Hormonal acne treatment: what works, step by step

Hormonal acne is acne that follows the body's hormone changes: flares before periods, spots along the jawline in adult women, acne that starts in pregnancy or around menopause, or acne from testosterone and steroids in men. It is treated with the same proven acne medicines as any other acne, plus a few prescription options that work on the hormones themselves. This guide sets out the treatment in the order dermatologists use it: what to start with, when to move on, and which prescription options fit which person. Each section links to a guide that goes deeper.

Skinli gives general education and is not a doctor. Spironolactone, birth control pills and the other prescription medicines below are decided by a prescriber, who checks your health first.

What makes acne "hormonal"

All acne starts the same way. NIAMS, part of the US National Institutes of Health, says androgens, the male-type hormones that both men and women make, enlarge the skin's oil glands and make them produce more oil. Oil and dead skin cells plug the pore, bacteria grow inside, and a spot forms.

"Hormonal acne" is a name for acne where hormone changes clearly cause the pattern. The American Academy of Dermatology (AAD) describes it by its signs: stubborn acne on the lower face, chin and jawline, and breakouts that come predictably with periods. The difference from ordinary acne is covered in hormonal acne vs regular acne.

Most people with hormonal acne have normal hormone blood tests. A 2025 review of adult female acne says the role of androgens in adult acne is unclear for this reason. A 2019 review of acne around menopause says women with a few acne spots and no other signs usually do not need extensive hormone tests.

Signs of a hormonal pattern

Pattern	What it looks like	Guide
Jawline acne	Spots and deep, tender bumps on the jaw, chin and neck in adult women	Jawline acne
Period acne	A flare in the week before a period, month after month	Period acne
PCOS acne	Acne with irregular periods, extra hair growth or hair thinning	PCOS acne
Acne in men	Acne linked to testosterone therapy, steroids or shaving	Hormonal acne in men
Pregnancy acne	New or worse acne in pregnancy, often worst later in pregnancy	Pregnancy acne
Menopause acne	Acne starting or returning in perimenopause or after menopause	Menopause acne

The AAD lists what brings the hormone changes in adult women: periods, pregnancy, perimenopause, menopause, and starting or stopping birth control pills. It adds stress, which makes the body produce more androgens, along with family history, some skin and hair products, medicines and undiagnosed medical conditions.

Step 1: treatment on the skin

Hormonal acne responds to the same treatments on the skin as other acne. The AAD says many adults with mild acne can treat it with store-bought products, and its dermatologists recommend one product containing one of these active ingredients:

Ingredient	What it does	Grade in the AAD's 2024 guideline
Adapalene, a retinoid	Clears blackheads, whiteheads and pimples, and prevents new ones	Strong recommendation for retinoids on the skin
Benzoyl peroxide	Kills acne bacteria. The AAD suggests starting at 2.5%	Strong recommendation
Azelaic acid	Fights acne and fades dark spots	Conditional recommendation
Salicylic acid	Unclogs pores. Best on whiteheads and blackheads	Conditional recommendation

A conditional recommendation is a weaker grade than a strong one. Skinli's free acne plan builds a routine from a photo using adapalene 0.1% and benzoyl peroxide 2.5%, two of the strongly recommended options.

How to use it

• Use one product at a time for 6 to 8 weeks. The AAD says not to add another product or stop during that time.
• Cover the whole area. Put a thin layer on all skin that breaks out, including skin with no spots, so you treat the next breakout before it forms.
• Start slowly if your skin is sensitive. The UK's NICE guideline suggests starting every other day, or washing the product off after an hour, and building up.
• Protect your skin from the sun. The AAD advises broad-spectrum SPF 30 sunscreen with a retinoid.

The AAD says that if a product works, you should see fewer breakouts in 4 to 8 weeks and clearing at 16 weeks. The salicylic acid vs benzoyl peroxide guide helps you choose between the two most common starting ingredients.

Face wash and daily care

The NHS advises washing twice a day with a gentle cleanser, using products that do not clog pores, and not scrubbing or picking. A wash with benzoyl peroxide or salicylic acid adds an active ingredient to the routine. See cleanser for acne-prone skin and benzoyl peroxide face wash.

Step 2: know when to see a dermatologist

The AAD says it is never the wrong time to see a dermatologist for adult acne, and that if you are not clear within a few months of treating it yourself, you should book a visit. See one sooner if:

• You have deep, painful lumps, which store-bought products are unlikely to treat
• Acne leaves scars or dark marks
• Acne comes with irregular periods, new hair growth or hair thinning
• Acne started after a new medicine, testosterone or steroids
• You are pregnant or planning a pregnancy

The AAD says women who answer yes to any of these questions may want to consider hormonal therapy: acne along the lower face, jawline and neck despite trying many treatments, disappointing results from an antibiotic, or acne on the chest or back that will not clear.

Step 3: prescription options

A dermatologist has several options, often used together:

Treatment	Who it suits	Grade in the AAD's 2024 guideline	Guide
Spironolactone pill	Women with stubborn acne on the lower face and jaw	Conditional	Spironolactone for acne
Combined birth control pill	Women who also want birth control	Conditional	Birth control for acne
Clascoterone cream	Males and females aged 12 and older	Conditional	See below
Prescription retinoid, such as tretinoin	Most people with acne, outside pregnancy	Strong, for retinoids on the skin	Prescription retinoids
Antibiotic pill, such as doxycycline	Inflamed acne, for a short course with benzoyl peroxide	Strong, for doxycycline	Severe acne and dermatologists
Isotretinoin	Severe or scarring acne, or acne that fails other treatment	Strong	Accutane
Steroid injection	A single large, painful spot	Good practice statement	Cystic acne

Hormonal treatment for women

The AAD names two hormonal therapies that can clear acne in women: birth control pills and spironolactone. It says the FDA has approved some combined birth control pills for acne, and that women notice improvement in 2 to 3 months. It says spironolactone can treat deep, tender acne on the lower face, jawline or neck when other treatments do not work, with fewer breakouts in a few weeks. Taking both together can work better.

A 2023 trial of 410 women in England and Wales, published in the BMJ, found that 82% on spironolactone reported improvement at 24 weeks, against 63% on a dummy pill. Its authors called spironolactone a useful alternative to antibiotic pills.

Both medicines need a prescriber's check. Combined pill labels say women over 35 who smoke should not use them. Spironolactone can cause serious birth defects, so the AAD says anyone who can get pregnant must use birth control while taking it.

The cream that works on hormones

The AAD says clascoterone is the first FDA-approved medicine that can treat the hormonal causes of acne in both males and females. It is a prescription cream for people aged 12 and older, applied twice a day. Its FDA label says it blocks the skin's androgen receptors. In the label's two 12-week trials, 18.8% and 20.9% of users reached clear or almost clear skin, against 8.7% and 6.6% on a cream without the medicine. The most common side effects were redness, itching and dryness.

Treatment for men

The AAD says spironolactone is not prescribed to men for acne, because men have developed breasts while taking it, and the birth control pills approved for acne are for females. Men use the treatments on the skin, clascoterone, antibiotics and, for severe acne, isotretinoin. See hormonal acne in men.

For severe or scarring acne

The AAD's 2024 guideline strongly recommends isotretinoin for acne that is severe, causes distress or scarring, or fails other treatment. The AAD says 85% of patients see permanent clearing after one course. A 2019 review of acne in older women says 30% to 40% fail after a course, and that acne returning right after a course should raise suspicion of a hormone disorder. Isotretinoin comes with strict pregnancy rules. See Accutane and pregnancy.

When a hormone condition is behind the acne

Sometimes acne is one sign of a wider hormone problem. The NHS lists oily skin and acne among the main symptoms of polyendocrine metabolic ovarian syndrome (PMOS), the condition once called polycystic ovary syndrome (PCOS), along with irregular periods, extra hair growth and weight gain. NICE's advice for people with PMOS and acne is to start with standard acne treatment, add a combined pill if that does not work, and consider a hormone specialist when there are other signs of high androgens. NICHD, the NIH's institute for women's and children's health, lists birth control pills, anti-androgen medicines and metformin as options. See PCOS acne.

Hormonal acne at different life stages

Pregnancy. The American College of Obstetricians and Gynecologists (ACOG) says many women get acne in pregnancy. Isotretinoin, spironolactone and retinoids must stop. ACOG lists benzoyl peroxide, azelaic acid, salicylic acid and glycolic acid on the skin as options. See pregnancy acne.

Perimenopause and menopause. The AAD says acne that starts in adulthood is most common among women going through menopause. A 2019 review names long-term treatment on the skin as the main approach, and spironolactone as the first choice when a pill is needed. See menopause acne.

Later in life. In a 2008 survey of 1,013 adults, acne was reported by 50.9% of women in their 20s and 15.3% of women aged 50 and older. See when does hormonal acne stop?.

Lifestyle, natural remedies and supplements

The evidence here is thinner than for medicines:

• Diet. The AAD says small studies link foods that raise blood sugar fast, and cow's milk, to more acne, while other studies found no link. See does diet cause acne?.
• Stress. The AAD says stress may worsen acne you already have.
• Natural remedies. Spearmint tea lowered testosterone in one small trial that did not measure acne. Tea tree oil on the skin has a few small studies. See natural remedies for hormonal acne.
• Supplements. A 2024 review says the FDA does not evaluate acne supplements, and found safety concerns with some common ingredients, including DIM and high-dose vitamin A. See supplements for hormonal acne.

How long each treatment takes

Treatment	When the AAD says to expect results
Store-bought product on the skin	Fewer breakouts in 4 to 8 weeks, clearing at 16 weeks
Spironolactone	Fewer breakouts and less oil within a few weeks
Birth control pill	Improvement in 2 to 3 months
Isotretinoin	Permanent clearing after one course in 85% of patients

The AAD warns that switching products every few days can irritate the skin and make acne worse. Give each step time.

Keeping hormonal acne away

Hormonal acne can come back after treatment stops. The AAD says that when hormonal therapy clears acne, women may stay on it for a long time, often stopping their other acne treatments, and that long-term use appears to be safe. NICE says maintenance treatment is not always needed, but should be considered for people whose acne often returns, and suggests a gel combining adapalene and benzoyl peroxide, reviewed after 12 weeks.

Track your skin as you go. A photo every two weeks, with the dates of your periods, shows whether a treatment is working and gives a dermatologist something concrete to look at. The progress photo guide explains how.