Welcome to your safe space for all things hormonal acne, hosted by me, your resident acne-prone editor. I’ve sobbed more times than I can count over throbbing blind pimples that surprise me every few days, or red breakouts that constantly adorn my chin (and subsequent hyperpigmentation). Which means I’ve also spent years bugging dermatologists and aestheticians for the best hormonal acne treatments—while being a pimple guinea pig in the process. I've been through it all trying to treat my adult hormonal acne: a stint with spironolactone, intricate facials, changes in my diet, every exfoliator and spot treatment known to humankind, everything. And if I haven’t (thanks to my dry and sensitive skin), I’ve genuinely spent weeks obsessively researching said treatment, doomscrolling reviews, and asking fellow beauty editors. These days my skin is my most complimented feature. No one knows what I went through just a few years ago. So, trust me when I say that your reoccurring acne isn’t hopeless, your skin won’t mess with your sanity forever, and you will find a treatment that works for you—I’m here to make that process easier. Let’s get into it, shall we? What is hormonal acne? Technically, all acne has a hormonal component (yup, even blackheads and whiteheads). But the “hormonal acne” you and your friends talk about is a term used to describe inflammatory acne that suddenly occurs (or worsens) in women in their 20s and 30s, says dermatologist Mona Gohara, MD. Of course, hormonal acne affects all genders and ages, but the worsening of acne in adult females has been so prominent in recent years—studies estimate more than 50 percent of women experience it—that it’s even earned its own studies, research, and clinical name: adult female acne. Adult female acne is caused by an overproduction of sebum (skin oils) that clogs pores, leading to cystic zits, blackheads, whiteheads, etc. “When your hormones stimulate excess oil production in your pores, bacteria settles in, feasts on the oil, and creates inflammation that leads to a pimple,” says Dr. Gohara. What causes hormonal acne? Hormonal changes (periods, PCOS, pregnancy, puberty) Lifestyle changes (anxiety, stress, lack of sleep, excess sugar and/or alcohol) Medications (starting or stopping birth control, corticosteroids, certain supplements) Hormonal acne is primarily caused by fluctuations in hormones, particularly androgens, which can increase oil production in the skin. Women experience daily hormonal changes, but those with a genetic predisposition to acne are more likely to develop breakouts. Before menstruation, rising androgen levels stimulate excess oil production, which, when combined with faster skin shedding, can lead to clogged pores—especially around the jawline and chin, where oil gland activity is higher. This is why hormonal breakouts in these areas are so common. "Two key factors in managing hormonal acne are reducing inflammation and using topical treatments," says Madalaina Conti, a licensed aesthetician who specializes in helping those with acne-prone and/or inflamed skin. "If your breakouts are closely tied to your menstrual cycle, addressing hormonal balance and skincare at the right time can help minimize those flare-ups." How do I get rid of hormonal acne? If you’re dealing with cystic or inflammatory acne, you should make that dermatologist appointment—yes, even a virtual one will do. For mild-to-moderate hormonal breakouts, you might see results with at-home treatments and skin-centric lifestyle changes. So, let’s break down your options: at-home solutions (for less severe breakouts) vs. professional treatments (some real game-changers). 1. Make your skincare routine acne-focused As someone who was on spironolactone for years, it worked to minimize the severity of my hormonal acne, but I still was experiencing monthly breakouts around my period and post acne-marks that I wanted to mitigate. The thing that really wiped most of my pimples away: a clean skincare routine with mandelic acid at its core. "A mandelic acid serum is a must-have for daily use—even if you don’t have acne. It’s excellent for brightening pigmentation, firming the skin, and maintaining overall skin health," says Conti. There's a reason why every acne expert swears by it. Here are some of our favorites: Another ingredient to consider is benzoyl peroxide, which not only kills acne-causing bacteria, but it also “decreases oil production by decreasing lipid and fatty acid production, and has mild whitehead and blackhead-fighting abilities,” says board-certifed dermatologist Joyce Imahiyerobo-Ip, MD. There are benzoyl peroxide-filled masks or face washes, choose your fighter: And a non-comedogenic moisturizer is obviously essential to protect the skin barrier and prevent over-drying too, so no matter what active ingredient you choose to treat your acne, make sure you're following up with a moisturizer. 2. Try prescription topicals Generally, prescription retinoids are the first line of (topical) defense against hormonal acne. “Retinoids speed up and regulate the shedding within your oil glands, so bacteria doesn’t have anything to feed off of to create inflammation,” says Dr. Gohara. Prescription-strength retinoids are the most effective against cystic acne, especially since many of them are formulated with additional acne treatments, like topical antibiotics and anti-inflammatories. If your skin is highly sensitive, or you really just want to try an at-home option first, “try to start with adapalene—like Differin or La-Roche Posay Effaclar—which is a prescription-strength drugstore retinoid specifically formulated to treat acne,” says Dr. Gohara. Apply it every other night to dry skin (followed by a thick layer of moisturizer), and if you’re still not seeing any positive results in six weeks, “go to the dermatologist; it’s just not worth the scarring or inflammation,” she says. 3. Look into hormone-regulating acne medication You’ve got two major options when it comes to regulating and stabilizing your hormones: oral birth control and spironolactone. Both of these medications work by limiting, regulating, or decreasing the effects of acne-stimulating androgens in your body (androgens, which include testosterone, are thought of as male sex hormones, though they’re found in all humans at varying levels). Dermatologists often prescribe both at once, and this combo works: “We usually start to see great results after three cycles, or about three months,” says Dr. Gohara. Of course, any medication has its potential side effects (your derm will fill you in), but more than half of the Cosmo staff is taking spiro and birth control right now, because it’s that effective. But if it’s not for you, there's more! 4. Keep your cortisol levels in check "Increased levels of stress, a lack of sleep, and depression can all be causes of acne," says Conti. "They lead to changes in cortisol levels and hormone imbalances." You can get your cortisol levels tested at a doctor, but some easy ways to decrease stress and cortisol are getting eight hours of sleep, daily exercise, and minimizing stress in your life (aka drop that situationship or toxic friend, stat!). 5. Monitor your diet If your meals currently consist of fries and cookies (guilty), all washed down with multiple glasses of wine or diet coke (guilty again), you should know you’re not exactly helping your hormonal acne situation. “The sugar found in sweets can actually spike acne-causing hormones,” says board-certified dermatologist Joshua Zeichner, MD. A rise in insulin, which can cause a hormonal cascade, can lead to inflammation and breakouts. While you don't need to completely eliminate your favorite meals, incorporating foods that are anti-inflammatory and high in omegas—like salmon and avocado—can be great for acne because they act as a 'pore lubricant' that helps keep the less congested and less prone to clogged pores, says Conti. 6. Examine your makeup routine We're curating a perfect skincare routine with acne-fighting ingredients, why would you wanna go and ruin it with a pore-clogging makeup routine?! I try to steer clear of makeup formulas with more than two pore-clogging ingredients in them. You can copy and paste ingredient lists into online checkers (I like Sofie Pavitt's version) to make sure they're not filled with sneaky acne-inducers. The foundation you wear is especially important, so be sure to run those ingredient lists through a pore-clogger checker or simply shop from our list of editor-vetted non-comedogenic foundations. 7. Track your cycle Keeping tabs on your menstrual cycle and then adjusting your skincare as needed can help prevent pre-period flare-ups. For example, if you only have hormonal acne before your period try using benzoyl peroxide every other night the week or two before your period is supposed to start to help keep breakouts in check," says Conti. 8. Utilise LED devices If you're not already on the LED train, it's time to hop on. Red light reduces inflammation and stimulates collagen production, while blue light can kill acne-causing bacteria. With consistent use, an LED mask can prevent and heal breakouts and improve your skin tone and texture too. 9. Wash your pillowcases often And by often I mean at least twice a week. Your pillows and sheets can carry bacteria and oil that can irritate the skin and cause breakouts. Many experts I've spoken to recommend using a gentle laundry detergent to wash your pillowcases and sheets too since certain heavily fragranced detergents can irritate the skin and end up exacerbating acne. 10. Consider a laser treatment AviClear, a professional laser treatment, hit derm offices a few years ago and has been a popular option for treating stubborn breakouts. It downregulates your oil-producing glands, making them less active and functional, to help prevent acne. That said, AviClear is expensive and doesn't address the root cause of hormonal acne (which is fluctuating hormones), so it's important to pair the laser treatment with a good skincare routine and healthy lifestyle. Final thoughts: Treating hormonal acne is truly a holistic process. You can't just swallow a pill or slather on a cream and expect 100 percent acne-free skin. But by incorporating some (or all) of these steps and tips into your routine and making an appointment to see a dermatologist, you're setting yourself up for clearer skin. Meet the experts: Joyce Imahiyerobo-Ip, MD, is a board-certified dermatologist and CEO of Vibrant Dermatology and Skin Bar MD in Boston, MA. Dr. Imahiyerobo-Ip has previously spoken to Cosmo about benzoyl peroxide in skincare products. Madalaina Conti is a licensed aesthetician in New York, NY who focuses on holistic skin health and wellness. Mona Gohara, MD, is an associate clinical professor of dermatology at Yale School of Medicine and a board-certified dermatologist. Dr. Gohara has also spoken to Cosmo about cystic acne and cortisone shots. Joshua Zeichner, MD, is an associate professor of dermatology and the director of cosmetic & clinical research in dermatology at Mount Sinai Hospital in New York, NY. Dr. Zeichner has also spoken to Cosmo about stress breakouts. Why trust Cosmopolitan? Jasmine Hyman is the assistant beauty editor at Cosmopolitan. She's endured her fair share of hormonal acne and, as a result, has tried just about every skin-clearing product, treatment, and tip over the years. For this story, she spoke to dermatologists and aestheticians for their best advice for treating hormonal acne. Lead image credit: Cosmopolitan US
