Acne occurs when the oil glands of the skin become blocked, causing spots and pimples. Although there are lots of factors which can contribute to the development of acne, it’s mainly caused by hormonal changes (1).
Who can get hormonal acne?
Hormonal acne affects both teenagers and adults (1). Women are more likely to experience acne than men (2). This is largely due to hormonal changes that occur in women during different stages of their life such as menstruation, pregnancy, and the menopause (3).
What are the symptoms of hormonal acne?
Hormonal breakouts usually develop on the lower facial areas including the lower cheeks, chin and jawline, as well as the back, and chest (1). Acne can be mild, moderate, or severe, and may consist of several different types of spots or pimples, including:
- Blackheads and white heads – small black or yellow bumps (1)
- Papules and pustules – small, sore red bumps, with or without a white tip (1)
- Nodules – large, painful, hard lumps underneath the surface of the skin (1)
- Cystic acne – large, pus-filled lumps (1)
In adult women, acne may appear more frequently on the lower part of the face, with chin and jawline acne being especially common (4).
What causes hormonal acne?
There are many hormones involved in the development of hormonal breakouts.
Androgens in Women
Androgens are one of the biggest contributors to hormonal acne - androgens are a group of sex hormones that include testosterone and dihydrotestosterone (DHT), a powerful androgen (5). Though they are commonly known as male hormones, the ovaries and adrenal glands also produce androgens in females (5).
Androgens are responsible for controlling the production of sebum, an oily substance secreted by the sebaceous glands in the skin (6). Sebaceous glands are connected to hair follicles - small holes in the skin from which hairs grow (3).
Sebum helps to hydrate and protect the skin, but high levels of androgen hormones can result in too much sebum being produced (5). The excess sebum mixes with dead skin cells, blocking the hair follicle and causing spots (3). Bacteria on the skin can then infect the hair follicle, causing inflammation and more painful acne (5).
Due to the effects of androgen hormones, many acne treatments have anti-androgen properties (5).
Estrogen and acne
Oestrogen (sometimes referred to as estrogen) is another sex hormone which reduces the size of sebaceous glands and therefore lowers the amount of sebum produced, preventing acne from forming (5).
It can also increase production of a protein called sex hormone-binding globulin (SHBG) (7). SHBG binds to androgens, making them inactive, which helps to improve acne (7).
This is why oestrogen-containing hormonal contraceptive pills are sometimes prescribed for acne treatment (5).
Does progesterone cause acne?
Progesterone can actually help to prevent acne by stopping testosterone being converted into the more powerful acne-causing androgen, dihydrotestosterone (DHT) (5). But just before your period, both oestrogen and progesterone levels drop, allowing for more DHT.
Insulin and insulin growth factor 1
Insulin prompts growth of the sebaceous glands, stops the production of SHBG and encourages the production of androgens. This increases sebum production, which can cause or exacerbate acne (5) (9).
Hormonal imbalances are common in polycystic ovary syndrome (PCOS). For example, high insulin levels are characteristic of PCOS (10). As a result, oily skin and hormonal spots are common symptoms of PCOS (10).
A sudden onset of adult acne, especially along with other symptoms of excess androgens, such as excessive hair on the face and body and light or irregular periods, may be a sign of a hormone imbalance caused by PCOS (1).
- Acne [Internet]. nhs.uk. 2021 [cited 29 July 2021]. Available from: https://www.nhs.uk/conditions/acne/
- Zeichner J A, Baldwin H E, Cook-Bolden F E et al. Emerging issues in adult female acne. Journal of Clinical and Aesthetic Dermatology. 2017;10(1):37-46.
- Acne - Causes [Internet]. nhs.uk. 2021 [cited 29 July 2021]. Available from: https://www.nhs.uk/conditions/acne/causes/
- Kamangar F, Shinkai K. Acne in the adult female patient: a practical approach. International Journal of Dermatology. 2012;51(10):1162-1174.
- Elsaie M. Hormonal treatment of acne vulgaris: an update. Clinical, Cosmetic and Investigational Dermatology. 2016;9:241-248.
- Picardo M, Ottaviani M, Camera E, Mastrofrancesco A. Sebaceous gland lipids. Dermato-Endocrinology. 2009;1(2):68-71.
- Edebe, T L, Arch, E L, Berson, D. Hormonal Treatment of Acne in Women. Journal of Clinical and Aesthetic Dermatology. 2009;2(12):16-22.
- Reed B G, Carr B R. The Normal Menstrual Cycle and the Control of Ovulation. South Dartmouth (MA): MDText.com, Inc.; 2000.
- Kim H, Moon S, Sohn M, Lee W. Insulin-Like Growth Factor-1 Increases the Expression of Inflammatory Biomarkers and Sebum Production in Cultured Sebocytes. Annals of Dermatology. 2017;29(1):20.
- Polycystic ovary syndrome [Internet]. nhs.uk. 2021 [cited 29 July 2021]. Available from: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/