According to the American Academy of Dermatology, hormonal acne affects around 50 percent of women aged between 25 and 29; and around 25 percent of women from 40 to 49 years old. It normally appears around the bottom areas of the face, such as around the jawlines, and manifests as whiteheads, blackheads, or red bumps that feature painful cysts underneath the surface.
There are many factors that contribute to the hormonal fluctuations that result in acne, foremost of which is menstruation. Many women report that they get acne before or during their monthly periods. Similarly, acne can result from increased androgen levels, polycystic ovarian syndrome, and menopause.
If you are suffering from hormonal acne, you know exactly how it can hamper your life. These spots look unsightly, first of all, which can detract from your self-esteem. In addition, they can damage your facial skin health, as the condition typically recurs until it is healed.
Fortunately, there are many options for acne medication that you can choose from. Below are ten of the best of them.
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Murad Anti-Aging Acne Starter Kit (Best Overall)
A popular starter kit among those who are suffering from adult acne, this kit contains a full suite of products with a clinically proven formula for fighting spots and restoring skin health. First off, its Time Release Acne Cleanser penetrates deep into the pores during and after cleansing; also, its Acne and Wrinkle Reducer is known to boost collagen production, for younger-looking and smoother skin. It also features a moisturizer that doubles as a sunscreen, with SPF 20. And it completes the acne regimen with a renewing eye cream.
Pros
- Perfect for all skin types
- Its cleanser packs a powerful combination of 0.5% salicylic acid, ascorbic acid, and glycerin for complete skin cleansing and rejuvenation, while its Acne and Wrinkle Reducer contains amino acids for better skin elasticity
- Also features natural botanicals, including willow bark extracts, clover flower extract, and sesame seed extract
Cons
- Its cleanser and moisturizer contain quite a huge amount of alcohol, which can be abrasive to the skin
- People with oily skin need to use as little of the moisturizer as possible
PCA Skin Intensive Clarity Treatment 0.5% Pure Retinol Night (Best in Value)
A topical retinol, this treatment from PCA combines retinol and salicylic acid to provide long-lasting relief from hormonal acne. The retinol ups the ability of the skin to fight acne, while the salicylic acid helps reduce sebum production. It also comes with a patented 10-hour time-release delivery system that ensures fast penetration of its blend of ingredients into the pores of the skin.
Pros
- Offers fast corrective benefits
- Keeps skin clear through stabilized retinol
- Features a retinopeptide and plant stem cell extract technology for enhanced skin strength and protection
Cons
- Requires a sunscreen, as retinol can leave the skin vulnerable to potential sun damage
- Requires using the right moisturizer for consistent positive results
Exposed Skin Care Acne Kit
This skin care kit for hormonal acne harnesses both science and nature in promising clear skin in a month. The brand also claims that this kit is preferred by 98% of users who have tried it, over other treatment options. It works for most types of skin, even sensitive skin. And it comes with a cleanser, tonic, acne treatment serum, and a derm x-cloth.
Pros
- Features a powerful blend of ingredients that sheds off dead skin cells, cleans and unclogs pores, and fights against acne bacteria, among other things
- Also uses natural components including witch hazel and green tea extract
- Can last up to two months, which makes it worth its price
Cons
- Contains fragrance, which may trigger allergic reactions to certain people
- Also contains alcohol, which may irritate and burn sensitive skin
- Not suitable for dry skin, as it can promote excessive peeling
Differin
Containing adapalene, this topical retinoid treatment is approved by the US Food and Drug Administration for the treatment of hormonal acne. The gel is available both over the counter (0.1% strength) and as a prescription product (0.3% strength). By virtue of its formulation, it is considered to be efficient in treating acne in 12 weeks.
Pros
- Easy to use, and can last for up to 90 days
- Has been known to treat acne by the end of the prescribed period
- Increases skin cell turnover to prevent future acne breakouts
Cons
- May take up to three months for it to work
- May exacerbate acne initially before it heals the condition
- Also contains a form of paraben that may cause irritation in some people
AcneFree 24 Hour Acne Clearing System
Another complete acne treatment system, this kit contains a cleanser, toner, and repair lotion that work best for normal and combination skin. It also features herbal extracts that work to clean and soothe skin, as well as skin conditioning ingredients that kill acne bacteria while reducing inflammation.
Pros
- Only a small quantity is needed for it to be effective
- Combines powerful and herbal ingredients to provide lasting relief
Cons
- Contains Benzoyl Peroxide, which may be irritating to some people
- Contains alcohol, which may burn and peel skin for some patients
- Also increases the potential for dryness and redness, especially if you’re using other topical treatments
Neutrogena Advanced Solutions Complete Acne Therapy System
A three-step system, the Neutrogena Advanced Solutions Complete Acne Therapy System makes use of different products that need to be used simultaneously to achieve optimal results. It features a skin polishing cleanser that removes dead skin cells and their residue, as well as extra sebum buildup. It also comes with an acne control lotion that protects from bacteria and an oil-free SPF15 lotion.
Pros
- Comes with a day and night treatment
- Contains salicylic acid, benzoyl peroxide, and panthenol for protection and healing from acne
- Also contains menthol, which can neutralize skin inflammation
Cons
- Only suitable for normal skin
- Features alpha hydroxy acid, which may worsen sensitivity to the sun for some people
- Can also cause skin dryness for those who are sensitive to benzoyl peroxide
Proactiv+ 3-Step System
Another 3-step system, this acne kit from Proactiv kills acne bacteria and clears damage. It is suitable for oily, combination, and even sensitive skin, so a lot more people can benefit from this compared to the previous product. It contains an exfoliator, a dehydrator, and a pore targeting treatment.
Pros
- Packs a powerful mix of ingredients including glycerin, Dimethicone, and benzoyl peroxide for ideal results
- Lasts for up to two months, which makes it a good buy for many customers
Cons
- Can cause negative reactions to people allergic to alcohol
- Can also irritate sensitive skin, as it includes fragrance
La Roche-Posay Effaclar Dermatological Acne System
This system has been specifically formulated to treat acne and contains two types of products. The first is the medicated gel cleanser, which contains salicylic acid for detoxification and purification of the skin. It also has a clarifying solution, which helps remove dead skin cells and mitigates sebum production. This kit works best for dry to oily skin.
Pros
- Non-comedogenic, paraben-free, and fragrance-free
- Features a simple formulation that many have reported nevertheless works
Cons
- Requires minimal exposure to the sun as its salicylic acid can boost sensitivity to UV radiation
- Also needs to be stored between 20-25 degrees
Lexli Aloe-Based Acne Clarifying Lotion
The Lexli Aloe-Based Acne Clarifying Lotion is an anti-aging serum that many patients also used to combat hormonal acne. It contains natural ingredients, which is ideal for those who have high skin sensitivity to chemicals. It is also touted to feature a formulation that goes right underneath the surface of the skin to correct its structure and improve health.
Pros
- Can positively impact skin health by preventing inflammation and breakouts, as well as increasing its strength
- Has a high absorption rating
- Also ideal for those who want to mitigate effects of skin aging and damage
Cons
- Does not come with specific details from the manufacturer
- Only available online
Cosmedix Clarity Serum
Formulated to correct and heal skin issues, this serum from Cosmedix can boost cell growth, curb sebum production, prevent inflammation, and detoxify complexions. It can also minimize the appearance of acne scars. It features three powerful ingredients: retinol A, salicylic acid, and pregnenolone.
Pros
- Specifically formulated to suit all skin types
- Combines the power of salicylic acid and retinol to effectively treat hormonal acne
Cons
- Can be quite expensive
- Contains essentially the same amount of salicylic acid in less expensive products
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Who Needs Hormonal Acne Medication?
There is an abundance of natural treatments for adult acne, but many have found them to be ineffective against more serious cases of hormonal acne. People who suffer from painful cystic bumps, in particular, can benefit from oral medication and other forms of treatments. Medication is also ideal for those who are dealing with certain medical conditions that result in hormonal instability or abnormalities.
Benefits of Hormonal Acne Medication
While there is a growing body of literature that supports the use of natural treatments for adult acne, topical and oral medication are still widely considered to be important to curing persistent and hormone-related acne more effectively.
First and foremost, numerous studies have indicated that hormone-based therapies are ideal for mitigating the symptoms of hormonal acne, as well as preventing recurrence. Oral contraceptives, for instance, have been found to reduce lesion counts of all types in patients, compared to placebo. A combination of oral contraceptives and spironolactone is also considered safe and effective.
In addition, hormone-based treatments aid in facilitating better changes for the body and for the skin. Antibiotics also improve skin health by eliminating excess bacteria, while retinol and retinoid-like drugs do a good job of clearing dead cells off the surface of the skin. Anti-androgen oral medications, for their part, block androgen receptors that can help curb cystic acne development, as well as prevent excess oil production.
If you want a wide catalog of options to choose from, hormonal acne medications come in various forms, too. This will not only ensure a comprehensive selection for you but also makes it easy to find the best possible option for your specific needs. Some women who have specific medical conditions, for example, cannot take oral contraceptives to deal with their acne, but they can use other forms of treatment.
Types of Hormonal Acne Medication
In addition to the products listed above, the following are among the different kinds of treatments that are available for hormonal acne. Most of these have not been included in the above guide as they require a prescription, as well as merit additional safety considerations for use.
Combined Oral Contraceptives
Oral contraceptives are among the most popular treatment methods used by many women for hormonal acne. In fact, some of them, such as Ortho Tri-Cyclen and YAZ, are approved by the US Food and Drug Administration for the medical condition. These contain the same form of estrogen (ethinyl estradiol), but different forms of progesterone (drospirenone, norgestimate, or norethindrone).
These combinations have been proven to effectively manage hormonal levels and activities in the body that lead to acne. Also, they are considered to be efficient in decreasing circulating androgens, which in turn, decreases sebum production. And they are especially beneficial at times when hormone levels peak, such as during ovulation. Women who have ever been on the pill and then gotten off it, in fact, found that their acne not only recurred but also intensified.
A study by the Cochrane Group discovered, though, that some forms of combination pills are more effective than others. The researchers asserted that there is slight evidence that pills with drospirenone are more effective than those that contain norgestimate or nomegestrol acetate plus 17 beta-estradiol. Additionally, pills that have cyproterone acetate are more effective than those with drospirenone. Still, the study reminded that this difference in efficacy is too minute to make significant recommendations of one type of pill over the other.
The same study also showed that all types of combination pills can treat both inflammatory and non-inflammatory acne.
Anti-Androgen Drugs
Androgens play an important role in the development of adult acne, especially in women. These are available from three sources, such as the ovaries, the adrenal glands, and peripheral conversion. They are critical to the enlargement of the sebaceous glands, as well as the production of sebum. When the levels of this production are somehow boosted or altered, acne can result.
Anti-androgen treatment works to limit the production of androgen, which has a direct impact on acne conditions in adult women. In the market, there are three main options: spironolactone, cyproterone acetate, and flutamide. Let’s look at each of these three in close detail.
Spironolactone. Usually used to treat hypertension, spironolactone has been used to treat adult acne for over 30 years. A known androgen receptor blocker, it limits the production of androgen by inhibiting androgen synthesis and competing with testosterone and DHT for androgen receptors, among other mechanisms.
The medical literature is rife with proofs of its efficacy in treating acne, as long as the proper dose is administered. In an article published by the US National Institutes of Health, three placebo-controlled trials showed that certain doses produce certain successful results. In one 12-week study, for instance, it was found that 21 women who were taking 200mg daily significantly showed signs of improvement from acne. Another 12-week trial, which involved both men and women, maximum benefits were displayed at doses of 100 to 200mg, daily. And a final 12-week trial of 34 participants taking 50mg of spironolactone daily showed that 24 people had had their acne cleared by the daily dose.
Topical spironolactone has also been studied to chart its effectiveness in localizing anti-androgen effects. Early research saw that there were no significant improvements in patients, but later studies found that compared to vehicle gel, topical spironolactone resulted in quite a significant reduction in sebum production 4 weeks after the end of treatment, but not right when the treatment ended.
In addition, the Cochrane review asserted that there is too little evidence to back the effectiveness of spironolactone alone in treating acne. It must be reserved for therapy, or for cases that do not respond to conventional therapies.
Cyproterone acetate. Among the first androgen receptor blockers that were studied, cyproterone acetate simultaneously functions as both an inhibitor of androgen receptors as well as acting as a progesterone in combination oral contraceptives. Research has discovered that used in doses of 50 to 100mg daily, it can produce about 75 to 90 percent of improvement of acne. In COCs, it is typically used in 2mg doses combined with 35µg of ethinyl estradiol. And it is widely used in Asia, Canada, and Europe.
Flutamide. Approved by the US Food and Drug Administration for the treatment of prostate cancer, Flutamide has been shown to exhibit 80-percent of improvement for acne treatment in doses of 250mg per day. Another study found that it is as effective as cyproterone-estradiol combinations in treating acne, and eight other studies found it to be better than baseline or placebo treatments. It can be
used on its own, combined with metformin, or in combination oral contraceptives for women with the polycystic ovarian syndrome. As with spironolactone, Flutamide is considered by the larger medical sector to still merit further studies with larger sample sizes to better study its effectiveness.
Retinoids
Derivatives of vitamin A, retinoids can be applied to the skin or taken orally as capsules. According to the Australian platform All About Acne, they are effective at unblocking acne pores and curbing the development of new blocks. Topical retinoid (gels or creams) usually contain adapalene, tretinoin, and tazarotene. Other products also combine adapalene with benzoyl peroxide. They are ideal for mild to moderate acne, and may also be used as skin maintenance after treatment.
Patients that use a retinoid for acne treatment will typically see the results during the early days; at this point, blackheads will get dislodged, but there may be some redness or peeling. After about three weeks, some acne spots will recur, which is normal, and will steadily disappear over the next three weeks. After twelve weeks, there should be a significant and noticeable improvement.
Some patients supplement the use of retinoids by taking a contraceptive pill or an oral anti-androgen treatment.
Safety Issues to Consider When Using Hormonal Acne Medication
Using hormonal acne treatments promises plenty of advantages, but it also carries various risks for certain types of people and situations. In this section, we will dissect the safety issues that should be considered for every type of treatment, as well as their noted side effects.
Combined Oral Contraceptives
Combined oral contraceptives should, first and foremost, only be used when risk factors have been vetted, along with lifestyle choices and patient history. This is because the pill is not ideal for people who:
- Smoke, and are over 35 years old
- Have undiagnosed abnormal uterine bleeding
- Are morbidly obese
- Have a history of jaundice in pregnancy, or with previous use of oral contraceptives
- Are pregnant and lactating
- Are suffering from cardiovascular diseases, including angina and valvular disease
Other contraindications include patients with estrogen-dependent neoplasms, hepatic adenomas, carcinomas, and breast cancer. Those who have the thromboembolic disease should also not take cOCPs.
When it comes to side effects, some of the most common (and mild) are breast tenderness, nausea, and bloating. Fatigue, weight gain, early cycle breakthrough bleeding, and menstrual irregularities may also occur. Serious potential effects include cardiovascular events, such as a venous thromboembolism or VTE. This is particularly critical for women with known thrombophilias, one of the most significant forms of which is factor V Leiden deficiency; women with this specific type of thrombophilia are 35 times more at risk of developing venous thromboembolism over other baseline risks. Women who don’t have thrombophilias but are over 45 years old, smoke more than 10 cigarettes a day, and have a personal history of VTE are also at risk.
Using cOCPs may also lead to the development of hypertension, so blood pressure must be continually monitored during visits to the doctor. Other cardiovascular risks are cerebral hemorrhage, myocardial infarction, arterial thromboembolism, thrombosis, and mesenteric thrombosis.
There may also be neurological side effects such as mood changes, depression, and migraine. Your skin may show signs of melasma, chloasma, and other dermatoses. Abdominal pain and cramping, leg edema, cervical secretions, a decrease in folate levels, rhinitis, and anaphylactic reactions may also be possible.
Finally, combined oral contraceptives may increase serum potassium levels. Women on the pill with kidney disease or taking medications that boost serum potassium levels should constantly have their potassium levels monitored.
Anti-Androgen Treatments
Spironolactone. The incidence of seeing side effects from taking spironolactone ranges from 75 to 91 percent but, fortunately, most of these are mild. These include menstrual irregularities, dizziness, breast tenderness, and diarrhea. However, spironolactone has been linked to hyperkalemia. It also carries a black box warning from the US FDA after it has been found, in long-term studies that involved rats, that it can lead to adenomas in the liver and the endocrine organs. And it is contraindicated in pregnant women since it has been shown to produce potentially feminizing effects on developing male fetuses.
Cyproterone acetate. Cyproterone acetate or CPA usually lead to headaches, nausea, breast tenderness, and some breakthrough bleeding. Patients taking it should begin on the first or fifth day of their menstrual cycle and stop on the 14th day before ovulation. It is also contraindicated in people with liver cancer, and patients should be on liver function monitoring as the drug has been linked to the potential of fatal hepatotoxicity. It is also not recommended for those with severe diabetes, malignancy, chronic severe depression, a history of meningioma, and hematological disorders. And like spironolactone, it may lead to the feminization of male fetuses, so it should be avoided by pregnant women.
Flutamide. Flutamide, for its part, may cause hot flashes, gastrointestinal disorders, muscle cramps, breast tenderness, and decreased libido. Serious side effects include fatal hepatitis, which is why patients on the medication should have regular liver function tests. And like the first two anti-androgen treatments, it is contraindicated in pregnancy since it has been found to potentially cross the placental barrier and cause feminization of male fetuses.
Retinoids
Retinoids, whether topical or oral, also cause side effects that merit careful consideration. For topical retinoids, among the most common side effects are dryness, scaliness, or skin irritation. This can be mitigated by using a gentle cleanser and an oil-free moisturizer; the initial application should also be limited to thin smears every other night to give the skin time to adjust to the effects of the product. Using sunscreens is also a must.
Oral retinoids such as Isotretinoin are a different matter. Isotretinoin, in particular, has been linked to a wide array of serious side effects, from inflammatory bowel disease to depression. It can also lead to ulcerative colitis, as well as liver damage. And it has been found to contribute to birth defects in babies of women who were on the medication while they were pregnant.
For this reason, the US FDA, in 2005, required women who wanted to get or renew a prescription for the drug to sign onto a database that asks members to submit two negative pregnancy tests before they can get a prescription for the drug for the first time. Those who need a refill should get a monthly pregnancy test.
Important Factors to Keep in Mind
In choosing your preferred method of treatment for hormonal acne, it is necessary to pay attention to certain facts, such as the material composition of the treatments, their various types, and the best way to use them. Let’s go over some of the most essential details, for each treatment type.
Combined Oral Contraceptives
One of the most critical pieces of information that you need to have about using combined oral contraceptives for hormonal acne is that, at present, there are only three of them that have been approved by the US Food and Drug Administration. These are:
- (1) Ortho Tri-Cyclen®: norgestimate (white tablets, 0.180 mg; light blue tablets, 0.215 mg; blue tablets, 0.250 mg); EE (0.035 mg);
- (2) Yaz®: DRSP (3 mg) combined with EE (0.02 mg); and
- (3) Estrostep® Fe: norethindrone acetate (1 mg) combined with EE (white triangular tablets, 20 µg; white square tablets, 30 µg; white round tablets, 35 µg) and ferrous fumarate (75 mg)
Also, as previously indicated, their formulations vary; all of them contain estrogen, but the accompanying progesterone varies from brand to brand. Studies, though, assert that there is little to no significant difference in the efficacy of cOCPs, depending on their progesterone formulation.
Still, there are over 40 types of options on the market, and choosing the right one should not only depend on proper assessments of risk factors, but also on lifestyle choices, personal preferences, side effect profiles, and costs.
Anti-Androgen Treatments
Spironolactone. Although spironolactone is among the four treatment options recommended by the American Academy of Dermatology for its treatment guidelines for acne vulgaris in 2016, the medication has no approval from the US Food and Drug Administration. On the other hand, it has been used since the 1950s to treat hormonal acne, and studies have painted an overall encouraging picture for its long-term use.
Women who are about to take spironolactone should, first, be assessed. Your healthcare practitioner must be able to establish that you have had no history of renal dysfunction, you do not use salt substitutes (particularly those that use potassium to replace sodium), you are not taking potassium supplements or other potassium-sparing diuretics, as well as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.
Doses are usually administered at a range of 25-200mg daily, but first-timers should start with a lower dose; over time, this can be escalated, according to the quality of results, as well as the type of side effects that the drug produces.
Cyproterone acetate. CPA, as it is an anti-androgen and a progesterone, is best taken with an oral estrogen to mitigate cyclic withdrawal bleedings as well as prevent conception. Like spironolactone, the dosage is best started low for first-timers and then accordingly adjusted.
Flutamide. Low doses of Flutamide are also ideal for the best optimal results. A study involving 52 women with acne vulgaris found that taking 250mg a day, with or without estrogen-progesterone, was beneficial to see an improvement in the women subjects.
Retinoids
There are three types of topical retinoid options on the market: two of these (tretinoin and tazarotene) require a prescription, while adapalene is available either over-the-counter or with a prescription. These are best applied once per day, but those who will show signs of skin irritation should limit their application to once every other day or less frequently. They exist as either gels or creams; choosing one depends on skin types and personal preferences. For example, if you have oily skin, you may find that you will need to stick to a topical retinoid gel.
Oral retinoid such as Isotretinoin, on the other hand, is usually taken once or twice per day for 20 weeks, and then terminated. During the first few weeks, a low dose is often prescribed to lower risks of initial acne flare up. Getting a prescription or a refill is also heavily regulated, as the drug has been known to produce serious side effects for women who are pregnant. Even women who cannot get pregnant or men must sign up to a healthcare platform that manages the regulation of prescriptions; the only difference is that they will not be required to secure pregnancy tests.
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Conclusion
Foregoing natural or home remedies for acne promises a slew of positive results, but it is necessary to ensure your safety before, during, and after you embark on treatment. Whichever treatment option you hope to choose, you should be well aware of the effects and risks that you need to consider so that you can make the most out of the treatment.
That requires the active and continual seeking of proper medical care. Your doctor should be able to advise you about any important practices or methodologies that you will need to submit to while you are on the treatment, and any necessary tests or checkups necessitated by your specific treatment method should be secured.
