Hormonal acne is driven by fluctuations in androgen hormones, which stimulate the sebaceous glands to produce excess oil. It predominantly affects women and typically presents as deep, tender spots along the jawline, chin, and lower cheeks. Flare-ups often follow a cyclical pattern, worsening in the week before menstruation.
Who Gets Hormonal Acne?
Hormonal acne is especially common in:
- Women in their twenties and thirties, even those who had clear skin as teenagers.
- Women with polycystic ovary syndrome (PCOS), which causes elevated androgen levels.
- Women going through perimenopause, when hormone levels become erratic.
- Women who have recently stopped hormonal contraception, triggering a rebound in androgen activity.
Treatment Options
Combined Oral Contraceptives
Certain combined pills are effective against hormonal acne. Co-cyprindiol (Dianette/Clairette) contains cyproterone acetate, an anti-androgen, and is licensed specifically for acne in the UK. Other pills containing drospirenone (e.g., Yasmin) also have anti-androgenic properties. Improvement typically takes 3–6 months.
Spironolactone
Spironolactone is a potassium-sparing diuretic that also blocks androgen receptors. It is used off-label for acne in the UK at doses of 50–200 mg daily. Studies show significant improvement in hormonal acne in up to 85% of women. Key considerations:
⚠ Off-label use: Spironolactone is not licensed by the MHRA for acne. It is licensed as a diuretic and for heart failure. Any prescription for acne is at the clinician’s discretion and requires informed consent. Your prescriber should discuss the off-label nature of this use with you.
- Not suitable during pregnancy — effective contraception is required.
- Potassium levels must be monitored, particularly at higher doses.
- Side effects can include dizziness, breast tenderness, and irregular periods.
Topical Treatments
Topical retinoids (adapalene or tretinoin) remain useful as part of a combined approach. Azelaic acid is another good option, particularly for women planning pregnancy, as it has a favourable safety profile.
Isotretinoin
For severe hormonal acne that does not respond to other treatments, isotretinoin may be considered. However, relapse rates can be higher in hormonal acne compared to other subtypes, so it is often combined with ongoing hormonal therapy.
Getting Diagnosed
If you suspect hormonal acne, your GP can check hormone levels through a blood test. Women with additional symptoms such as irregular periods, excess hair growth, or weight gain should be assessed for PCOS. A dermatology referral may be appropriate for treatment-resistant cases.
Hormonal acne can be frustrating, but targeted treatments that address the underlying hormonal drivers are highly effective for most women.