How to tackle hormonal acne

The ESK blog

How to tackle hormonal acne

23 August 2022

What causes acne?

There are 4 causes of acne. 

  1. 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. 

  2. 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. 

  3. 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. 

  4. 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.

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

Hydroxy Cleanser

A soap free, lightly foaming cleanser.

  • Leaves skin feeling clean and soft
  • Doesn't strip natural oils
  • Perfect for normal/oily skin

Calming Cleanser

Calming Cleanser

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

An Alpha Hydroxy Acid exfoliating serum for daily night use.

  • Smoother skin
  • Evens out skin texture
  • Promotes skin cell turnover

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+

Ultimate A+

A Vitamin A (Retinal – 0.1%), B3 (Niacinamide – 4%) and AHA (Glycolic Acid – 2%) based night cream. Vitamin A is the ingredient with the strongest anti-ageing evidence and Retinal is the most effective and least irritating form of Vitamin A. 

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

Hydroxy Overnight Mask

Combined with 5% Salicylic Acid and 10% Urea to combat break outs and replenish your skin, our Hydroxy Overnight Mask gently exfoliates and hydrates over night so that you can wake up with softer, glowing skin.

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

Calm sensitive, oily or acne prone skin with this light-weight vitamin B3 and Salicylic Acid moisturising cream that glides on like silk.

  • Improve skin's barrier function
  • Manage the skin's oil production
  • Improve acne and rosacea symptoms.

New formula: We added Salicylic Acid making it more light-weight, hydrating and more effective in managing acne and red and sensitive skin. 


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

Zinc Shade – UV Protection Skincare Product

Zinc Shade based daily moisturiser providing you with the protection you need from both UVA (aging) and UVB (burning) rays.

  • Protects from the sun's UVA and UVB rays
  • Can be used under make-up
  • Rated SPF15

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

Spotless: Microneedle Patches

Banish and fade early stage pimples with 300 dissolving Hyaluronic Acid microneedles tipped with Salicylic Acid, Vitamin B3, Tea Tree Oil and Green Tea.

  • Reduce the size & severity of early-stage pimples
  • Manage acne and acne scars
  • No irritation, redness or rebound pigmentation
Each pack contains 8 patches. 

    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 

      1. 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. 

      2. 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.

      3. 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. 

      4. 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. 

      Any questions about hormonal acne? Let us know! Email us at