Skincare Scoop: How I Manage Hormonal Acne

Today begins a new five-part “spring cleaning” weekly skincare series answering all the questions I receive about my skincare routine. Some of the topics I’ll be covering include: my morning and nighttime skincare regimens, beauty tools I love, pregnant/nursing skincare products, including “clean beauty” favorites. Today’s post I am starting with my history of acne. As much as I didn’t want to write about this first topic, I feel like it’s a big part of my skincare decisions. I also know there are probably lots of people out there who struggle with this and may benefit from hearing my story. So here we go!

My first sign of cystic acne was in 7th grade when I developed a painful under-the-skin bump on my chin. My mom told me to leave it alone, but I just couldn’t. I thought if I could pop what I thought was just a big pimple it would subside. Wrong!

There was no popping this pimple. It was so deep under the skin that made myself bleed, infected the area, and – duh -made it look SO MUCH WORSE. I was mortified and tried to avoid eye contact in the middle school hallway for nearly a week to avoid people looking at the injury on my face.

Starting then – and for the rest of my teenage years – I was baffled as to why some of my friends, who barely washed their faces, had perfect skin while others like me, who  did everything from Clinque’s 3-step system to spending my hard-earned high school money on Erno Lazlo products(used by Jackie Kennedy), suffered from these long, painful breakouts.

It wasn’t until I was 21 and about to get married that my OBGYN told me that birth control would help my breakouts. I began to realize that my painful breakouts weren’t because I wasn’t washing my face enough, but because of my fluctuating hormones. But it wasn’t actually until my second miscarriage at 29 that I was told the root cause of my acne all those years: I had Polycystic Ovarian Syndrome

What is Polycystic Ovarian Syndrome?

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. According to the May Clinic’s website, “women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels; the ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.” I was told that PCOS often occurs in obese women which is why I was probably undiagnosed for so long. It also can cause infertility and miscarriages. Perhaps I will share about that another time.

Anyway, it is the excess androgen from PCOS that can causes the cystic acne, which is common on the chin and jawline. When more androgens are produced, the skin’s oil glands react by producing an excess of sebum (oil). The increased amount of oil traps bacteria which then multiplies causing major inflammation. Everyone has bacteria on their face; but people with PCOS or hormonal acne are more likely for that bacteria to turn into an inflamed area.

Can you have cystic acne without PCOS?

Yes. A surge in hormones or hormones that are “out of whack” can cause cystic acne, which is why cystic acne often appears in adult women. But if you have PCOS chances are you suffer from cystic acne.

What is the difference between a regular pimple and cystic acne?

A pimple is when your a pore gets clogged with oil and dead skin cells, causing the area to be red and swollen. A blackhead is when the pore remains open (so it looks grayish black). A whitehead is when the pore remains closed. Cystic acne is when a cyst forms around the area of inflammation and occurs deep in the skin and does not come to the surface. You can tell because it’s painful to the touch.

Oral medication for Cystic Acne

  • Birth control
  • Oral Antibiotics
  • Anti-Androgen Medication
  • Accutane

As a teenager I was prescribed antibiotics which mildly helped, but eventually they stopped being effective (and I didn’t really want to be on oral antibiotics for years and years anyway). The birth control pill definitely helped, because it regulates hormones, but it had other side effects. And like antibiotics, when I stopped the pill the acne came back.

There are other oral medicines, too, but the only thing proven to really stop cystic acne altogether is Accutane. Because I got married so young I was hesitant to be on anything that might cause birth defects and other serious side effects). Looking back, though, I kind of wish I had used Accutane before I had children. It probably would have saved me years of internal turmoil about my acne. This Atlantic article sheds light on what she calls a “scorched Earth” skin campaign but with good results. See a recent article in Allure with before and after pics here.

Topical Treatments for Cystic Acne

  • Salicylic acid – these never really helped me
  • Topical antibiotics in conjunction with benzoyl peroxide – this didn’t have a big effect either
  • Retinoid/Retinol – I use this now in combination with other things

People without cystic acne often don’t understand that treatments for normal acne have little to no affect on cystic acne. Yes, I’ve tried Proactiv. I had high hopes in Rodan and Fields’ Unblemish along with just about every other expensive acne treatment I’ve tried. This is the thing: most topical acne treatments are not enough because the root cause of cystic acne is hormonal and the infected area is deep down in the skin where topicals don’t always reach.

What has Worked for Me

When my acne gets better I often wonder “Is it something I am doing or are my hormones just changing?” It’s hard to know but after over twenty years of struggle, here is what I think has made the most difference:

1. Communicating with my doctors

Finding and regularly seeing a great a dermatologist, who understands my medical history and concerns about being on certain oral medicines, has been super helpful. (I see Dr. Claire Reddick in Dallas.) I also saw a reproductive endocrinologist at one point about my PCOS after we had several miscarriages. (If you have PCOS I recommend seeing one, particularly if you are of child-bearing age.)

2. Regular facials

Getting a facial every 4-6 weeks has been a key, I believe, in maintaining clear skin the past few years. I have been going to the Pure Beauty Spa at Neiman Marcus Northpark for several years and Lulu, the esthetician I see, totally “gets” my hormonal acne and treats my skin accordingly.I think part of the reason facials work so well for me is because Lulu uses machines that kill the bacteria deeper than what what normal topical cleaning can do.

First, the high-frequency tool she uses that kills bacteria deep down in the skin (in the layers that topical creams can’t reach) is a game-changer. I have never tried the home version but would definitely consider if I wasn’t getting regular facials.

Second, the LED light tool does a similar thing but on a deeper level. Here is a highly rated home version. And here is one highly rated by Neutrogena. These two tools not only help prevent breakouts but make such a big difference on existing cystic breakouts.

Tip: if you book a facial make sure they have these machines. I hate when I get a facial and the esthetician just puts on a bunch of masks and leaves the room for 20 minutes;).

3. Retinoid/Retinol cream

Most dermatologists will recommend a retinoid (Retin-A or Tretinoin are commonly prescribed). If not for acne, then for fine lines and wrinkles. I know some people don’t like retinoids, but overall they have been beneficial to my skin. And I only use a pea sized amount of prescription retinoid a week. (More than that makes me peel like crazy.)

For over the counter, I would recommend this Obagi  as it’s one of the highest concentrates you can get over the counter. I know a lot of people like the Rodan and Fields product as well.

4. Chemical Peels

When my cystic acne was TERRIBLE in my 20s my dermatologist recommended chemical peels to not only help with cystic acne but the scarring it left behind. While peels certainly have negative side effects (peeling, redness) the overall result can be amazing for both acne and fine lines. I haven’t had one in years but am getting one in a few weeks and I’ll share about it!

5. Reducing my dairy intake

I don’t think it’s proven but many suspect dairy products can worsen hormonal acne. I LOVE milk but I do notice that when I don’t drink it my cystic acne is so much better.

On a similar note, I wish I could say eating healthy and drinking a lot of water has helped me. Maybe they have helped but have not been a solution on their own.

6. Over the counter treatments

Topical treatments like salicylic acid and benzoyl peroxide never really helped my cystic acne. But in recent years I’ve found that there are some topicals that seem to reduce at least the inflammation. Lately I have been using this Mario Badsecu drying lotion on any pimple I feel forming, including cystic ones. I’ll talk about this in a future post but this Skinceuticals clay mask is a game changer for getting impurities to the surface. I also hear Beautycounter’s Balancing Facial Mask is amazing, too.

7. Beauty tools

In addition to the machines mentioned above I also regularly use a Clarisonic and PMD and just start using the Glo Pro. Believe it or not, all serve different purposes to keep bacteria from getting trapped. I will be sharing more about these in an upcoming post so be sure you are on DoSayGive’s email list if you want to read more.


Every story is different when it comes to cystic acne so feel free to share your story or what has helped you below. And just to be clear: I am not a doctor and am not recommending anything for anyone. Just sharing my story and what has worked for me!

Photo: Sweet Memory Photography

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14 thoughts on “Skincare Scoop: How I Manage Hormonal Acne

  1. Thank you! I too suffer with cystic acne and now that I am done having babies I am going to start accutane. I’m tired of fighting the battle! I’ve pretty much done all what you have done to help my face!

    1. Thanks so much for commenting. I never thought I’d say I wish I had done Accutane but you get it. Let me know how it works out for you if you do.

        1. I have the Classic. If you scroll down to the bottom of this link you can see a comparison chart: https://rstyle.me/n/c2gsffbhbtf

          Basically I think with the more expensive models you can more discs and different speeds. I’ve been happy with the basic. Just saw they are doing a $50 promotion on PMD’s website!

  2. Thanks for sharing your story, Lee. Unfortunately we have cystic acne in common, but I loved hearing some things that you’ve tried and done to help it. I’ve tried soooo many things you mentioned and have just started using a foreo blue light and it’s been a game changer! I ordered a pmd after hearing about it from your stories which I’m hoping will help the scarring. I currently have 3 emerging cysts on my face and it’s all bc of hormones. I’ve neber been diagnosed with PCOS, but you have me seriously thinking I need to have a conversation with my ObGyn. I’m always doing research on cystic acne and what works for other people.

    1. I am so glad you commented. Yes it’s the blue light that has the biggest effect on cystic acne. Is this the one you have? https://rstyle.me/n/c2f95bbhbtf

      Also, I feel like some OBs will brush off PCOS so I would push and ask. You can do blood work or an utrasound to diagnose. There are some other oral meds you can take for PCOS but like all meds there are side effects.

  3. I found your post so interesting. I suffered as a young adult, not teenager, with cystic acne. My late 20’s and early 30’s were the worst. Accutane was a game changer after my second was born (35 years old). Like you, antibiotics did not do the trick. Now that I am in menopause, my skin has never looked better! I get compliments all the time. Clearly my hormones were out of whack for years and were the cause of my cystic acne. I also swear by monthly facials and am very careful to use sunscreen – i love the Colorscience mineral powder.

  4. Hi Lee. Thanks for this post. It resonates. I also have PCOS and have struggled life long with hormonal acne. It’s been a challenge at times to get pregnant and always skin care is a challenge. So I am very thankful to have your tips! I will add that I took Acutane as a teenager and would NOT recommend it to anyone!!! For someone with hormonal acne it is only a temporary fix. And a very costly one in terms of side effects. I lost half my hair (hair thinned a great deal) and it never came back. All my joints became brittle. I literally felt like someone dehydrated every fiber of my being. The pamphlet of side effects is so long it is literally a book. And I had to have my blood drawn every month to monitor my health because the medicine is so strong. All that to say, as one who has taken this medicine, please consider carefully. If I had the choice over, I would have just gotten on the birth control pill and not taken Acutane.
    Sincerely,
    Dorothy Peterson

    1. Dorothy, Thank you so much for sharing your story. I can’t believe you went through all that. I am so sorry!! So often we hear the side effects but don’t think they will ever happen. I appreciate you opening up because I know others will read this. Thank you again! Love, Lee

  5. Thanks for sharing, Lee. I’m right there with you on this, although I’ve done Accutane twice (once as a teen once as an adult). For me it just worked for awhile and then everything came back. The thing that seems to work the best for me is a combination of spironolactone and birth control, but as I get older I do not like being on all of that. The risks and the side effects are a bummer. I do love chemical peels for scarring but to be effective for me they require significant down time which is not very realistic. I recently did Whole 30 specifically to see if it would impact my acne….maybe helped a little but not a cure all. SO…the only thing I have left to try is the facials and maybe the light/zapper that you mentioned. Would you recommend starting with one over the other? Or would it be best just to see Lulu first and talk to her about that? It is encouraging to me to hear other women who struggle with this…sometimes I feel like the only one!

    1. Erica,

      Thanks for sharing this! So helpful for me and others to read. I am with you that I don’t want to be on medication forever. And, yes, I wish whole cleaning eating was a fix, but for most it’s not. I have not used any of the over counter light or high fewquency tools but people seem to love them. A reader mentioned another one in a comment above. Maybe treat yourself to a facial and ask to use these extra tools (the light tool might be an extra fee; I can’t remember). If they work then maybe purchase? Also, Neutorgena has a light tool that’s only $25! You could also try that and see! Let me know!

  6. Thank you for sharing! My daughter struggles with acne and this information is really helpful. Which facial do you get at Neimans?

    1. Lulu sees a lot of teens! I get the regular facial but the light therapy (I think!) is an extra fee but worth it. I would do an initial facial with Lulu and see what she recommends. She has such a good sense of skin!

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