Can't Get Your Breakouts Under Control? You Need to Read This
Tackling day-to-day acne is quite the process as it is, but when you add hormones into the mix, it gets increasingly frustrating. Getting hit with a hormonal breakout is a major letdown: it makes me feel like I have to start from scratch to get my skin balanced again. I know I'm not the only one who knows this struggle all too well. That's why I spoke to some leading experts in the skin care industry to find out what causes hormonal acne, how to prevent it, and ways to manage once you have a flare-up.
Acne: An Overview
Let's start with the basics of what causes acne in general. Contrary to popular belief, it's not always about the amount of oil but the quality of oil. Some of us get breakouts when the production of excess sebum and oil is too thick and waxy. "Instead of flowing freely through pores, this type of oil becomes blocked and forms a plug," New York City dermatologist Dr. Dennis Gross explained. That plug congests the pore and results in a blemish.
Oily complexions aren't the only source of spots. If you have dry, flaky skin and still suffer from breakouts, you may have an oil flow problem. Dead skin cells prevent sebum from making it to the surface of the skin, so it gets trapped inside of pores and creates acne-causing bacteria. This typically results in blackheads, enlarged pores, and even drier skin.
Francine Porter, founder of Osmotics Cosmeceuticals, told me another root of acne can be "abnormally sticky skin cells" because they don't properly shed, clogging hair follicles. That's why cell turnover is so important when combating breakouts (more on that later).
What Causes Hormonal Acne and Who Gets It?
According to Porter, it's typically caused by the increase in the male hormone called androgen. Androgen overstimulates oil glands and alters the behavior of skin cells, contributing to acne flare-ups.
If you think hormonal acne is just something women have to deal with, you'd be surprised to find out that this isn't the case at all. It actually affects both men and women. Porter explained that men are more likely to develop severe forms of acne (including inflammatory and cystic) during adolescence. Luckily for them, these skin problems tend to diminish once they are adults.
Unfortunately, ladies have the reverse issue. While women tend to have milder breakouts when they're younger, they are more prone to develop adult acne. This can be explained by the fact that women's hormones fluctuate more.
How to Determine If Your Acne Is Hormonal
There are a few major clues that can help you figure out whether or not your zits are due to hormones. The first big one, Porter explained, is the timing of your breakouts. "You'll often have flares during menstrual cycle or ovulation, starting a new birth control pill, or during other hormonal shifts such as pregnancy or menopause," she said.
Another indicator is the location of your acne. Hormonal acne is usually located under the cheekbones, along the jawline, or around the mouth.
The appearance of the pimples also offers clues. "Hormonal acne tends to be deep or cystic and sensitive or painful to touch; it is also more likely to leave a scar," Porter said.
Also be sure to pay attention to what type of treatments your acne responds to. Porter explained that if your breakouts are not responding to topical treatments or change (for better or worse!) when you take or stop taking hormonal birth control, these are all signs that hormones are the offender. "The problem isn't coming from the surface of your skin but from hormonal shifts and imbalances that affect your entire body," she said.
If you're on birth control, Porter recommended checking the brand and type. There are brands that help keep skin clear and others that can trigger breakouts. Ask your doctor which prescription is best for you.
Preventing and Controlling Hormonal Breakouts
A good skin care routine is key to keeping hormonal inflammation at bay and minimizing inevitable flare-ups. For the best results, use a gentle noncomedogenic cleanser daily and avoid products containing irritants like fragrance or witch hazel. A mild spot treatment containing salicylic acid will help stave off any surface-level breakouts, and a lightweight moisturizer will add soothing moisture. And, of course, no touching, squeezing, or pinching pimples! Read on for some of my favorite product picks.
A Well-Rounded Routine
The root cause of acne is when oil glands are blocked. You can prevent this from happening by using a topical exfoliant.
"Many people do not realize that a blemish may begin to form two to three weeks before it appears on the surface of the skin," Dr. Gross said. This means you have to be on top of your acne-fighting game at all times, not just when zits rear their ugly heads. Some of my favorite blemish-fighting treatments come in the form of peel pads, such as Dr. Dennis Gross One Step Acne Eliminating Pads ($38), which use l-carnitine to prevent pores from getting clogged. A gentle peel containing a mix of salicylic acid and AHAs (alpha hydroxy acids) can also become part of your regular acne-fighting routine. I like M-61's Power Glow Peels ($28). These no-rinse peels offer up gentle exfoliation by removing dead, skin-clogging cells.
Other topical products you can use daily include SkinCeuticals' Blemish + Age Defense ($90). It reduces fine lines and wrinkles on aging skin, but it also contains salicylic acid to prevent breakouts and even skin tone. Salicylic acid can be a bit drying, so pairing it with a moisturizer is key. Using one with the potent antioxidant vitamin C will protect your skin against harmful free radicals (and fade dark spots!) while erasing redness left behind by breakouts. Embryolisse's Moisturizing Cream With Orange Extract ($30) is noncomedogenic, making it ideal for anyone suffering from acne.
Incorporating a product containing retinol into your routine is something you might want to consider. Sure, we all think of retinol as an antiaging tool because it accelerates cell turnover, but that same process is helpful for preventing and reducing the effects of breakouts. It also reduces pore size. Pro-Essentials: A15 by Twinmedix ($90) is powerful enough to deliver results while gentle enough to use on acne-prone skin.
Having a good spot treatment is a necessity for your arsenal. Sulfur is a great ingredient to reach for when it comes to banishing eruptions, because it controls that dreaded acne-causing bacteria. I've found Eve Lom's Dynaspot ($34) to be super effective.
It's also important to work from the inside out when hormonal fluctuations come into play. According to Julie E. Russak, M.D., FAAD, and founder of Russak + Aesthetic Center, not only is your diet important, but specifically the time of day you eat. She suggested skipping that late-night snack: "Sweets or even a sugary cocktail before bed can spike blood sugar levels and create inflammation, worsening acne."
To really give your skin TLC, you should drink plenty of water and eat lots of bright fruits and veggies. Celebrity facialist Ildi Pekar also suggests cutting down on dairy and soy before and during your period as they also tend to cause flare-ups.
Learn more about how diet can affect your skin here.
A good night's sleep can do wonders for our mood and general well-being, but it's also an important part of a good skin care routine. "The less sleep you get, the more your body releases glucocorticoid, a steroid that can exacerbate breakouts," Dr. Russak said. She also believes in changing your pillowcase at least once a week for clearer skin. A satin pillowcase is preferable because the weave reduces chafing on the skin. If you have long hair, sleep with it pulled away from your face — your leave-in hair products might be aggravating your skin.
Reducing stress and taking some time to relax can actually help to nip acne in the bud. Getting a facial every six to eight weeks will not only help clear congested skin, keep it balanced, and prevent future breakouts, but it will also give you some time to unwind.
In addition to facials, LED therapy has proven to work well on acne. LED treatments are quick, painless treatments that use different colored UV-free light to address all kinds of skin concerns. Opt for a blue light one when dealing with acne. "The blue light penetrates deep into skin to kill bacteria and heal damaged skin cells," Pekar said. She also mentioned that blue LED therapy helps increase serotonin production in the brain, which can improve your overall mood.
Overcleansing is a common error made by those with acne, according to Dr. Dennis Gross. Yes, you need clean skin, but if you go overboard, it can cause drying and more inflammation. Cleansing twice a day is enough to keep your skin clean without causing undue irritation.
Other typical mistakes include using gritty scrubs, astringents, or harsh masks. These can strip your skin and overexfoliate. To overcompensate for the excessive dryness, your skin might respond by producing more oil!
Opt for a mild, fragrance-free cleanser formulated with gentle, calming ingredients. Purlisse's Gentle Soy Milk Cleanser and Makeup Remover ($36) employs white tea and blue lotus to soothe irritation and calm redness. After cleansing, a noncomedogenic moisturizer should be your next step. My go-to is Algenist's Splash Moisturizer ($58). Its soothing formula leaves skin with a megadose of hydration. Plus, because it's a lightweight gel, it's gentle enough to use on acne.
How to Avoid Scarring
There have been many mornings when I wake up with a whitehead, blackhead, or pimple that I so desperately want to squeeze into oblivion. I know better than that; we all do. Still, listen to your mother when she told you, "Don't touch your face!" Not only can picking, popping, or prodding at blemishes lead to scarring, but it can also make the infection worse by pushing bacteria deeper into your skin.
According to Dr. Gross, we get acne scars when too much collagen forms a wound on your skin as it tries to heal. A particularly bad pimple can leave skin wounded and cause scarring without your intervention, so intentionally messing with them is a major no-no.
Ildi Pekar has seen hundreds of clients come in who have caused themselves scarring due to improperly trying to extract blemishes on their own. "With the wrong angle and improper pressure, you can break capillaries, which can cause lasting redness and form scars that take a lot of time to heal." She recommended applying a hot compress to the spot and calling your esthetician for a professional extraction.
Even when it feels like a whitehead is taunting you, just remember: patience is a virtue. Severe breakouts can take eight to 10 weeks to heal, while pimples can take two to four weeks. Picking will only prolong the healing process and can leave a lot of damage in its wake.
When to See a Doctor
If it feels like you've tried everything and your acne won't budge, it might be time to see a doctor. This is especially true if breakouts start causing you a lot of stress or interfering with your day-to-day life. That's no way to live! Calling in the help of a dermatologist may be just what you need to get your acne — hormonal or otherwise — under control.