The ESK blog

How to tackle hormonal acne

23 August 2022

Dr Ginni Mansberg

What causes acne?

There are 4 causes of acne.

Hyperkeratinization.

Overproduction of superficial skin cells coupled with slow skin cell turnover causes skin cells to clump and block the pores resulting in pimples and blackheads.
Overactivity of the sebaceous (oil) glands.

Here is your hormonal cause!!! The culprit here is an excess of Testosterone and DHEAS, an adrenal hormone that both acts like and turns into the male hormone, testosterone.

Literally the more DHEAS, the worse the acne, especially in girls.
Overgrowth of bad actor bacteria in the skin.

Especially by Cutibacterium acnes which just love a blocked follicle and turn a blackhead into a pussy pimple. Some people seem to be hypersensitive to it and so mount a huge inflammatory response. Voila redness, painful massive pimples.
Inflammation of the skin.

It is a vicious cycle as the inflammation not only turns the skin red but also causes all the other problems above.

The inflammation is partly caused by the C. Acnes bacteria but ultraviolet radiation from the sun’s rays can cause inflammation, as can picking at the skin, as well as the wrong skin care.

How do hormones affect my skin?

Testosterone and DHEA stimulate sebaceous glands to grow and pump out sebum or oil.

Oestrogen has the opposite effect, and they stop the overgrowth of oil glands and slows down their production of oil.

The balance in your body between oestrogen and testosterone or DHEAS determines the oil gland activity.

Teenagers tend to get a surge in both testosterone and DHEAs. Especially boys. Teenaged boys get more acne than girls. But teenaged girls still get a bump in male hormones.

But this male hormone level is higher if they have a condition called polycystic ovarian syndrome.

This condition can cause cysts on the ovaries (hence the name) but the bigger issue is the hormonal imbalance where we end up with excess male hormones and as a result, excess hair on the face and body as well as more acne.

As we get older, women start to overtake men with acne. At age 25, the age at which you officially have ‘adult acne’, 50.9% of women still have acne versus 42.5% of men. Twice as many women have acne as men from age 30 to 60.

Older women have different acne.

Younger people with acne get it in the T zones-the forehead, down around the nose and onto the chin. Older women get pimples mainly on the lower part of the face, including around the mouth, along the jaw as well as the chin, giving a U-shape. It can also hit up the front of the neck.

Handling hormonal acne

If your acne is moderate to severe, see a doctor for prescription options.

Regardless of whether your teen’s acne is mild, moderate or severe, and whether they’re prescribed a medication, the right skincare will help.

Managing acne in hormonal teens

Soap free cleanser.

Soap is irritating and can dry out the skin and disrupt the chemistry of the skin.

Shop ESK soap free cleanser:

Hydroxy Cleanser

Our Hydroxy Cleanser is a soap-free, pH-balanced cleanser that provides gentle yet effective cleansing for your skin. Lightly foaming, it removes dirt, excess oils, and impurities without drying or irritating, making it perfect for maintaining a healthy skin barrier. Designed with a neutral to acidic pH, it’s ideal for sensitive skin types, including those with acne, aging skin and pigmentation. This cleanser helps preserve hydration, supports the skin’s microbiome, and normalises skin pH, creating the perfect base for your skincare routine. Free from harsh soaps, astringents, and irritants, Hydroxy Cleanser leaves skin feeling fresh, balanced, and ready for any treatment.

Featuring

Gentle, soap free syndets to leave your skin feeling clean and soft
A pH of 4.5-5 to maintain the skin barrier
Perfect for daily use for normal/oily skin

Calming Cleanse

Our Calming Cleanser is a non-foaming, coconut sugar-based formula with a gentle pH of 4.5-5, making it ideal for sensitive skin types, including those with eczema and rosacea.

This creamy cleanser effectively removes impurities while preserving the skin’s natural hydration and pH balance. Its non-soap formula minimises irritation and dryness, providing a soothing cleanse without disrupting the skin barrier.

Designed for sensitive skin, Calming Cleanser avoids harsh ingredients like astringents, camphor, and menthol, which can trigger irritation. Gentle yet thorough, it supports a healthy microbiome and barrier, leaving skin calm, soft, and ready for the next step in your routine.

Featuring;

A coconut sugar base with soothing botanical
A thorough yet gentle cleanse
Suitable for daily use and even as a make-up remover

A creamy soap-free cleanser for skin that needs a gentle, silky wash.

Coconut based with soothing botanicals
Leaves skin clear & hydrated
May be used as a make-up remover

Alpha Hydroxy acids.

AHAs including glycolic acid, lactic acid, malic acid, tartaric acid, and citric acid are pretty common players in cosmeceutical skin care. For good reason.

AHAs break down some of the bonds between skin cells helping older skin cells shed or exfoliate. That’s why they tend to be used in higher concentrations as “skin peels”.

But they are also effective when used at lower doses on a daily basis.

Shop ESK AHA serum:

Smooth Serum

Smooth Serum is a night treatment formulated with 3% Glycolic acid, 1% Lactic acid, and 1% Gluconolactone. This gentle AHA blend supports the appearance of skin texture and surface renewal, helping maintain the look of even skin tone.

Key features:

Combination of alpha hydroxy acids to support skin texture
Supports the appearance of smoother, more even skin
Can be used alongside products containing Retinal to maintain overall skin texture

Caution: Not recommended for very sensitive skin or skin prone to rosacea.

Vitamin A products (retinoids) are the best topical for treating acne.

Retinoids help with skin cell turnover, they are comedolytic (pimple busting) plus they are anti-inflammatory.

Retinoids are used at night only, because they are actually broken down and rendered ineffective by sunshine.

Over the counter retinoids, include retinal (AKA retinaldehyde) or its weaker and less effective cousins, retinol or retinyl palmitate.

Prescription retinoids often cause irritation, redness, dryness and even peeling and certainly initially, many teenagers can’t use them every night.

Shop ESK Retinal:

Ultimate A+

Building on the proven performance of Ultimate A, Ultimate A+ Night Cream is designed for those looking to refine texture and tone or support skin prone to congestion. With 0.1% Retinal (the next-generation form of Vitamin A), Niacinamide, and 2% Glycolic Acid, this formula delivers visible improvements while remaining gentle and well tolerated.

This unique combination supports smoother-looking skin, helps refine the appearance of pores and uneven tone, and promotes a more hydrated, balanced complexion.

Featuring:

Potent yet gentle formulation suitable for daily use
Helps improve the appearance of uneven tone and texture
Supports firmer, more supple-looking skin
Formulated with evidence-based ingredients known to enhance skin clarity

Note: Retinal is not suitable for use during pregnancy.

Beta Hydroxy acids AKA salicylic acid.

This is a total winner when it comes to acne.

Apart from also being an exfoliator, salicylic acid, a first cousin of aspirin, has antibacterial, anti-inflammatory, and anti-comedogenic (pimple busting) properties which all give it a really good role when tackling acne.

Shop ESK Salicylic overnight mask:

Hydroxy Overnight Mask

Our Hydroxy Overnight Mask is your go-to for clearer, glowing skin! With 5% salicylic acid and 10% urea, it’s a powerful yet gentle way to take on blemishes and keep skin hydrated. In oiler skin, Salicylic acid gently exfoliates for a smooth finish, while urea deeply moisturises. Use it as a spot treatment, or apply it once a week for an all-over refresh. Just cleanse, apply, and let this overnight mask work its magic while you sleep—wake up to softer, clearer, and radiant skin ready to take on the day!

Featuring;

- Gentle exfoliators for a weekly skin refresh

- Convenient size means you can keep it on hand to tackle blemishes when and wherever they happen

Vitamin B3 AKA Niacinamide.

This is another ingredient that has evidence for its anti-inflammatory and antibacterial effects, as well as reduced sebum or oil production.

It can also improve that all important skin barrier function by preventing water loss through the epidermis (the outer skin layer).

Given that many people with acne have dry skin underlying their overproduction of oil, this too can be helpful for acne.

Shop ESK Niacinamide morning cream:

B Calm

B Calm is formulated to support irritable and blemish prone skin while maintaining a healthy skin barrier. Ceramides strengthen resilience, Salicylic Acid exfoliates and calms the skin, and Niacinamide helps regulate oil and reduce the appearance of blemished skin.

Featuring:

- Ingredients to support an improved skin barrier

- Helps manage excess oil production

- Supports a clearer-looking skin

Sunscreen.

I know most teenagers- especially teenaged boys will actually look at you like you’re insane if you suggest they use sunscreen.

But UV damage causes inflammation to the skin which dries it out and causes the redness that is a big part of the problem.

So for the highly motivated teenager who seriously wants to get rid of their acne, look for a non-comedogenic (non zit producing) broad spectrum sun screen.

Ideally, a zinc-based sunscreen is ideal. Not only is zinc oxide, non-comedogenic, zinc also reduces sebum production.

Shop ESK zinc sunscreen:

Zinc Shade

Zinc Shade is a lightweight matte day cream and primer. Its non-greasy, matte finish allows for smooth application and works well under makeup.

We spent countless iterations perfecting this lightweight, non-greasy formula to avoid the typical white cast and thick feel of zinc products. The results? A matte finish that works beautifully under makeup. With well tolerated matte finish, it's also well suited to irritable and blemish and bump prone skin. With SPF 15 it also provides broad-spectrum sun protection against UVA and UVB rays.

Key features:

Lightweight, matte formula suitable for daily use
Smooth application with minimal white cast
Broad-spectrum UV protection
Tested SPF 15 with enhanced UVA coverage

Usage: Apply evenly to all exposed areas of skin before sun exposure. Reapply as needed throughout the day.

Dissolving microneedle patches.

Relatively new in skincare, microneedle patches have been found to be both anti-bacterial and anti-inflammatory in acne.

The tiny microneedles can painlessly penetrate the outer layers of the skin to effectively deliver actives to the acne-affected skin.

Shop ESK dissolving microneedle patches:

Spotless: Microneedle Patches

Microneedle patches.

Our Spotless Patches are your new go-to for tackling early-stage bumps, right from home! Each pack includes 8 patches, each patch packed with 300 dissolving, painless Hyaluronic Acid microneedles.

These microneedles deliver a potent blend of ingredients like salicylic acid, vitamin B3, tea tree oil, and green tea directly to the spot. This powerful formula works to calm and clear the skin and helps you stop bumps in their tracks. Keep a pack on hand for a quick, targeted solution that’s easy, effective, and skin-friendly. Say goodbye to surprise unwanted blemishes and hello to clear, confident skin!

Featuring;

Painless 0.3mm dissolving microneedles made of hyaluronic acid
Ingredients to tackle early-stage bumps
Proven results for both acne and acne scars
Gentle application and no rebound dark spots

Each pack contains 8 patches. Each patch is single use.

Managing hormonal acne in adults

See above, rinse and repeat.

But for women over 25 with breakout, we should assume there is an excess of male hormone and look for it with a blood test.

If it’s there, it needs to be treated regardless of the severity of acne.

According to an expert task force of endocrinologists (hormone specialists) who created a set of guidelines, women with acne should really consider going on the pill.

The more expensive pills are recommended but any pill will do. If that doesn’t work on its own, spironolactone, a testosterone blocking diuretic can be added in.

What NOT to use for hormonal acne

Scrubs.

Whether they’re made from crushed apricot seeds, environmentally unfriendly “microbeads” or sand, these exfoliators will remove a layer of skin giving you a short-term gain.

They’re pro-inflammatory so will make you break out more the next day or the day after.
Rubbing the face dry after washing.

Again, this can bust open pimples that weren’t ready and cause physical trauma to the skin. Use warm water then pat dry.
Fad diets.

From celery juice to going dairy or gluten free, there is no evidence for these diets and they can be inadequate to meet your teens nutritional needs.
Lemon juice.

Loved by TikTok. Hated by dermatologists. Lemon juice can be proinflammatory and its extremely low pH can dry out the skin and make acne worse.