What is hormonal acne?

How to identify the typical pattern of hormone-influenced acne and what to do safely, without falling into myths or improvised treatments.

Summary in 60 seconds

• So-called «hormonal acne» usually refers to outbreaks that worsen with hormonal changes, especially around the menstrual cycle.
• It is not a rigid label or a separate diagnosis, but a frequent clinical pattern.
• It often affects the chin, jaw, and lower face, although it does not always follow that exact pattern.
• It can appear in adolescence, persist into adulthood, or begin later, especially in women.
• Factors influencing this include sebum, pore obstruction, inflammation, and the sensitivity of the pilosebaceous unit to androgens.
• It is not due to «dirt» and it does not improve by washing harder or more often.
• Yes, it can leave stains and scars if there is manipulation, nodules, or a delay in treatment.
• Management usually combines realistic habits, consistency, and, if necessary, topical, oral, or hormonal medical treatment.
• If there are also irregular periods, increased hair growth, hair loss, or weight gain, it is advisable to assess whether there is a hormonal disorder such as PCOS (Polycystic Ovary Syndrome). 

What is hormonal acne?

“Hormonal acne” is a practical way to describe acne breakouts that appear to be related to hormonal fluctuations or increased skin sensitivity to those hormonal signals. Simply put: the hormone doesn’t act alone; it promotes more oily skin, more clogged pores, and more inflammation. (Vasam 2023, Bagatin 2019 )

Why does it appear? (common causes)

It usually appears due to a combination of factors: genetic predisposition, sebum production, follicle obstruction, inflammation, and the effect of androgens on the sebaceous gland. In some people, outbreaks worsen before menstruation, during certain hormonal changes in adulthood, or in the context of polycystic ovary syndrome (PCOS). Some medications, certain cosmetics, and, in some cases, high-glycemic-index diets can also play a role. NHS 2023b Telkkälä 2025 Teede 2023

“Acne is not caused by poor hygiene; washing more does not clear clogged pores and can further irritate the skin.” NHS 2023b

What does it look like and what symptoms does it cause?

It can appear as blackheads, whiteheads, red papules, pustules, and, in more severe cases, painful nodules. In many adult women, the pattern is concentrated on the chin, jawline, or neck, and outbreaks tend to recur around the time of menstruation. However, not everyone with acne in this area has an underlying hormonal problem, and not all hormonal acne is limited to the lower face. AAD 2024b Tan 2017 .

What can you do today? (safe and concrete measures)

Start with the basics and stick to a consistent routine: gentle cleansing once or twice a day, non-comedogenic products, avoiding picking at the lesions, and not changing your routine every few days. If your outbreaks are mild, some topical treatments may help, but it’s best to use them with professional or pharmacist guidance, as improvement often takes weeks or even months and irritation from overtreatment is common. NHS 2023a NHS 2023c AAD 2024a

What NOT to do? (common mistakes)

• Don’t wash your face aggressively or more often than necessary.
• Do not squeeze or «burst» the lesions.
• Do not use toothpaste, alcohol, abrasive exfoliants, or irritating home remedies.
• Don’t rely on the sun or tanning beds as a treatment.
• Do not start hormonal or oral treatments on your own. NHS 2023b NHS 2023a .

When should I consult?

• If acne leaves marks or scars.
• If there are deep, painful, or recurring nodules.
• If it clearly worsens before each period and does not improve with basic measures.
• If it started in adulthood and persisted.
• If you also have irregular periods, increased facial/body hair, scalp hair loss, or weight gain.
• If you are pregnant, trying to conceive, or breastfeeding.
• If the emotional impact is significant. NHS 2023a NHS 2022 .

What does a dermatologist usually do?

The dermatologist typically assesses the type of lesions, their distribution, severity, duration, individual risk of scarring, and whether the pattern suggests a hormonal component. They also review medications, skincare routine, and medical history, such as irregular periods or signs of hyperandrogenism. In most cases, a biopsy is not necessary; the diagnosis is clinical. Depending on the case, they may prescribe topical treatment, limit antibiotics when unnecessary, consider hormonal therapies in selected women, or isotretinoin for severe acne. AAD 2024a AAD 2024b

Modern acne treatment typically combines topical measures with, when necessary, systemic or hormonal options depending on the case. AAD 2024a Reynolds 2024

Frequently Asked Questions

Does hormonal acne only occur in women?

• No. Hormones influence acne in everyone, but the term is usually used more when there are cyclical or persistent breakouts in adult women. Bagatin 2019 .

Does having hormonal acne mean I have PCOS?

• Not necessarily. But if acne is accompanied by irregular periods, excess hair growth, hair loss, or weight gain, it does warrant evaluation by a specialist. NHS 2022 .

Does washing your face more often help?

• No. Acne is not caused by poor hygiene, and excessive washing can actually irritate the skin further. NHS 2023b .

Does makeup always worsen acne?

• Not always. In general, it’s best to use specialized (non-comedogenic) products and remove them gently. NHS 2023b .

How long does it take to get better?

• Improvement is not usually immediate. Many people need several weeks or months to notice a clear improvement. NHS 2023c .

Can it be completely cured?

• Sometimes it is very well controlled and can go into remission, but in other people it tends to relapse. The most realistic approach is to talk about control and prevention of scarring, not a “guaranteed cure.” AAD 2024a .

When are pills considered hormonal treatment?

• When the pattern, intensity, or lack of response warrants it, and always after specialized medical evaluation. These are not options for self-medication. AAD 2024b .

Bibliography and sources

• Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, et al. Guidelines of care for the management of acne vulgaris . J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30. doi:10.1016/j.jaad.2023.12.017.
• National Institute for Health and Care Excellence. Acne vulgaris: management. NICE guideline NG198 [Internet] . London: NICE; 2021 [actualizado 30 abr 2026; consultado 19 jun 2026] . Available from: NICE .
• Nast A, Al Wattar BH, Beylot-Barry M, Brüggemann H, Bukvić Mokos Z, Caruana DM, et al. Update of the EuroGuiDerm evidence-based guideline for the treatment of acne—Short version . J Eur Acad Dermatol Venereol. 2026. doi:10.1111/jdv.70331.
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• Bagatin E, Freitas THP, Rivitti-Machado MC, Machado MCR, Ribeiro BM, Nunes S, et al. Adult female acne: a guide to clinical practice . An Bras Dermatol. 2019;94(1):62-75. doi:10.1590/abd1806-4841.20198203.
• Zeichner JA, Baldwin HE, Cook-Bolden FE, Eichenfield LF, Fallon-Friedlander S, Rodriguez DA. Emerging issues in adult female acne . J Clin Aesthet Dermatol. 2017;10(1):37-46.
• Ebede TL, Arch EL, Berson D. Hormonal treatment of acne in women . J Clin Aesthet Dermatol. 2009;2(12):16-22.
• Elsaie ML. Hormonal treatment of acne vulgaris: an update . Clin Cosmet Investig Dermatol. 2016;9:241-248. doi:10.2147/CCID.S114830.
• Geller L, Rosen J, Frankel A, Goldenberg G. Perimenstrual flare of adult acne . J Clin Aesthet Dermatol. 2014;7(8):30-34.
• Santer M, Lawrence M, Renz S, Eminton Z, Stuart B, Sach TH, et al. Effectiveness of spironolactone for women with acne vulgaris: pragmatic, multicenter, phase 3, double blind, randomized controlled trial . BMJ. 2023;381. doi:10.1136/bmj-2022-074349.
• American Academy of Dermatology Association. Acne clinical guideline [Internet] . Rosemont (IL): American Academy of Dermatology Association; 2024 [consultado 19 jun 2026] . Available from: American Academy of Dermatology Association .
• American Academy of Dermatology Association. Acne: diagnosis and treatment [Internet] . Rosemont (IL): American Academy of Dermatology Association; 2026 [consultado 19 jun 2026] . Available from: American Academy of Dermatology Association .