Hormonal acne unlike the part 1 series which dealt with “physiological condition of the skin”, has more to do with internal functions of the skin or what’s going on inside rather than the surface of this skin​.

Hormonal acne also has a lot more to do with oil production, and as the name implies has to do with an imbalance in the hormones in the body​.

Usually , acne results when we have more of the male hormones than the female, because this leads to overproduction of oil in the skin which can be a trigger for acne if not well managed​.

We will focus on hormonal acne in the following life stages​:

  • Puberty
  • Pregnancy
  • Pre-menstral
  • Pre-menopause
  • Stress


  • During puberty, in boys and girls alike, there tends to be an increase in the androgen hormones, this causes the sebeacous glands to produce more oil .
  • High levels of androgens are linked to excess sebum production in the skin. This can result in clogged pores and eventually, hormonal acne.
  • During puberty, hormonal acne usually occurs on your forehead and nose bridge. This is because most of your sebaceous glands are located in your T-zone.

Things to consider with teenage acne​:

  • Choose a mild cleanser
  •  Don’t scrub with a washcloth; use fingertips and wash the face gently, 
  • Just don’t overdo it: Washing your face once in the morning and once at night is enough
  • A mild daily moisturizer lotion or cream can be beneficial, especially if you’re using drying prescription creams from your doctor, but don’t use heavy ointments or grease. These can further clog pores and aggravate acne
  • Do Choose Nonoily Hair Products, Which May Touch Your Face
  • Don’t Pop or Pick at Your Pimples — Doing So Will Do More Harm Than Good
  • Avoid spending too much time in the sun
  • Always Wash Your Face After exercising
  • Change Your Pillowcases

Basic acne routine ages 11-15 years​:

  • Use a mild sls free cleanser
  • Use a mild , calming toner.. Alcohol free and acid free
  • Use a mild moisturiser
  • Scrub once a week, with a gentle face scrub
  • Spot treat

Basic acne routine ages 15-19 years​:

  • Cleanser
  • Mild alcohol free, antibacterial toner
  • Vitamin c serum
  • Night time serum with salicylic acid alernating with a hydrating serum
  • Light day moisturiser with SPF and light hydrating moistursier for night
  • Face masks once a week


Menopause/ peri menopause

  • Women experience a reduction in estrogen levels and an increase in androgens during menopause. This can also cause you to break-out.

Things to consider with menopausal acne​:

Lifestyle tips to include:

  • Optimise your weight
  • Optimise your amount of exercise
  • Make sure you are getting adequate sleep
  • Decrease stress levels in general
  • Quit smoking if you smoke
  • Remove makeup before bed 
  • Make sure you are having regular bowel movements, constipation increases your toxin load and can show in your skin as its a secondary elimination pathway.

Lifestyle tips to avoid​:

  • Avoid frequent washing (1-2 daily MAX, even water disturbs the skins delicate pH balance)
  • Review all facial products and remove all oil-based cosmetics
  • Avoid scrubs
  • Avoid popping and picking
  • Avoid tanning

Dietary advice​:

  • Maintain good hydration levels
  • Avoid sugar
  • Avoid dairy
  • Avoid insulin spiking carbohydrates (grains)
  • Increase consumption of beneficial anti-inflammatory oils such as fish oil
  • Avoid deep-fried or processed “bad” fats
  • Increase soluble fibres
  • Increase anti-oxidant rich fruit and vegetables

Tests to consider:

  • Reproductive Hormones: Testosterone, SHBG, DHEAS, Prolactin, LH, FSH, Androstenedione
  • Thyroid function: TSH
  • Metabolic syndrome testing: Insulin, glucose, lipid profile
  • Skin microbiome testing

Supplements to consider:

  • Zinc – major building block for healthy skin
  • Fish oil 
  • Other antioxidants – Vitamin A, Vitamin C
  • Probiotics 
  • Herbal medicine

Menstural cycle

  • Fluctuations in hormones before the beginning of your menstrual cycle may trigger acne . A significant number of women reportedly experience premenstrual acne symptoms.
  • Estrogen and progesterone levels fall as your “time of the month” approaches. Testosterone levels remain constant, making it the dominant hormone during your period. This can contribute to sebum production, causing your skin to break out.

Basic routine to manage acne during menstural cycle

  • Daily cleansing ( morning and evening)
  • Light, non greasy moisturiser morning and evening
  • Use a mild , alcohol free-acid toner/serum
  • Weekly use of clay mask


  • Pregnancy can cause acne due to an increase in androgen hormones that lasts throughout pregnancy.​
  • Pregnant women are more at risk of developing acne if they have a history of acne prior to pregnancy.​
  • Pregnancy acne will likely become worse in the third trimester when androgen levels increase even more.​


Which treatments are safe during pregnancy?

  • The absence of safety data can make it difficult to advise on treatment of acne in pregnancy. Most experts agree that topical treatments that can be used safely in pregnancy include:
  • Benzoyl peroxide
  • Azelaic acid
  • Fruit acids such as glycolic acid
  • Lactic acid

Which treatments are unsafe during pregnancy?

  • The following drugs must be avoided in pregnancy or if pregnancy is being contemplated.
  • Do not use topical preparations containing:
  • Topical retinoids (tretinoin, isotretinoin and adapalene)
  • High concentration salicylic acid 
  • Do not take the following oral medicines:
  • Tetracyclines in later pregnancy, eg doxycycline, minocycline, lymecycline – these may discolour the teeth of the baby
  • Other oral antibiotics such as trimethoprim + sulphamethoxazole or fluoroquinolones
  • Isotretinoin – a teratogen if taken during early or mid-pregnancy, causing fetal loss (miscarriage) or severe birth deformities


  • To prepare ourselves for a stressful environment, our bodies overproduce certain hormones like cortiso. These hormones stimulate your oil glands and put them into overdrive. This overproduction of oil then clogs pores, which is what’s actually causing you to break out, not the stress itself.
  • While most women experience hormonal acne on their jawline, stress acne more closely resembles the breakouts you probably got when you were a teenager, since it’s caused by an overproduction of oil. “Stress acne, unlike your regular breakouts, usually occurs on the oiliest parts of your face—your forehead, nose, and chin areas. Given the increase in oil production, your skin will usually look greasier and slightly more inflamed.​​

Tips for managing stress acne​

  • Getting a good night’s sleep to keep cortisol levels low and keeping up a healthy diet
  • Working out, meditation, deep breathing, therapy, or watching hours of reality TV (to each her own). The most important thing is figuring out what works best for you
  • Using oil fighting products like salicylic acid, azelaic acid and benzyl peroxide
  • Using lighter moisturisers rather than heavy ones