founder of Dr. Denis Gross Skincare.

Francine Porter is the founder of Osmotics Cosmeceuticals, a brand that creates science-backed antiaging products for skin and hair.

Julie E. Russak, MD, FAAD, is the founder of Russak + Aesthetic Center.

Ildi Pekar is a celebrity facialist who uses Hungarian practices and a holistic approach to skin care in her services.

Let's start with the basics of what causes acne in general. Contrary to popular belief, it's not always about the amount of oil but the quality of oil. Some of us get breakouts when the production of excess sebum and oil is too thick and waxy. "Instead of flowing freely through pores, this type of oil becomes blocked and forms a plug," New York City dermatologist Dennis Gross, MD, tells PS. That plug congests the pore and results in a blemish.

Oily complexions aren't the only source of spots. If you have dry, flaky skin and still suffer from breakouts, you may have an oil flow problem. Dead skin cells prevent sebum from making it to the surface of the skin, so it gets trapped inside of pores and creates acne-causing bacteria. This typically results in blackheads, enlarged pores, and even drier skin.

Francine Porter, founder of Osmotics Cosmeceuticals, says another root of acne can be "abnormally sticky skin cells" because they don't properly shed, clogging hair follicles. That's why cell turnover is so important when combating breakouts (more on that later).

According to Porter, it's typically caused by an increase in the male hormone called androgen. Androgen overstimulates oil glands and alters the behavior of skin cells, contributing to acne flare-ups.

If you think hormonal acne is just something women have to deal with, you'd be surprised to find out this isn't the case at all. It actually affects both men and women. Porter explains that men are more likely to develop severe forms of acne (including inflammatory and cystic) during adolescence. Luckily for them, these skin problems tend to diminish once they are adults.

Unfortunately, ladies have the reverse issue. While women tend to have milder breakouts when they're younger, they are more prone to develop adult acne. This can be explained by the fact that women's hormones fluctuate more.

There are a few major clues that can help you figure out whether or not your zits are due to hormones. The first big one, Porter says, is the timing of your breakouts. "You'll often have flares during menstrual cycle or ovulation, starting a new birth-control pill, or during other hormonal shifts such as pregnancy or menopause," she says.

Another indicator is the location of your acne. Hormonal acne is usually located under the cheekbones, along the jawline, or around the mouth.

The appearance of the pimples also offers clues. "Hormonal acne tends to be deep or cystic and sensitive or painful to touch; it is also more likely to leave a scar," Porter says.

Also be sure to pay attention to what type of treatments your acne responds to. Porter explains that if your breakouts are not responding to topical treatments or change (for better or worse!) when you take or stop taking hormonal birth control, these are all signs that hormones are the offender. "The problem isn't coming from the surface of your skin but from hormonal shifts and imbalances that affect your entire body," she says.

If you're on birth control, Porter recommends checking the brand and type. There are brands that help keep skin clear and others that can trigger breakouts. Ask your doctor which prescription is best for you.

Skin Care

A good skin-care routine is key to keeping hormonal inflammation at bay and minimizing inevitable flare-ups. For the best results, use a gentle noncomedogenic cleanser daily and avoid products containing irritants like fragrance or witch hazel. A mild spot treatment containing salicylic acid will help stave off any surface-level breakouts, and a lightweight moisturizer will add soothing moisture. And, of course, no touching, squeezing, or pinching pimples!

The root cause of acne is when oil glands are blocked. You can prevent this from happening by using a topical exfoliant.

"Many people do not realize that a blemish may begin to form two to three weeks before it appears on the surface of the skin," Dr. Gross says. This means you have to be on top of your acne-fighting game at all times, not just when zits rear their ugly heads.

Other topical products you can use daily include SkinCeuticals's Blemish + Age Defense ($110). It reduces fine lines and wrinkles on aging skin, but it also contains salicylic acid to prevent breakouts and even skin tone. Salicylic acid can be a bit drying, so pairing it with a moisturizer is key. Using one with the potent antioxidant vitamin C will protect your skin against harmful free radicals (and fade dark spots!) while erasing redness left behind by breakouts.

Incorporating a product containing retinol into your routine is something you also might want to consider. Sure, we all think of retinol as an antiaging tool because it accelerates cell turnover, but that same process is helpful for preventing and reducing the effects of breakouts. It also reduces pore size.

Additionally, having a good spot treatment is a necessity for your arsenal. Sulfur is a great ingredient to reach for when it comes to banishing eruptions because it controls that dreaded acne-causing bacteria.

Diet

It's also important to work from the inside out when hormonal fluctuations come into play. According to Julie E. Russak, MD, FAAD, and founder of Russak + Aesthetic Center, not only is your diet important, but specifically the time of day you eat. She suggested skipping that late-night snack, saying, "Sweets or even a sugary cocktail before bed can spike blood-sugar levels and create inflammation, worsening acne."

To really give your skin TLC, you should drink plenty of water and eat lots of bright fruits and veggies. Celebrity facialist Ildi Pekar also suggests cutting down on dairy and soy before and during your period as they tend to cause flare-ups.

Sleep

A good night's sleep can do wonders for our mood and general well-being, but it's also an important part of a good skin-care routine. "The less sleep you get, the more your body releases glucocorticoid, a steroid that can exacerbate breakouts," Dr. Russak says. She also believes in changing your pillowcase at least once a week for clearer skin. A silk or satin pillowcase is preferable because the weave reduces chafing on the skin. If you have long hair, sleep with it pulled away from your face — your leave-in hair products might be aggravating your skin.

Other Solutions

Reducing stress and taking some time to relax can actually help to nip acne in the bud. Getting a facial every six to eight weeks will not only help clear congested skin, keep it balanced, and prevent future breakouts, but it will also give you some time to unwind.

In addition to facials, LED therapy has proven to work well on acne. LED treatments are quick, painless treatments that use different-colored UV-free light to address all kinds of skin concerns. Opt for a blue-light one when dealing with acne. "The blue light penetrates deep into skin to kill bacteria and heal damaged skin cells," Pekar says.

Ani Palen is a PS contributor.