Hormonal Acne 101

Updated: Nov 6, 2018

I like to educate my patients about the physiology of their acne. I try to be as

simple as possible and draw them a diagram of their sebaceous glands and all

the things that act on it to produce acneic lesions like pustules, comedones or

cysts. Then we can formulate a plan of ATTACK that addresses all of these

factors – like inhibiting sebaceous glands, controlling the hormones acting on

them, managing the skin bacterial load and enhancing the skin immunity.

The most important thing for them to understand is that hormonal acne is a

complex interplay and everyone is a little different. It’s not necessarily just

your PCOS or just the cheese in your diet or the stress or polluition… it’s a

unique gamut of factors that create the perfect recipe for acne.

The main culprit in acne is the sebaceous gland. This little guy is highly

susceptible to the balance of hormones in our body. It will respond to

hormonal disarray by overproducing sebum. Ultimately the sebum blocks the

gland making it a sitting duck to be colonised by bacteria on the skin and form

an inflamed or cystic or pus-filled spot.

Hormonal disarray is increasingly common – there are many postulations

about why. You may have heard a few, for example the abundance of women

on the contraceptive pill, hormones in our food, high stress causing the body

to overproduce oestrogen in relation to progesterone. There may be more

than one reasons your hormones are not happy. The most common reasons I

see in non-PCOS patients would be stress and lifestyle factors. The main

lifestyle factor that we can easily address would be glycaemic load in the diet.

A big shot of sugar or alcohol (which acts like sugar) causes an insulin spike

which is ultimately a stress response. This has a complex interaction with your

sex hormones. It is easily managed by veering toward a low glyaemic index diet

and reminding yourself that binge drinking is going to negatively affect your


The ideal way to intervene with hormonal disarray would have to be lifestyle

management– but this can be a long and challenging road for some. Other

options include androgen blocking medications like Aldactone or some forms

of the contraceptive pill. Apart from managing hormones, we can manage the

skin by inhibiting sebaceous glands using vitamin A or gentle acids. We can also

treat infection and inflammation using low dose antibiotics or my favourite –

high quality zinc supplementation.

Everyone’s different when it comes to the causes and the management of

hormonal acne. It is often a journey of finding exactly what works for the

patient. My biggest piece of advice would be to seek medical support early.

You can integrate your wishes for naturopathic or herbal management with a

medical protocol if you like. When hormonal acne is causing scarring, pigment

alteration or social awkwardness, I caution you to turn toward a multi-modal

treatment using both conventional medicine and the alternative medicine of

your choosing. The power is in the two working together to ensure you are not

left with permanent scarring. There are great solutions to offer from both

herbal and scientific realms of medicine.