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It’s More Than Skin Deep: How to Deal With Hormonal Acne

Fact Checked
Written by
Medically reviewed by
Dr. Holly Lucille, ND, RN

Last updated: July 31, 2020

Approximately 85% of individuals will experience acne during their lifetime, most often during adolescence. (13) However, scientific literature reports that a growing number of adult females are affected by acne beyond adolescence. (3) One factor that commonly contributes to acne in women is an imbalance of hormones, particularly with androgens. (13)

Hormonal acne is more than just a cosmetic issue, as it may lead to psychological distress and be a sign of underlying endocrine (hormonal) disorders. (13) In this article, you’ll learn about hormonal acne causes and how to fix hormonal acne.

What is hormonal acne?

Acne vulgaris is an inflammatory condition that affects pilosebaceous units, which are found throughout the body and consist of a sebaceous (oil) gland and hair follicle. (8)(12) The skin condition is characterized by lesions, commonly referred to as zits or pimples, and possible scarring. (8)(13) Lesions commonly occur on the face, neck, shoulders, chest, and back. (8)

One of the causes of acne vulgaris is an increase in certain hormones known as androgens. (6) Androgen hormones increase the sebaceous glands’ secretion of sebum, an oily substance. (12) A healthy pilosebaceous unit will release the sebum through the skin’s follicle opening (pore) onto the skin surface. (8)

woman looking at her skin after shower

According to the American Academy of Dermatology, up to 15% of women are affected by adult acne. (1)

However, in the case of acne, increased sebum and certain skin cells called keratinocytes may block the skin’s pore, allowinge microbes to grow. Blocked follicles may burst and release pro-inflammatory chemicals, which stimulate inflammation of the skin. The sebum, skin cells, and microbes that are released, including Cutibacterium acnes, Staphylococcus epidermidis, and Malassezia furfur, contribute to this inflammatory process, resulting in the acne lesions. (8)(12)

Hormonal acne vs regular acne

It’s important to understand that various processes can cause acne. (13) Hormonal acne occurs as a result of androgen hormones that increase the production and secretion of sebum. (6)(13) The androgen hormones involved in sebum production and acne development include testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and androstenedione. (4)

In women, certain changes can increase the proportion of androgenic hormones in relation to estradiol (estrogen). For example, premenstrual, pregnancy, and perimenopausal changes are often associated with acne aggravation. (3)

Other processes that contribute to acne include:

  • Complex mechanisms that involve the immune system (13)
  • Irregular increase of keratinocyte cells and change in keratinization (a function of these cells) (6)(13)
  • Overgrowth of Cutibacterium acnes bacteria (also referred to as Propionibacterium acnes) (6)(13)

Did you know?
It’s estimated that acne affects up to 50 million people in the U.S. annually. (6)

Male hormonal acne

According to research, adult women are more commonly affected by acne than men of all ages. (3) Androgen hormones may play a greater role in acne development seen in women, however, males can still experience hormonal acne. (11)

One study assessed the levels of various hormones in both men and women with acne compared to a control group without acne. The findings demonstrated that the female acne group had elevated levels of testosterone, DHEA, and cortisol, along with decreased estrogen. Males with acne had elevated cortisol levels, without differences in other hormones compared to the control group. (11) This suggests that cortisol commonly referred to as the “stress hormone”, may play a role in male hormonal acne.

What causes hormonal acne?

Hormonal acne causes may include:

  • Certain health conditions (e.g., polycystic ovary syndrome (PCOS), hyperandrogenism) (12)(13)
  • Hormonal changes (e.g., puberty, premenstrual period, pregnancy, perimenopausal period) (3)(12)
  • Hormonal therapies (e.g., oral contraceptives, anti-androgen medications) (13)

Certain factors may aggravate acne, including:

  • Dietary factors (e.g., dairy, high-glycemic food intake) (3)(12)
  • Facial massages (12)
  • Sleep loss (3)
  • Stress and certain emotions that may increase stress hormones (e.g., anger, anxiety) (3)(12)
  • The use of oil-based cosmetics (12)
man putting cream on his face

Use oil-free skin and hair products to care for acne-prone skin. (8)

How to get rid of hormonal acne

If you struggle with it, you’ve likely tried to find out how to fight hormonal acne. Certain hormonal medications, such as oral contraceptive pills (OCPs), are a common treatment. However, they are limited to use in women and have been associated with certain health risks. (6) While you should always discuss treatment options with your healthcare provider, we’ve outlined some dietary and lifestyle approaches to consider for hormonal acne.

Hormonal acne diet

There are several dietary factors that may exacerbate acne. Foods with a high glycemic load and index are known to increase levels of insulin, a hormone that is responsible for transporting blood glucose (sugar) into cells to be used as energy. Higher insulin levels, in turn, increase the level of androgen hormones, contributing to sebum production and acne. (7) Similarly, dairy products contain insulin-like growth factor 1 (IGF-1), a compound that stimulates the production of androgens in the body. (7)

Limit these foods in your diet by reducing dairy products and high-glycemic foods, such as breads, breakfast cereals, rice, snack foods, and sugars. (2) You can also increase your consumption of foods that help hormonal acne, including:

  • Certain grains (e.g., oats)
  • Healthy fats (e.g., flax seeds, olive oil, sardines, tuna, walnuts)
  • Meats and liver
  • Yellow and green vegetables (e.g., bell peppers, broccoli, cabbage, lettuce, spinach, squash) (9)

These foods are generally low-glycemic and contain nutrients that may help prevent acne, such as vitamins A, E, zinc, and essential fatty acids, by providing antioxidant and anti-inflammatory support. (9)

Hormonal acne and stress

Managing stress may help to control acne. (12) Stress has been shown to increase the release of pro-inflammatory compounds and corticotropin-releasing hormone (CRH), which increase cortisol levels. (3)

Home remedies to treat hormonal acne

The National Institutes of Health (NIH) provide some self-care tips for addressing acne that you can try at home, including:

  • Avoid touching, picking, or squeezing lesions, which can lead to scarring
  • Avoid sun tanning and sunburns, as acne medication may make you more susceptible to sunburns
  • Choose cosmetics and hair products labeled oil-free and/or non-comedogenic (won’t clog pores)
  • Shampoo your hair frequently
  • Shave gently, and reduce the frequency of shaving if possible
  • Use a gentle skin cleanser and avoid rough scrub pads when washing your skin (8)
man holding omega 3 supplements in one hand and water in the other

Natural supplements including antioxidant vitamins, omega-3, and zinc may improve acne.

Best supplements for acne

Consider the following dietary supplements, which have been researched for their effects on acne. If you’re a patient, speak with your integrative healthcare practitioner before trying any new supplements.

Antioxidant vitamins: vitamin A and E

Vitamin A and E are both fat-soluble antioxidant vitamins that can protect against free radical damage and the inflammatory process that contributes to acne. (9) Low blood levels of these nutrients have been found in individuals with acne when compared to control groups. (7)(9) Vitamin A and E supplementation may regulate keratinization, and research suggests these vitamins have a synergistic effect, meaning that they may be more effective when combined. (9)

Omega-3 fatty acids

One of the dietary factors that impact inflammation levels in the body is the ratio of omega-3 to omega-6 fatty acids. Increasing your consumption of omega-3s can improve acne by inhibiting the synthesis of pro-inflammatory molecules known as cytokines and lowering levels of IGF-1. Eicosapentaenoic acid (EPA), an omega-3 found in fish oil, may be particularly effective at inhibiting inflammatory processes. (7)

Zinc

One study that assessed serum levels of zinc in individuals with varying acne severity and healthy controls found that zinc levels may be associated with the type of lesions and the severity of acne. (10) Zinc supplementation has been used in a variety of skin conditions and has been found to improve mild to moderate acne when applied topically (on the skin), as well as moderate to severe acne when taken orally as zinc sulphate and zinc gluconate. (5)

The bottom line

Acne is a complex condition that has various underlying causes, including hormonal changes seen in hormonal acne. Certain lifestyle approaches and supplements such as vitamin A, vitamin E, omega-3 fatty acids, and zinc may improve acne. Work with your integrative healthcare practitioner to identify and address individual factors contributing to hormonal acne.

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  1. American Academy of Dermatology. (n.d.). Skin conditions by the numbers. Retrieved from https://www.aad.org/media/stats-numbers
  2. Atkinson, F. S., Foster-Powell, K., & Brand-Miller, J. C. (2008). International tables of glycemic index and glycemic load values: 2008. Diabetes Care, 31(12), 2281–2283.
  3. Bagatin, E., Freitas, T. H. P. de, Rivitti-Machado, M. C., Machado, M. C. R., Ribeiro, B. M., Nunes, S., & Rocha, M. A. D. da. (2019). Adult female acne: A guide to clinical practice. Anais Brasileiros de Dermatologia, 94(1), 62–75.
  4. Elsaie, M. L. (2016). Hormonal treatment of acne vulgaris: An update. Clinical, Cosmetic and Investigational Dermatology, 9, 241–248.
  5. Gupta, M., Mahajan, V. K., Mehta, K. S., & Chauhan, P. S. (2014). Zinc therapy in dermatology: A review. Dermatology Research and Practice, 2014, 709152.
  6. Kircik, L. H. (2020). Game changer in acne treatment. Journal of Drugs in Dermatology: JDD, 19(3), 28.
  7. Kucharska, A., Szmurło, A., & Sińska, B. (2016). Significance of diet in treated and untreated acne vulgaris. Postepy Dermatologii I Alergologii, 33(2), 81–86.
  8. National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2016, September 1). Acne. Retrieved from https://www.niams.nih.gov/health-topics/acne
  9. Ozuguz, P., Dogruk Kacar, S., Ekiz, O., Takci, Z., Balta, I., & Kalkan, G. (2014). Evaluation of serum vitamins A and E and zinc levels according to the severity of acne vulgaris. Cutaneous and Ocular Toxicology, 33(2), 99–102.
  10. Rostami Mogaddam, M., Safavi Ardabili, N., Maleki, N., & Soflaee, M. (2014). Correlation between the severity and type of acne lesions with serum zinc levels in patients with acne vulgaris. BioMed Research International, 2014, 474108.
  11. Schmidt, J. B., Lindmaier, A., & Spona, J. (1990). Endocrine parameters in acne vulgaris. Endocrinologia Experimentalis, 24(4), 457–464.
  12. Sutaria, A. H., Masood, S., & Schlessinger, J. (2020). Acne vulgaris. In StatPearls. StatPearls Publishing.
  13. Tan, A. U., Schlosser, B. J., & Paller, A. S. (2018). A review of diagnosis and treatment of acne in adult female patients. International Journal of Women’s Dermatology, 4(2), 56–71.

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