After spending your teenage years dealing with the predictable hormonal changes that come with puberty, the last thing anyone wants as an adult is a bunch of pimples.

Unfortunately, acne is extremely common in adulthood. Not only does this skin condition affect 80% of the U.S. population during their lifetime, but about 50% of women experience acne in their 20s, and 25% of women report breakouts in their 40s. What can be deeply frustrating about adult acne – also known as “hormonal acne” – is that sometimes it feels like it just won’t go away.

“I tried just about everything to manage my hormonal acne,” says Amanda Thompson, founder and CEO of Kick Peach Beauty, a waterless skincare brand. Thompson’s breakouts began when she was in her late 30s, and they intensified during menopause. “It shook my self-assurance,” she says. But after working with a dedicated dermatologist, Thompson figured out a skincare treatment plan that emphasized a “less is more” approach.

Since hormonal acne covers a broad spectrum, there’s no one-size-fits-all cure. We did however speak with several board-certified dermatologists who were able to break down your breakouts – and offer guidance for potential prevention and treatment. 

What is hormonal acne?

Although acne is caused by hormonal fluctuations at any age, the term “hormonal acne” specifically refers to the kinds of breakouts that occur in adulthood as opposed to during puberty. “It is similar to acne experienced by teenagers,” says Tina Alster, M.D., creator and founder of the A Method skincare line. The difference is that teenage acne is “associated with hormonal changes during puberty that leads to increased oil production and clogged pores.” Dr. Alster goes on to explain that hormonal acne in adulthood “can occur due to a variety of hormonal imbalances.”

Even though it can seem like teenage acne lasts forever, hormonal acne is actually more aggravating because puberty-era breakouts do clear up eventually. Jennifer Baron, M.D., a board-certified dermatologist in San Jose, California, says there’s a “tendency for the younger version to self-resolve in a matter of a few years or less, and the other to persist for an indefinite time, even decades for some.” 

Another difference between hormonal acne and teenage acne is the location of the breakouts. Typically, hormonal acne appears “as deep, cystic pimples on the lower face and jawline,” says Bertha Baum, D.O., a board-certified dermatologist in Boca Raton, Florida. Teenage acne “is more common on the face, neck, chest, and back.” 

Causes of hormonal acne

“Acne is not caused by just one factor,” says Dr. Baron, which makes it such a tricky skin condition. She says that while pregnancy can sometimes be a trigger, “this is not universal.” The same goes for other factors that can cause hormonal fluctuations: Menopause, birth control pills, steroid medications, or supplements can possibly bring about acne, but not in every case. Also adding to its complexities, hormonal acne isn’t restricted to a specific age group or gender. It is, however, more commonly observed in females than in males, says Dr. Baum, due to the aforementioned triggers like menstruation, pregnancy, menopause, or even conditions like polycystic ovarian syndrome (PCOS)

Signs of hormonal acne

Adulthood acne is pretty hard to miss given its symptoms. Instead of blemishes that go away on their own, “the key signs of hormonal acne include deep, painful cysts or nodules that often appear along the lower half of the face, particularly the jawline and chin,” says Dr. Alster. “These lesions are typically inflamed, red, and can sometimes contain pus.” 

Dr. Baron also advises keeping an eye out for “pustules on the forehead and temples,” which she says can be “strongly affected by hormone changes in all genders.”

Treating hormonal acne

Because acne is “complicated,” says Dr. Baron, it’s wise to see your dermatologist immediately to establish a treatment plan. “Over-the-counter and home remedies rarely improve hormone-related acne,” she says.” You also don’t want to delay treatment because early intervention can help “prevent scarring and hyperpigmentation,” says Dr. Baum. 

While treatment for every patient is different, as plans are based on the types of acne lesions, the severity, and a patient’s medical history, Dr. Baron says she “will often try oral medications along with a multi-faceted topical routine tailored specifically to [the patient].” 

In addition, here are some options recommended by Dr. Alster:

  • Topical or oral antibiotics to reduce inflammation and bacterial overgrowth

  • Birth control pills or hormonal therapy to regulate hormones

  • Anti-androgen medications such as Spironolactone (Thompson found success with this drug, and Dr. Baum says this is the most common in-office treatment she uses)

  • Topical retinoids to unclog pores

  • Skincare products containing benzoyl peroxide

  • Chemical peels or laser therapy for severe cases

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Even with personalized treatment, it’s important to remember that hormonal acne still takes time to go away. “It may take several weeks to a few months to see significant improvement,” cautions Dr. Alster. 

Taking control of your hormonal acne

So what can we do to help keep those blemishes at bay? First of all, tempting as it may be, stop picking at your pesky pimples! “Picking or squeezing acne lesions can worsen inflammation and lead to scarring,” warns Dr. Alster. She also recommends avoiding “harsh, abrasive skincare products,” and switching to non-comedogenic makeup.

Dr. Baron advises talking to your dermatologist to determine all of the causes of your hormonal acne, and then developing a lifestyle plan. This could mean eliminating certain trigger foods and creating a specific skincare routine. She also recommends avoiding animal-sourced dairy products.

Like any other medical issue, combating hormonal acne should be a team effort between you and your provider and not something you just learn to live with. “Acne is an inflammatory disease of the skin,” says Dr. Baron. “It is not a ‘normal’ part of life or a ‘rite of passage.’”  

Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.