How to Identify If Your Acne Is Hormonal

Managing face and body breakouts is a common challenge for many people. In fact, about 1 in 10 people worldwide struggle with acne, according to the National Institutes of Health (NIH). Recognizing the type of acne you're dealing with is a crucial step in treating and clearing it. With the help of dermatologists, we’re focusing on the differences between hormonal and bacterial acne, which may appear similar but have important distinctions.

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What Is Hormonal Acne?

Hormonal acne occurs due to hormonal changes in the body, often appearing as painful, deep cystic bumps primarily on the lower face and neck, according to Brooke Jeffy, MD, FAAD, a board-certified dermatologist from Scottsdale, Arizona.

“It is more common in teens and women, especially during menstruation, pregnancy, and menopause,” she states. “These hormonal shifts lead to increased oil production, which blocks pores and fosters bacterial growth.”

Kiran Mian, DO, FAAD, a board-certified dermatologist at Hudson Dermatology & Laser Surgery, mentions that hormonal acne typically appears in a cyclical pattern following the menstrual cycle.

“It usually starts flaring up one week before or during the start of the menstrual cycle,” she explains. “The lower face, jawline, and chin are the most commonly affected, but it can also appear on the forehead and cheeks.”

Addressing Hormonal Acne

Treating hormonal acne typically requires a dual approach: topical treatments to unclog pores and oral medications to regulate hormonal fluctuations (particularly by blocking the androgen receptor). Dr. Jeffy suggests using salicylic acid, benzoyl peroxide, and/or retinoids, along with either an oral contraceptive or a medication called spironolactone.

“Getting enough sleep is crucial to minimize cortisol fluctuations, which can also lead to increased oil production,” she emphasizes. “Cutting back on dairy can also help reduce oil production and inflammation.”

What Is Bacterial Acne?

Acne with a significant bacterial component typically involves pustules. Dr. Mian explains that it can appear anywhere on the face or body, but it most commonly affects areas rich in oil glands, such as the forehead, cheeks, and nose.

The lesions typically appear in an unpredictable pattern, often red and inflamed. While they may not always be painful, they usually involve pus-filled acne that can be 'squeezed,' though it’s best not to try squeezing them, she warns.

Managing Bacterial Acne

When tackling bacterial acne, the main aim is to reduce the amount of bacteria present on the skin’s surface.

Dr. Mian explains that using benzoyl peroxide—whether in a wash or as a topical treatment—followed by an antibacterial lotion like clindamycin can significantly lower bacterial levels, helping to control bacterial acne.

She also notes that sebum essentially 'feeds bacteria,' so using a retinoid to prevent oil buildup can be beneficial. Additionally, avoiding dairy, which can be inflammatory, may also help.

Hormonal Acne vs. Bacterial Acne

In short, hormonal acne arises from hormonal changes and typically manifests as deep, painful cysts beneath the skin. On the other hand, bacterial acne is caused by an excess of bacteria and oil, usually appears more on the skin’s surface, and often contains pus.

These two types of acne require different treatment strategies. Hormonal acne can benefit from oral medications that regulate hormone levels, whereas bacterial acne needs antibacterial lotions to reduce bacterial growth. Both types can improve with topical acne treatments like benzoyl peroxide, salicylic acid, and retinoids, along with changes in sleep, stress, and diet.

When to Consult a Dermatologist

If your hormonal or bacterial acne hasn’t shown improvement after three months of over-the-counter treatments and lifestyle modifications, it’s time to see a dermatologist for further treatment.

Dr. Jeffy emphasizes that persistent acne—particularly large, painful cysts—can lead to permanent scarring, making it crucial to seek treatment. With professional care, clearer skin can start to appear within weeks, bringing both greater comfort and an increased sense of confidence.