Acne: hormonal influences and skin types explained

What is acne?

Acne is a chronic inflammatory condition of the hair follicle and sebaceous gland, typically caused by a combination of factors. It is not solely about sebum production; hormones, follicle blockage, changes in the skin microbiome, and inflammatory responses all play a role.

This explains why acne manifests differently in different individuals. Some may experience blackheads and shiny skin, while others contend with red pimples, deep inflammations, or recurring breakouts around the jawline. Skin type also matters: acne-prone skin can be oily but may also feel sensitive or tight. To truly understand acne, it is important to consider the broader context.

How hormones can influence acne

Hormonal fluctuations or increases, particularly in androgens, can worsen acne. These hormones stimulate the sebaceous glands, increasing oil production and triggering processes that lead to clogging and inflammation. Testosterone (an androgen) rises during puberty, often causing the onset or aggravation of acne. Elevated levels of this hormone can lead to sebaceous glands producing more oil than the skin requires.

In adults, hormonal fluctuations can also contribute to acne. This is why women are relatively more likely to experience acne in adulthood compared to men. In women, it often occurs around menstruation, pregnancy, menopause, or in cases of polycystic ovary syndrome (PCOS), a condition where ovulation is infrequent or absent.

In men, androgens such as testosterone also play a role in acne. It is not just the quantity of hormones but also the skin’s and sebaceous glands’ sensitivity to them that matters.

When acne may indicate hormonal influences

At times, acne is not merely a skin issue but may reflect broader hormonal influences. In adult women, acne can be accompanied by symptoms of androgen excess, such as seborrhoea (excessively oily skin), excessive hair growth, hair loss, or irregular menstrual cycles. Acne can also be associated with conditions that increase the production of male hormones. However, acne does not necessarily indicate a hormonal disorder.

While hormones can influence acne, it is usually the result of a combination of genetic predisposition, skin biology, inflammation, and external factors. Therefore, it is important to consider not only the spots themselves but also the pattern of symptoms and any accompanying signs when dealing with persistent or recurring acne.

How does skin type influence acne?

Oily skin: more sebum, higher risk of clogging

Oily skin is the skin type most commonly associated with acne, as increased sebum production plays a central role in its development. Research shows that people with acne generally produce more sebum and that changes in its composition can also contribute to blackheads and inflammation. While oily skin does not automatically cause acne, it does create conditions that are more conducive to its development.

Sensitive or reactive skin: acne and irritation can coexist

Acne-prone skin can also be sensitive. Studies suggest that the skin barrier may be compromised in individuals prone to acne. This can result in redness, irritation, or a heightened sensitivity alongside blemishes. Sensitive skin may be more susceptible to external factors. Acne symptoms can worsen in individuals with sensitive skin, which may react strongly to certain products or an overly aggressive skincare routine (e.g., excessive use of makeup, creams, or oils).

Dry or tight skin does not rule out acne

Dry or tight skin does not exclude the possibility of acne. Acne can occur alongside an imbalanced skin condition, meaning someone may experience spots while also dealing with skin that feels tight, dry, or sensitive. This is particularly common in individuals with a compromised skin barrier or during medical treatments.

What you can do yourself to manage acne

There are several steps you can take to help prevent or reduce acne:

• A gentle skincare routine is essential. Use lukewarm water to cleanse your face once or twice daily. If using a cleanser, opt for a non-alkaline, pH-neutral, or slightly acidic synthetic cleanser.
• When choosing skincare products or sunscreen, avoid oil- or fat-rich formulations.
• Avoid picking at spots or squeezing pimples, as this increases the risk of scarring.
• Smoking can exacerbate acne.

Although there is no definitive evidence linking diet to acne, maintaining a healthy lifestyle supports overall wellbeing.

If these measures are insufficient and acne persists, medical treatment may be necessary.

Treatment of acne

Acne often does not have a single identifiable cause. It typically results from a combination of factors, so a multifaceted treatment approach is often more effective than relying on a single method. This includes medical treatments as well as adjustments to lifestyle, diet, or skincare routines. For mild to moderate acne, treatment usually begins with topical applications such as creams, gels, or lotions. Examples of medications include:

• YouSo Tretinoin
• YouSo Tretinoin and Clindamycin
• Treclinac
• Inderm
• Differin

For more severe acne, or if initial treatments are ineffective or there is a risk of scarring, a doctor may recommend stronger treatments, such as tablets or capsules. Examples include:

• Isotretinoin
• Minocycline
• Doxycycline

These medications should not be used during pregnancy or breastfeeding without consulting a doctor.

The most appropriate treatment depends on the severity of the acne, the effectiveness of previous treatments, the risk of scarring, and the impact of the condition on daily life.

Conclusion

Acne is rarely caused by a single factor. It usually results from a combination of increased sebum production, follicle blockage, microbial changes, inflammation, and hormonal influences. Skin type also plays a role: skin can be oily, sensitive, or tight and still be prone to acne. An effective approach is always tailored to the type of acne, the severity of symptoms, and the skin’s response.

Frequently asked questions about acne

Is acne always hormonal?

No, acne is not always hormonal. While hormones can exacerbate acne, it typically arises from a combination of genetic, hormonal, microbial, and inflammatory factors.

Can dry skin also develop acne?

Yes, dry skin can also develop acne. Although acne is more commonly associated with oily skin, having dry or tight skin does not exclude the possibility of acne. Research indicates that the skin barrier may be compromised in acne, allowing pimples and sensitivity to occur simultaneously.

Where does acne usually appear?

Acne commonly appears on the face, back, shoulders, and chest. In adult women, it is sometimes more prevalent around the chin and jawline, which may be influenced by hormonal factors. However, the location of acne does not always indicate its underlying cause.

Does a specific diet help with acne?

At present, there is insufficient evidence to confirm that a specific diet helps with acne. Nonetheless, maintaining a balanced diet is essential for overall health.