Hormonal & Adult Acne: 5 Signs To Look For & Natural Treatments

Here, we dive into what adult acne is, what makes it different, how you can tend to it naturally—and why it's very closely related to your hormones.

The prevalence of adult acne in women over men likely has to do with one of the triggers of acne: fluctuating hormones. Women's hormones fluctuate more frequently, and given that hormones affect every aspect of your body, they also affect the skin. Here's a summary from the American Academy of Dermatology of how hormones affect the skin as it relates to acne: Hormones can increase sebum production; they can affect how "sticky" skin cells are, making shedding the cells more difficult and leading to clogged pores; and they can cause increased overall inflammation.

There are a few ways to tell if your breakouts might be triggered by hormones:

Adult acne tends to look and appear different from breakouts you might get because you worked out in your makeup or because it's humid out. First thing to consider: the location. Hormonal acne appears around the chin area, jawline, and neck (and sure, this is suggested by face mapping, but research even confirms this5). And while all acne is triggered by inflammation on some level, hormonal acne tends to show signs of that inflammation more aggressively: meaning it's usually red, tender, and puffy.

Do you tend to break out around your period? This is an incredibly common, and research-backed6, phenomenon: According to a survey, almost two-thirds of acne-prone women report having flares before or on their menses7 (more specifically in the "late luteal phase of the menstrual cycle," or after ovulation and right before you start bleeding). And while the exact mechanism of this is not confirmed, the most general understanding8 tends to be the increased presence of the hormone androgens, specifically DHEA-S, which stimulates the sebaceous glands to produce excess sebum.

Board-certified dermatologist Jaimie Glick, M.D. agrees that together these form a one-two punch: Overactive sebum production means excess oil traps dead skin cells in our pores. This becomes an ideal environment for the rapid multiplication of the common bacteria that live on our skin. The result is pores that are very inflamed and can quickly become painful pimples. And to top it all off, your body may be less able to deal with existing acne and scarring when you're really stressed. "[One study on stress and wound healing12] has shown that stress can slow down healing, which may worsen acne and acne scarring," says Glick.

Foods with a high glycemic index, notably, have a good amount of research to back them. Overconsumption of foods with a high glycemic load is also a main characteristic of a Western diet and is a key factor in acne development or severity15," says Molly Knudsen, M.S., RDN. "Blood glucose and insulin could affect the skin14 in a couple of different ways: First, this spike in blood sugar causes the release of insulin and insulin-like growth factor-1 (IGF-1). Insulin then stimulates the production of androgens (male hormones) that can then lead to higher sebum production in the skin, and then lead to acne. Secondly, high amounts of insulin in the blood before or after a meal may make the skin create more skin cells, making acne that's already present worse." 

Menopausal acne has more to do with the changes in the microbiome, since acne is highly influenced by changes in the makeup of your skin flora. "As our hormones diminish in menopause, the functions they perform to maintain the health and vitality of the skin diminish as well, characterized by a change in sweat, sebum, and the immune functions resulting in significant alterations in the skin surface including pH, lipid composition, and sebum secretion," board-certified dermatologist Keira Barr, M.D., previously told us about menopause and skin. "These changes also provide potential alterations in the skin that may affect the skin microbiome." 

So you've developed acne late in life. Now that you're here (welcome to the club, by the way), there are plenty of ways to tend to your adult skin so you can clear up those blemishes STAT, and keep them away.

First, consult with a professional about your acne treatments. (Although acne is non-life-threatening, the presence can affect a person's well-being. Studies show16 that those with acne experience anxiety and depression. And on a more superficial level, untreated acne and picking can lead to permanent scarring.) For more severe cases, they might recommend prescription topicals or oral medications, such as Accutane, spironolactone, or birth control, if you feel comfortable taking these. You can also visit a hormone specialist, if you think your acne warrants it.

Here are our favorite moisturizers for acne.

"On Day 14 there is a surge in luteinizing hormone (LH), which not only harkens a rise in progesterone, but testosterone peaks at Day 14, and these two hormones both contribute to increased sebaceous gland activity and oilier skin including an oily scalp and greasy hair," says Barr. "As estrogen levels are declining, there may be more inflammation, irritation, and disruption of the skin barrier and microbiome, which can also contribute to breakouts."

"If you're breaking out, you may not be able to tolerate the treatments you used as a teenager because the skin is thinner and drier and the treatments may be too harsh," says Barr. Instead, focus on supporting your skin barrier function (through things like peptides and ceramides), reducing inflammation in the skin, and keeping sebum production balanced.

Given everything we've learned about acne's hormonal triggers, you should also treat acne holistically. Consider whether food and stress are triggers. You can try putting yourself on a clear-skin eating plan, or at least limit dairy and foods with a high-glycemic-index rating. As for stress, we know that lowering levels of stress can be good for multiple factors—but we also know it's hard to do, so the best advice here is to try multiple modalities until you find one that is right for you.

Adult acne, sigh. You think you're in the clear once you've made it out of your teens only to deal with blemishes well into your 20s, 30s, 40s, and beyond. If this is you, don't worry: There are are plenty of ways to remedy your breakouts.