Hormonal acne is an all too often misused term. This is because most people use it as a diagnosis and assume their acne is hormonal simply because it appears in adulthood, clusters around the jawline or relates to hormone changes. In practice, the truth it is a bit more complex than that. All acne has some hormonal drivers but that does not mean it is hormonal acne. In this article, we’ll explore what hormonal acne is, how to tell if you have it and how to treat it.
What Does “Hormonal Acne” Actually Mean?
First off, all acne is has an element of hormone input. Specifically, androgen hormones regulate sebaceous (oil) gland activity which is a major driver of pore clogging and acne formation. However, not all acne is clinically hormonal. The distinction lies in whether hormonal sensitivity is the dominant driver of the acne or whether other factors such as abnormal keratinisation and slow skin cell shedding are more important. This varies from person to person.
Acne is described as hormonal when sensitivity to androgens becomes the dominant driver. This should be the lead trigger rather than things like surface inflammation, bacteria overgrowth or simple pore blockage. Whilst hormone levels are usually normal, the skin shows an exaggerated response to androgens. In these cases, sebaceous glands respond excessively, leading to increased sebum production and persistent pore dysfunction despite appropriate topical treatment. Hormonal acne frequently emerges or worsens due to hormonal shifts. Hormonal contraception, pregnancy, perimenopause and menopause are common triggers. Stress can also amplify androgen activity and worsen hormonal acne flares.
What’s the Difference Between Hormonal Acne vs Regular acne?
The difference between hormonal acne and “regular” acne lies less in how the acne looks and more in what is driving it. Whilst all acne has hormone involvement to some extent, not all acne is hormonally driven in a clinical sense. The key differences between hormonal vs regular acne include:
- Primary Driver: The primary driver of hormonal acne is higher sensitivity to normal androgen signalling at the sebaceous gland. This leads to ongoing sebum (oil) overproduction and follicular dysfunction. Whilst increase in oil production due to androgens is also a feature of regular acne, it is not the main driver. Instead, the drivers of regular acne are more often surface inflammation, bacteria overgrowth and abnormal keratinisation. These lead to pore blockage and pimple formation.
- Pattern & Timing: Hormonal acne often follows a cyclical pattern. It has predictable flares linked to menstrual cycles, stress or other hormonal shifts. Regular acne tends to be more continuous or situational, influenced by skincare, environment or stress.
- Distribution: In general, hormonal acne often affects the jawline, chin and lower face although this is not exclusive. Regular acne tends to have a more even spread and often affects the forehead, cheeks and upper face.
- Lesions: In hormonal acne lesions are often deeper, slower to resolve and prone to recurring in the same areas. Regular acne lesions are more likely to resolve fully and be replaced by new lesions elsewhere.
- Response to Treatment: Regular acne often responds well to treatments that target bacteria, inflammation or congestion. Hormonal acne may improve initially with these treatments but frequently relapses or plateaus unless you tackle the underlying hormonal driver.
- Long-term: Hormonal acne is more likely to persist into adulthood and require ongoing management. Regular acne is often more responsive to short- to medium-term treatment and may resolve as skin behaviour normalises.
Can You Have Both?
In practice, most people have features of both. Acne is rarely driven by a single mechanism, particularly in adult skin. Many people experience acne that combines hormonal sensitivity with surface inflammation, bacterial activity and follicular blockage. As such, this distinction becomes clinically relevant only when hormonal sensitivity is the dominant driver. This overlap explains why acne can behave inconsistently. Some lesions respond well to regular common acne treatments, whilst others persist, recur in the same areas or flare cyclically. This is because, hormonal sensitivity continues to influence sebum production. This leads to recurrence even if the treatments are targeting regular acne drivers like cell turnover and bacterial inflammation. Effective management requires addressing multiple drivers rather than relying on a single ingredient or approach.
How to Tell if Your Acne is Hormonal Acne?
Hormonal acne tends to follow recognisable clinical patterns. However, not every feature needs to be present for hormones to be playing the lead role. The diagnosis is rarely based on a single sign. Instead, it is the combination of timing, distribution, behaviour of lesions and response to treatment that raises suspicion of a hormonal driver. Common signs to help tell if your acne maybe hormonal include:
- Cyclical Flares: Breakouts often worsen predictably in the days or weeks leading up to a menstrual period or hormonal change. This cyclical pattern reflects changes in androgen activity rather than abnormal hormone levels.
- Lower Face Distribution: Pimples commonly cluster along the jawline, chin and lower face. Whilst hormonal acne can appear elsewhere, this distribution is particularly suggestive of hormonal acne when persistent.
- Deeper Lesions: Spots tend to form deeper within the skin, are often more tender and take longer to settle compared to surface inflammatory acne.
- Recurrent Breakouts in Same Areas: Pimples frequently return to the same regions, reflecting ongoing hormonal sensitivity rather than isolated clogged pores.
- Incomplete Response to Standard Treatments: Acne may improve partially with standard acne treatments but usually fails to clear fully or relapses quickly.
Why Standard Treatments Might Not Work
Standard acne treatments are often effective at reducing pore clogging, surface inflammation and bacterial load, which is why initial improvement is common. In hormonally driven acne, however, these treatments do not address the key driver which is oil excess due to androgen sensitivity. This then increases pore clogging and bacterial overgrowth which lead to microcomedones, comedones and inflammatory acne lesions. As such, pimples may not resolve completely, progress may plateau or acne may persist. The initial temptation is to assume that the acne is becoming treatment resistant. So rge response is often to escalate by increasing the strength, frequency or amount of regular treatments like benzoyl peroxide, exfoliating acids, antibiotics or retinoids. This however tends to yield very limited results and the most common reasons these standard treatments fall short include:
- Don’t Address Oil Overproduction: Treatments such as antibiotics, azelaic acid and benzoyl peroxide can calm active inflammation and reduce bacterial growth providing early improvement. However, they do not reduce androgen-driven sebum production. Excess oil therefore continues to fuel pore clogging and bacterial overgrowth beneath the surface.
- Can’t Prevent Microcomedone Formation: In hormonally driven acne, increased oil alters the follicular environment, promoting microcomedone formation even when surface inflammation is controlled. Treating visible lesions without addressing this process allows new blockages to form continuously which is the precursor to acne formation.
- Improvement Due to Suppression Not Control: Acne may appear stable while treatment is intensive, but often recurs once strength, frequency or number of products is reduced. This pattern reflects temporary suppression of downstream effects rather than modification of the main underlying hormonal driver.
- Escalation Can Make Things Worse: Increasing the strength or frequency of typical ingredients like benzoyl peroxide, exfoliating acids, antibiotics or retinoids rarely improves control when oil excess is the primary issue. Instead, they can increase the risk of barrier disruption, irritation or antibiotic resistance which can worsen inflammation and hold up progress.
- Repeated Product Changes Can Delay Appropriate Treatment: Cycling through different acne products can often delay introduction to treatments that target sebaceous behaviour more directly.
How to Treat Hormonal Acne
Treating hormonal acne requires a practical, layered approach that reflects how the acne behaves in real life. Because most people have a mixed acne pattern, treatment should normally combine therapies that address hormonal sensitivity whilst also controlling inflammation, bacteria and cell keeping pores clear. Crucially, the goal is not to eliminate every driver at once, but to target the dominant one whilst supporting the rest through:
- Targeting Hormonal Sensitivity: Prescription treatments such as spironolactone, roaccutane or certain combined oral contraceptives can help modify oil gland behaviour. This reduces sebum production to prevent hormonal acne formation rather than simply calming existing spots.
- Controlling Cell Surface Activity: Ingredients such as topical retinoids help normalise follicular turnover to reduce pore blocking. Agents like benzoyl peroxide, antibiotics or azelaic acid can reduce inflammation and bacterial activity. In hormonal acne, these treatments tend to improve severity and speed up healing of inflammatory papules, pustules and cysts rather than prevent recurrence.
- Adjusting Treatment for Mixed Acne Patterns: Many people have hormonally driven breakouts alongside regular blackheads, whiteheads or inflammatory lesions elsewhere on the face which may have other main drivers. In these cases, treatment should combine a hormonal therapy with exfoliants, retinoids and anti-inflammatories.
- Protecting Skin: More treatment is not always better. Overusing multiple actives can compromise the skin barrier, trigger flareups and worsen inflammation. Simplifying your routine to key actives that include oil suppression without stripping the skin or disturbing the microbiome often yields better results.
- Reassessing Treatment: Acne can fluctuate overtime depending on your age, health and environment. It makes sense to adjust treatment over time depending on how the skin behaves.
Hormonal acne is a misleading and misunderstood term. All acne is hormonally driven but from a clinical standpoint, hormonal acne is where androgens are the main driver. To make matters worse, most people often have a mix of acne which has different main drivers. That’s why it is often hard to diagnose but there are some strong signs and patterns of behaviour that can help you tell whether you have hormonal acne. Identifying hormonal influence as the key driver does not automatically determine treatment. However, it does explain why certain approaches repeatedly fall short and why progress often plateaus when the underlying driver is not addressed. Optimal treatment usually requires addressing the hormonally driven excess oil production in addition to using typical acne treatments that also target exfoliation, inflammation and bacterial growth.
At City Skin Clinic, we are extremely passionate about personalised skincare. Our virtual skin clinic offers safe and effective custom skin treatments. Where appropriate our doctors use ingredients such as Tretinoin, Hydroquinone and Spironolactone to treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. Start your online consultation today. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
