Hormonal acne is one of the most common skin problems in adults. It differs from teenage acne in terms of its cause, appearance, and treatment. Despite this, it is often treated in the same way, which in many cases makes the situation worse. To understand why, a broader perspective is needed, which we explain in this article.
Hormonal acne is largely driven by androgens, a group of sex hormones such as testosterone, which stimulate the sebaceous glands to produce more sebum. But it's rarely just a matter of too much sebum.
Hormonal acne occurs when several parts of the skin's functions are affected at the same time. Hormones drive sebum production, but how strongly the skin reacts also depends on cell turnover, inflammation and how strong the skin barrier is. When the whole thing is out of balance, breakouts often become deeper and more recurring.
Many describe a similar course. The skin has previously been relatively stable. Then, individual, deeper pimples begin to appear along the chin or jawline. They disappear but return, often in connection with the menstrual cycle. Over time, the outbreaks become more frequent.
Typical characteristics of hormonal acne are:
- eruption along the jawline, chin, and lower face
- deeper, inflamed pimples rather than superficial blackheads
- deterioration associated with hormonal fluctuations
- onset or worsening in adulthood
Many people find that their skin becomes more reactive and difficult to understand. This is often where overtreatment begins.
Hormonal acne is rarely caused by a single factor. Rather, it is a combination of hormonal fluctuations, lifestyle, and how the skin is treated.
Menstrual cycles, pregnancy, changing or stopping birth control pills, and prolonged stress can affect androgen balance. Sleep, diet, and stress levels can also play a role in how the skin reacts.
In some cases, there is a more obvious hormonal imbalance, for example in PCOS. If this is suspected, medical investigation is important. Read our article about PCOS here.
Teenage acne is often characterized by more general excess sebum, superficial blackheads and pimples over larger areas of the face. The skin is often more resistant to strong treatment.
Hormonal acne is more often concentrated on the lower part of the face and consists of deeper inflammations. At the same time, the skin can be combination or even sensitive.
This is a crucial difference. Treatment that works for oily teenage skin can worsen already stressed adult skin.
"So many people come to us for skin consultations struggling with acne-prone skin, pimples and breakouts, who tell us how much it affects their well-being and health. Often they are stuck in a vicious cycle of over-treatment, irritation and skin that becomes more reactive rather than better."
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When your skin breaks out, it's natural to want to do more. Stronger cleansing, more acids, multiple active ingredients at once. The problem is that hormonal acne often occurs in skin that is already out of balance.
Aggressive treatment can weaken the skin barrier, increase inflammation, and negatively impact the microbiome. The skin then responds with increased reactivity and sometimes more or longer-lasting outbreaks.
It becomes a self-reinforcing process where intensified treatment has the opposite effect.
In acne, changes in the skin's microbiome are often seen, including reduced bacterial diversity and imbalance between different strains.
In the past, the focus was on eliminating bacteria. Today, we know that the skin ecosystem is more complex than that. The goal is not to sterilize the skin, but to support its balance.
Treatment that takes into account the barrier and microbiome may therefore be more sustainable in the long term than strategies that focus solely on drying out.
The key is rarely to do more, but to do more thoughtfully.
It is about:
- reduce inflammation
- support the skin barrier
- normalize cell turnover
- work strategically with active ingredients
In practice, this often means simplifying the routine, avoiding over-treatment, and introducing active ingredients strategically.
Azelaic acid
Azelaic acid is interesting because it acts on several mechanisms at once. It has anti-inflammatory properties, affects the bacterium C. acnes and can help normalize the skin's renewal process.
It acts on several of the underlying mechanisms at the same time - without being particularly irritating, which is important for skin that is already reactive.
Retinal
Retinal is a form of vitamin A that is converted to retinoic acid in one step in the skin. It is more potent than retinol but generally better tolerated than prescription retinoic acid.
Retinal can contribute to increased cell turnover and reduced propensity for clogged pores. Proper formulation and gradual introduction are crucial for tolerance.
However, it is important to distinguish between cosmetic retinoids and medical treatment. For more severe acne, prescription alternatives may be considered in consultation with a doctor.
You should consider medical evaluation if your acne is deep and painful, if you develop scars, or if self-care does not provide improvement.
The same applies if hormonal influences are suspected, such as in PCOS.
A dermatologist can assess the need for drug treatment or further investigation.
In case of severe, long-lasting or worsening skin problems, you should always contact your dermatologist.
Hormonal acne is not just a hormonal problem. It is an expression of how hormonal signals interact with the skin barrier, inflammation and microbiome.
What often worsens the condition is not a lack of active ingredients, but overload.
A more sustainable strategy is based on understanding the biology of the skin, reducing unnecessary irritation and working with well-thought-out formulations that support rather than stress the skin.
Routine for oily/acne-prone skin that prevents breakouts and clogged pores.
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