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How to Clear Hormonal Acne

Whether you’re 47 or 17, male or female, whether your breakouts are once a month or multiple times a week, the reason they come back and back is frustratingly simple: Human error. The minute a breakout clears, suddenly, you’re a person with clear skin—one who no longer needs to be quite so vigilant with their skincare routine. But the only way to keep skin blemish-free on any sort of long-term basis is to constantly treat it as an active, broken-out complexion. The right products make a serious difference, but the key is major, unwavering consistency.

Is It Hormones?

Caused by a bacteria that lives on our skin, acne comes to life at any age when our hormones produce excess oil, essentially throwing fuel on the fire. “Our skins’ oils are a wonderful environment for acne bacteria to thrive in, unfortunately,” says Dr. Robert Anolik, clinical assistant professor of dermatology at the NYU School of Medicine. Add dead skin cells, dirt, stress that can cause further oil production, irritation from everything from diet to skin products, and a breakout is going to result unless you (constantly) work to prevent it.

You’re a typical hormonal-acne patient if, well past puberty, you’re breaking out around your period, usually in the jawline area, says Anolik. “Hormonal acne can be relatively easy to treat or very severe,” he says. Whatever the case, and whatever course of treatment you choose, a consistent routine is key—as is enduring a waiting period of two to three months for said routine to work, he says: “Even powerful prescription treatments can take a few months to really clear things up, and that’s our biggest challenge. People who get frustrated and don’t stick to their treatments get stuck in a cycle of trying and quitting too early, and feeling like nothing works.”

Find a System—and Stick to It

This is true of even very mild cases. “One of the main reasons things like ProActive work is because they’re systems,” says Anolik. Faithfully follow a routine of cleanser, mild exfoliation, and treatment product every day, and your acne should improve; switch products, or use them sporadically, and breakouts will return. Our favorite system from Juice Beauty comes in a month’s supply size ($29.99, juicebeauty.com) or three-months ($79.99, juicebeauty.com), the time Anolik recommends giving a system time to work.

OTC Ingredients

While over-the-counter products don’t treat the hormonal component of acne, salicylic acid—a.k.a. willow bark, a.k.a. what aspirin is made of—smooths away dead skin cells that clog pores, decreases inflammation and has a mild antibacterial effect on acne bacteria. “It works,” says Anolik, who recommends using salicylic acid-based products in conjunction with benzoyl peroxide preparations that target acne bacteria with greater strength. Benzoyl peroxide can definitely cause dryness and irritation; if you decide not to use it, know that you’ve got to be even more vigilant about the bacteria on your skin, so cleanse and treat more often. Tea-tree oil has documented antibacterial properties, so preparations like Tammy Fender’s Clarifying Dermagel ($72, tammyfender.com) are great, clean substitutes. Burt’s Bees Natural Solutions Acne Spot Treatment ($10, burtsbees.com) combines tea tree and salicylic acid for powerful (yet easy on skin) results.

Over-the-counter retinol or vitamin A can also have an exfoliating, slightly antibacterial effect on skin; Juice Beauty’s Green Apple Peel ($45, goop.com) incorporates vitamin A with other natural ingredients for gentle but thorough treatment. Anolik says retinols can be incredibly effective, especially higher-strength prescription retinoids: “They’re the gold standard in acne and aging treatments.” The prescription versions, from Tazorac to Differin, are usually covered by insurance in the case of acne. Vitamin C can also treat pores and exfoliate; Tammy Fender’s System ($165, goop.com) comes with a vitamin C toner; Odacite makes an oil called An Autumn On the World ($149, goop.com) packed with vitamin C.

Clays—especially in the form of overnight masks or spot treatments—can treat oil, dead skin cells and, left on overnight, fight bacteria to some degree. Tata Harper’s Resurfacing Mask ($55, goop.com) mixes pink clay with salicylic acid (white willow) for a one-two punch. Charcoal can help purify skin just as it does water, drawing out impurities, as it does, in May Lindstrom’s Problem Solver Correcting Masque ($90, goop.com).

Alcohol-based toners have been an anti-acne step since forever, but are so harsh and drying on skin that they can cause skin to produce even more oil, and they can irritate; as with benzoyl peroxide or any other irritant, they can further inflame a case of acne. But dabbing skin with witch hazel or non-alcohol toner (we love S.W. Basics’ toner with witch hazel and raw apple cider vinegar, $22, swbasicsofbk.com) can serve as a mild exfoliant, to unclog pores and deposit a bit more treatment ingredient, like tea tree oil or salicylic acid. Tea Tree Oil Facial Cleansing pads from Desert Essence ($7.99, desertessence.com) are particularly brilliant, combining both ingredients.

What (Not) to Eat

Many theories about diet and acne abound; Anolik is most convinced by the ones surrounding sugar and dairy. “Dermatologists really didn’t believe in all the dietary restrictions for acne, but studies in the past ten years have convinced us a bit,” he says. “Dairy and high-glycemic foods do seem to play a part.” High-sugar diets are known to feed bacteria; any diet that increases overall inflammation in the body doubtlessly plays a part. Specific diets—from Ayurveda to low-carb to veganism—definitely work for some people.

Dermatologist-Office Solutions

If you’ve made a concerted effort with over-the-counter regimens and/or diet and still aren’t seeing results, a dermatologist is absolutely worth it. There are many levels of care: Prescription retinoids (Retin A, Tazorac, Differin et al) and/or topical antibiotics are the mildest, along with blue-light treatments like Isolaze, which kill bacteria and clear pores, with virtually no downtime. Light lasers like Clear and Brilliant can clear pores and treat the red and brown tones left by old acne lesions. “Some patients think they’ve got a severe problem, when they really only have a few pimples, surrounded by red and brown marks from old breakouts,” notes Anolik. Oral antibiotics represent a more aggressive (and unsustainable long-term) solution; birth control pills and hormone-mitigating medications like Spironalactone and Deldactone can get many more-severe patients’ acne under control. Most aggressive is Accutane; while it can be severely drying and can cause birth defects if taken during pregnancy, it represents a cure for truly-severe acne cases, says Anolik. “Used correctly, it is something of a miracle for people who’ve tried everything and failed,” he says.

Most situations are thankfully much less dire—and can be treated with a firm regimen and…constant vigilance. Below, our favorites for treating hormonal acne—they’ll work if you keep using them, over and over and over.

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