You likely know the ones: The kind with deep roots that set up shop on your chin and jawline—otherwise known as the "hormone belt"—and threaten to stick around forever and haunt your dreams. They make your regular old whiteheads look like a walk in the park, because not only are they annoying to look at, but they are painful—especially if you make the mistake of trying to pick at them.
It's an unfortunate reality that hormonal acne doesn't just go away because you've made it through puberty (a fact I'm reminded of every month, without fail, three days before my period). To make things easier (or at least in an attempt to keep you from regularly cursing your endocrine system or clawing at your pimples), I chatted with the experts to find out everything you need to know about that pesky hormone belt on your face, and what you can do so that you'll never have to see it again.
First up: Why does hormonal acne actually happen?
"Hormonal fluctuations cause acne to those who are susceptible,” explains Sherry A. Ross, MD, a New York City OB/GYN and Author of she-ology. The Definitive Guide to Women’s Intimate Health. Period. "Some of the hormones responsible for acne are called androgens, including testosterone, which have a more male hormone affect causing oily skin, skin inflammation, clogged hair follicles, which all lead to acne. Hormonal imbalances and an increase in androgens are the main reasons women are prone to hormonal acne.”
But according to Ellen Marmur, MD, a NYC-based dermatologist and founder of Marmur Medical, “hormones cause acne” is a bit of an oversimplification of what's really going on. “It’s about how all of the hormones [cortisol, estrogen, testosterone, and progesterone] are working together, and how that effects the oil glands and hair follicles, specifically of the chin area,” she explains. "We have a lot of hair follicles in the chin area, so that’s one reason why the chin area is prone to acne from cortisol and testosterone. Estrogen increases testosterone, cortisol increases testosterone, and they all increase the oil gland production in the area that’s attached the hair follicle, so that’s why you see that pattern.” In addition to showing up on the hormone belt—these bad boys may make an appearance on your hairline, shoulders, buttocks, back, and chest.
Aunt Flo isn’t the only unwanted hormonal visitor that tends to pop up once a month, though. "The face is definitely singled out by the hormonal changes two weeks before a period,” says Dr. Ross. "The hormonal surges before a period make the oil glands of the face hyperactive creating oilier skin, attracting unwanted bacteria and those dreaded monthly pimples.” However, other hormonal triggers such as PCOS, pregnancy, perimenopause, and menopause can also cause an acne influx.
The major factors in hormone belt flare-ups
The old adage “'you are what you eat' rings true for acne," says Dr. Marmur. "If you’re eating something that’s not easy for you to digest, you could also have the stress response, which is the cortisol hormone." This, she says, can trigger an pimples to pop up as well. "Also if you’re eating foods that are high in soy you’ll be getting extra estrogen. If you’re eating meats that are antibiotic fed meats or hormone fed meats, you’ll be ingesting those as well.” Foods like chocolate, pasta, white bread, and rice can also be problematic, because they spike your blood sugar, which increases the production of insulin and can lead to oilier skin.
So what should you be munching on? "Foods high in antioxidants will reduce inflammation in the body which may help prevent acne,” says Dr. Ross, who suggests choosing plant-based foods such as kale, strawberries, blueberries and artichokes that are high in antioxidants. Foods high in omega-3 fatty acids can help to reduce inflammation, and Vitamins A, E and zinc are also helpful.
You've probably been vaguely aware that your birth control has some effect on your skin, but it's important to understand what exactly is going on beneath the surface. "Certain birth control pills can control the hormones that bring on more oily skin and increase your chance of getting acne," says Dr. Ross. "Birth control pills that have a higher level of progesterone, with a male hormone effect on the body, tend to cause more acne. Higher levels of estrogen in the pill tend to reduce the effect of acne as a side effect. The new lower-dosed estrogen containing birth control pills are more likely to have acne as a side effect.
There's no "one size fits all" method—and not all progesterones are created equally—so you may have to tweak your regimen until you find something that works for you. "Your over the counter products are not taking away all of your hormones—they’re just balancing them so that the highs and lows of the hormone fluctuations are more balanced so that your skin doesn’t fluctuate as well,” says Dr. Marmur.
Above all: Proper care is a must
Even though hormonal acne comes from within, how you care for it on the outside still seriously counts. In fact, mild-to-moderate hormonal acne can be treated solely with topical solutions. Look for products that contain wild indigo, which helps blunt the cortisol spike that increases oil production, and anti-inflammatory ingredients to help keep scarring, inflammation and redness at bay, according to the pros. "Avoid picking, scratching, popping or squeezing acne sores—these types of habits can spread infection and potentially cause scarring," says Dr. Sherry, who also suggests sticking to oil-free makeup and looking for descriptors like "water-based," "noncomedogenic," or "nonacnegenic" on your skin-care bottles.
If this isn't quite cutting it, topical medication is the next line of defense. Chat with your dermatologist about options like a retinoid or tretinoin cream, benzoyl peroxide, salicylic acid and azelaic acid (Azelex, Finacea). And remember: It really does happen to the best of us.
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