Hormonal Acne: Causes, Diagnosis, and Treatment

Hormonal acne is commonly associated with deep, painful breakouts around the chin, jawline, and lower cheeks. It often becomes worse before a period, although some people experience persistent breakouts throughout the month.

Hormones play a role in nearly every form of acne. Androgens can stimulate the sebaceous glands to produce more oil and contribute to clogged pores. However, a person does not need to have abnormally high hormone levels to develop hormonal acne. In many cases, the oil glands are simply more sensitive to hormonal activity.

How to Recognise Hormonal Acne

Signs of a hormonal pattern may include:

Breakouts that worsen before a period
Spots around the chin and jawline
Deep, painful lumps beneath the skin
Acne repeatedly appearing in the same areas
Acne beginning or returning in adulthood
Worsening after stopping hormonal contraception

Location alone is not enough to confirm hormonal acne. Jawline breakouts may also be related to cosmetics, hair products, friction, touching the face, or other factors.

Common Causes

In women, hormonal acne may become worse during the menstrual cycle, pregnancy, the postnatal period, and perimenopause. It may also appear after starting or stopping certain forms of hormonal contraception.

Polycystic ovary syndrome, or PCOS, is another possible cause. In addition to acne, signs may include irregular periods, excess facial or body hair, thinning scalp hair, ovulation problems, and insulin resistance.

Acne alone does not mean that someone has PCOS.

Testosterone therapy, anabolic steroids, certain corticosteroids, some prescription medicines, and workout supplements may also cause or worsen acne. Some people notice increased breakouts while using whey protein.

Are Hormone Tests Necessary?

Hormone testing is not required for everyone with acne. If menstrual cycles are regular and there are no other signs of a hormonal disorder, a dermatologist can often begin treatment without additional tests.

Further investigation may be recommended when acne is accompanied by:

Irregular or absent periods
Excess facial or body hair
Thinning scalp hair
A sudden and severe onset
Ovulation or fertility problems
Significant weight changes
Signs of insulin resistance

A doctor may recommend tests for androgens, thyroid hormones, prolactin, blood glucose, and other relevant markers. The choice of tests depends on the individual’s symptoms and medical history.

An ovarian ultrasound may form part of the assessment, but an ultrasound result alone is not sufficient to diagnose PCOS.

How Is Hormonal Acne Treated?

Topical treatment may include retinoids, benzoyl peroxide, azelaic acid, or salicylic acid. The appropriate choice depends on the type of acne, skin sensitivity, and whether pigmentation or scarring is also present.

Retinoids help prevent clogged pores and new breakouts. Benzoyl peroxide reduces inflammation and targets bacteria involved in acne. Azelaic acid can be particularly useful when acne is accompanied by redness and dark marks.

A basic skincare routine should include:

Gentle cleansing
An appropriate acne treatment
A non-comedogenic moisturiser
Daily sun protection

Harsh cleansing, frequent exfoliation, and combining too many active ingredients can damage the skin barrier and make irritation worse.

For persistent hormonal acne in women, a doctor may consider certain combined oral contraceptives or spironolactone. These medicines are not suitable for everyone and should only be used after an assessment of their benefits and potential risks.

Oral antibiotics may be prescribed temporarily for more extensive inflammatory acne. Severe, deep, or scarring acne may require isotretinoin under close dermatological supervision.

Retinoids, spironolactone, and isotretinoin must not be used during pregnancy. Anyone who is pregnant or planning a pregnancy should consult a healthcare professional before using acne medication.

Conclusion

When Can Results Be Expected?

Hormonal acne does not disappear overnight. Topical treatments usually need several weeks to begin working, while meaningful improvement is often assessed after approximately three months of consistent use. Hormonal treatments may also take several months to produce noticeable results.

A dermatologist should be consulted when acne is deep, painful, causes scarring, or does not respond to an appropriate skincare routine. A gynaecological or endocrinological assessment may be necessary when acne occurs alongside irregular periods, excess hair growth, thinning scalp hair, or other signs of a hormonal disorder.

Hormonal acne can be persistent, but it can usually be controlled with the right treatment. The goal is not simply to dry out existing spots, but to prevent new inflammation, protect the skin barrier, and reduce the risk of pigmentation and permanent scarring.

Frequently asked questions

Hormonal acne commonly presents as painful inflammatory nodules, papules, and cysts mainly on the lower face, including the chin, jawline, neck, and sometimes the upper chest. These lesions often occur cyclically, corresponding to hormonal changes such as menstrual cycles.

Hormonal acne predominantly affects adult women, especially during life stages with hormonal fluctuations such as puberty, menstrual cycles, pregnancy, postpartum, and menopause. Conditions like polycystic ovary syndrome (PCOS) can also contribute to hormonal acne persistence and severity.

Diagnosis involves a detailed history and physical exam focusing on lesion distribution and timing with hormonal cycles, alongside hormone level laboratory tests. Collaboration among dermatologists, gynecologists, and endocrinologists is often necessary to identify underlying hormonal imbalances or disorders.

Hormonal acne is localized mainly on the lower face, fluctuates with hormonal cycles, is more resistant to standard treatments, and tends to involve painful inflammatory lesions with a higher risk of scarring. Other acne types may be more widespread and include non-inflammatory comedones.

Treatment options include topical retinoids, benzoyl peroxide, topical and systemic antibiotics, oral isotretinoin for severe cases, and hormonal therapies like combined oral contraceptives or antiandrogens such as spironolactone. These require individualized plans under healthcare provider oversight.

Yes, professionally supervised cosmetic treatments like deep cleansing facials, chemical peels with salicylic or glycolic acid, microneedling, and laser therapies can support acne management and address scarring or hyperpigmentation. However, aggressive or irritating procedures should be avoided to prevent exacerbation.

Individuals should consult healthcare providers when acne is persistent, worsening, painful, resistant to over-the-counter treatments, or causing scarring. Early professional intervention enables accurate diagnosis and tailored treatment to prevent long-term physical and psychological effects.

Treatment often requires months to achieve noticeable improvement and may involve multiple therapies. Patients need regular monitoring for side effects, adherence to prescribed regimens, and collaboration with specialists to optimize outcomes and manage expectations effectively.

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