Whether it’s a pimple or a full-blown breakout, the source of our acne can often feel like a mystery, especially when we’ve been putting skin care at the top of our priority list. But, according to dermatologists, using the best products in the world means nothing if your acne is being caused by hormones or stress. Here, two top dermatologists break down the differences between these two (very similar) blemish triggers, how to tell which is affecting you, and what you can do to prevent and treat each.
Look at the root cause
“Acne is triggered by so many factors, so it’s oftentimes hard to isolate just one cause,” says Delray Beach, FL dermatologist Janet Allenby, MD, who explains that identifying a cause can get even more tricky during different phases of female hormone cycles. “Our monthly hormones can make our stress levels seem out of control as we get closer to menstruation and our estrogen levels decrease,” she says.
Spokane, WA dermatologist Wm. Philip Werschler, MD agrees that there are many causes of hormonal and stress-induced acne, but he adds that there is one common thread between the two. “The underlying cause of hormonal acne is an absolute or relative increase in androgenic—or male-based—hormones. The hormones stimulate the oil glands which can clog the follicular opening. Chronic stress can also alter your hormone levels, resulting in more sebum production and the onset of acne through the traditional route.” According to Dr. Allenby, a good way to tell what is stimulating our acne is by looking at where it’s located.
Look at location
Dr. Allenby explains that stress increases the amount of sebum (oil) that the glands produce. Because of this, “Hormone-induced acne in women tends to be located around the chin area rather than all over the face,” she says. New York dermatologist Julie Russak, MD notes that this area around the jawline is where we have the highest concentration of oil glands, “which is why we tend to breakout around our jawline during our period rather than on the forehead or cheeks.”
Stress-induced acne, on the other hand, likes to present itself front and center. “This type of acne is typically cystic, and might show up as one big pimple on the middle of the forehead,” says Dr. Russak. “It’s not small whiteheads that typically come from external inflammation; stress-induced acne is really more internal inflammation.”
Look at timing
“The way you know it’s stress-induced or hormonal acne is the timing,” says Dr. Russak. “If you’ve been stressed—either from emotional stress or from stress on the body—and you’re not sleeping or keeping up with your diet, this can lead to metabolic stress, which can then show up on the skin as inflamed cystic acne.” She also explains that stages of our cycle can have an influence on our hormonal breakouts, too.
Look at treatment options
While breaking out from internal factors can be frightening and seem untreatable, Dr. Allenby says not to fear: “Acne is overall very treatable with topical and oral medications that help to stabilize and regulate the factors causing the breakouts.” In order to find the right treatment plan, Dr. Werschler recommends visiting a board-certified dermatologist. “There are many excellent treatments for acne that your dermatologist can discuss. It starts with good skin care, the use of appropriate products for cleansing, clean makeup, and sun protection. There are other treatments your dermatologist may also recommend, like therapies, dietary alterations, a careful review of medications, laboratory blood tests, or testing for hormone irregularities such as polycystic ovary syndrome or endometriosis.”
A course of action varies by patient, but Dr. Allenby explains that her typical method of acne treatment is as follows: Stabilizing the hormones, reducing acne-causing bacteria, and incorporating healthy lifestyle habits like “eating well, sleeping well, exercising and practicing yoga and meditation for mental health.”
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