How to Know If Your Acne Is Hormonal

Dealing with face and body breakouts is something that tons of people experience. In fact, roughly 1 out of every 10 people deal with acne across the globe, according to the National Institutes of Health (NIH). Understanding the different type of acne you have is a giant step toward treating and clearing it up. With dermatologist insight, we’re zero-ing in on hormonal vs. bacterial acne, which can look similar but have some key differences. 

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What Is Hormonal Acne? 

Hormonal acne is triggered by hormonal fluctuations in the body and presents as painful, deep cystic lesions usually on the lower face and neck, notes Brooke Jeffy, MD, FAAD, a board-certified dermatologist in Scottsdale, Ariz. 

“It is more common in teenagers and women, especially during menstruation, pregnancy, and menopause,” she explains. “These fluctuations increase oil production which clog pores and promote bacterial overgrowth.” 

Kiran Mian, DO, FAAD, a board-certified dermatologist at Hudson Dermatology & Laser Surgery, adds that hormonal acne typically shows up in a cyclical way following a menstrual cycle. 

“It tends to start flaring one week before the cycle or during the onset of the menstrual cycle,” she explains. “The lower face, jawline, and chin area seem to be most commonly affected, but it can occur on the forehead and cheeks, as well.” 

Treating Hormonal Acne 

Treating hormonal acne is often a two-fold approach that involves topical treatments to clear up the pores and oral medications to control hormonal fluctuations (specifically: blocking the androgen receptor). Dr. Jeffy recommends using salicylic acid, benzoyl peroxide, and/or retinoids along with either an oral contraceptive or a medicine called spironolactone. 

“Adequate sleep is important to reduce cortisol fluctuations which can also increase oil production,” she adds. “Reducing dairy can also decrease oil production and inflammation.” 

What Is Bacterial Acne? 

Acne with a large bacterial component almost always has some pustules involved. Dr. Mian says that it can appear anywhere on the face or body, but shows up most often in areas with lots of oil glands, including the forehead, cheeks, and nose. 

“The lesions do not happen in a cyclical way, and tend to be red and inflamed,” she notes. “They may or may not be painful, but usually do involve some pus-filled acne lesions that are ‘squeezable’ — not that you should squeeze them!” 

Treating Bacterial Acne 

When clearing up bacterial acne, the goal is to decrease how much bacteria is sitting on the skin’s surface. 

“Using benzoyl peroxide—whether that’s in the form of a face wash or topical—followed by an antibacterial lotion like clindamycin can help decrease bacterial count on the skin, helping to minimize bacterial acne,” explains Dr. Mian. 

Also, she notes that our sebum is basically “food for bacteria,” so using a retinoid to prevent oil congestion is helpful. Dairy tends to be inflammatory so avoiding that can also help.

Difference Between Hormonal Vs. Bacterial Acne 

In a nutshell, hormonal acne is caused by hormonal fluctuations and usually presents as deep, painful cysts under the skin. Conversely, bacterial acne occurs due to high quantities of bacteria and oil, sits more on the skin’s surface, and often has a pus component. 

Both have different treatment approaches, with hormonal acne benefitting from oral medications that control hormonal fluctuations and bacterial acne requiring an antibacterial lotion to control bacteria count. They also both benefit from topical acne medications like benzoyl peroxide, salicylic acid, and retinoids, as well as lifestyle adjustments related to sleep, stress, and diet. 

When to See a Dermatologist 

You should see a dermatologist to treat your hormonal or bacterial acne if you haven’t seen an improvement within three months using over-the-counter treatments and making lifestyle shifts. 

Dr. Jeffy notes that ongoing acne—especially large, painful cysts—can result in permanent scarring, so it’s important to get treatment. With professional treatment you can start to see clearer skin within a matter of weeks, resulting in more comfort and a boost of confidence.