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Hormonal Acne by Stefani Ruper

Hormonal Acne: Where It’s Coming From, and What to Do about It

Even though many dermatologists would deny it, hormonal acne is a real and serious problem for women.

Gut health and inflammation are both major players in acne. (read more about causes of acne other than hormones in this post, or this amazing guide).

Yet hormones can be the biggest problem for women.

In today’s post I discuss all the variations of hormonal acne, where it comes from, and what to do about it.

Hormonal Acne: When and how it shows up


Hormonal acne for many women presents at certain times of the month. Popular times include 1) at ovulation, which occurs almost precisely smack in the middle of the cycle, two weeks after the first day of bleeding (read about how to pinpoint ovulation in this post), 2) the few days before a period, and 3) at the start of a woman’s period.

Hormonal acne can also be present all of the time. For women with hormonal problems such as PCOS (read here to start figuring out if you have PCOS) and Hypothalamic Amenorrhea (read here to figure out if you have HA), this is unfortunately the case.

When I had both PCOS and HA at the same time, I had terrible acne every day for three years.


Hormonal acne usually occurs in the form of cysts. Cysts are those lovely, pus-filled, painful and inflamed red bumps. They often culminate in a peak of white pus.

Hormonal acne also appears as more mild forms called comedones. These are those whitehead “bumps” that never break the surface.

Hormonal acne can even show up just as smaller lesions. These are not quite as angry and painful as full out cysts, and may appear more rash-like or just smaller than typical acne. Below is a photo of my own cysts (on a “good” day) back in 2011.

Stage 3 Hormonal Acne

These are cysts, classified as “stage 3” acne by dermatologists. There are 4 stages of cysts in hormonal acne


Hormonal acne occurs first and foremost around the mouth. It shows up on the chin, below the nose, around the sides of the mouth, and sometimes up the jawline.

As hormonal acne worsens, however, it spreads to the cheeks and the forehead.

Other body parts can be affected, too. This usually includes the shoulders, back, and buttocks–where the body’s testosterone receptors are most prominent.

The physiological mechanism of hormonal acne

Hormonal acne is caused by increased oil production beneath the skin. Think of it like a river. Ordinarily there is a healthy flow of oil to the surface. This is important because it lubricates the skin.

But when there is too much oil – and when it combines with the normal skin cells and other debris on the surface of the skin – it can clog the pores.

When oil clogs pores, bacteria go on a feeding frenzy. This causes inflammation.

The worse inflammation is, the more irritated the oil gland can become, and thus the more red, and the more painful.

Yet it is important to remember that hormonal acne does not occur unless there is an oil problem.

This is the reason no amount of washing will ever completely eliminate hormonal acne. Admittedly, it can be helped by antioxidant cleansers, serums, or creams.

But it will never go away completely without curing the hormonal acne from underneath. The only way to fix it is from the inside out.

Hormonal Acne: Causes of increased oil secretion

The primary causes of oil secretion are male sex hormones, also called androgens. Testosterone is the primary culprit. Another androgen, called DHEA-S, is also very important. They both increase oil secretion.

This effect is worsened when female sex hormone levels – particularly of estrogen – fall. Estrogen balances male sex hormones in the skin. Without a healthy balance, problems occur.

1. The most prominent androgen is testosterone.

Testosterone causes oil production in the skin.

Why might you have high testosterone?

You might have it if you have PCOS.

(Acne is one of the clearest indicators of PCOS.)

You may also have high testosterone if you have diabetes or insulin resistance, because when the body produces insulin, the ovaries produce testosterone. It’s a very simple yet very damaging process.

When might you show hormonal acne from high testosterone?

If you still have a menstrual cycle, you may find that you break out around ovulation. This is the middle of your cycle. It is also when your testosterone levels are the highest.

But if you have a hormone condition like PCOS – you will probably have hormonal acne most of the time.

(If you struggle with PCOS or think that you may have it, you may want to check out my handy guide on overcoming PCOS.)

2. Another androgen, called DHEA-S, causes oil production as well.

Yet unlike testosterone, which is a sex hormone, DHEA-S is a stress hormone.

It is produced primarily in the adrenal (stress) glands. Whenever a woman is under any degree of stress, her body faces a choice: it has to decide if it wants to produce normal sex hormones like progesterone and estrogen, or if it wants to produce stress hormones like DHEA-S.

For this reason, Hypothalamic-Pituitary-Adrenal (HPA) Axis dysregulation is usually the first place to look to as the origin of DHEA-S problems. Women with a lot of stress – whether from emotions, poor sleep, or under-feeding – have higher levels of DHEA-S levels.

3. Estrogen fights acne.

Estrogen helps promote clear skin. It does this in a number of ways.

First, it has the power to off-set high testosterone levels in the blood. Estrogen increases levels of sex-hormone-binding-globulin (SHBG), which in turn binds testosterone and makes it impotent.

Second, the skin has many estrogen receptors in it, so estrogen directly performs a balancing and soothing function at the site of acne.

For women with chronically low estrogen, hormonal acne is often a consistent problem. They have acne 100% of the time.

In women with relatively healthy hormone systems, low estrogen can still be a problem. This is because estrogen levels fall at the end of each menstrual cycle, and are low at the beginning. Having such low estrogen levels during this time can lead to monthly breakouts.

Because hypothalamic amenorrhea is characterized by low hormone, and particularly low estrogen levels, boosting estrogen is one of the main and most helpful ways women with hypothalamic amenorrhea cure their acne.

Because menopause significantly decreases estrogen levels–almost to zero–this is also the primary reason women in menopause can see a re-emergence of hormonal acne after decades of clear skin.

4. Finally, progesterone can also play a role in acne. Progesterone, in high doses, acts as an inflammatory agent, and can cause acne to flare up. Progesterone levels are highest during the days leading up to menstruation, which explains why many women experience outbreaks at this time.

Synthetic progesterone, such as that found in birth control pills, can also cause acne.

Whether a certain variety of the pill causes acne for you or not, however, is entirely dependent upon your own body chemistry and how your body reacts to external hormones. Know only that if you noticed a change in your skin while experimenting with birth control methods, this is most likely why. You may want to consider a birth control method that has a different kind of progesterone in it, or one that has a different progesterone-estrogen balance, to see if it helps relieve your acne.

Aggravators of hormonal acne

There are many factors other than hormones that can worsen hormonal acne. Here is a list of the most common:

Stress: Stress plays an important role. It acts as an inflammatory agent, especially if cortisol levels remain high for a long time. Stress also  decreases production of healthy, skin-supporting hormones like estrogen, and increases production of acne-causing stress hormones like DHEA-S. Stress is not necessarily the cause of hormonal acne, but does exacerbate it, and prevent proper healing.

Heat.  Heat is inflammatory, and also causes sweat, which can clog pores.

UV Rays. The sun’s rays are some of the most potent acne inflamers out there. Protect the skin on your face with at least an SPF of 20, or consider wearing a hat in the summer months.

Inflammatory foods: grains, dairy, nuts, and omega 6 vegetable oils can all contribute to poor gut health and inflammation.

Dairy: While already mentioned for being inflammatory, dairy deserves special mention because it is a highly hormonal food.  Pregnant cows produce several hormones designed for growth. Growth hormones can both cause androgen levels to rise as well as promote production activities that lead to acne.

I have seen enormous success with women with hormonal acne eliminating dairy for their skin.  Many people at least anecdotally least respond to dairy with acne more strongly than any other food.

Phytoestrogens: soy and flax are the primary phytoestrogens to be concerned about, with legumes and nuts coming in a distant second place. Phytoestrogens (“phyto estrogen” is greek for “plant estrogen”) have the power to act as estrogens in the body. This may sound like a good thing for acne, but this role is ambivalent and should be treated with caution, especially with the skin. Different estrogen receptors read different kinds of phytoestrogens differently, such that phytoestrogens usually perform estrogen-lowering effects in skin tissue despite what they do in other locations.

Low carbohydrate diets: Having sufficient glucose stores is important for skin healing, and can speed the recovery of acne lesions. Glucose is also helpful for preventing hypothyroidism. Find out 8 of the most important signs you need to eat more carbohydrate here.

Poor sleep: Sleep both enables healing and promotes healthy hormonal production.

Hypothyroidism:  Without sufficient levels of T3, the active form of thyroid hormone, in the blood, a woman’s skin cells lack the ability to heal properly.  Many women who suffer hypothyroidism suffer chronic acne.

Dealing with hormonal acne

The best thing you can do for hormonal acne is get blood work done and figure out precisely what your underlying problem is. That way you can target the problem and treat it effectively.

Unfortunately not all of us can afford this, so it’s okay to guess. Nevertheless, the better an idea you have of what is going on in your body, the more specific you can be about what to do to fix it.

In general, hormone dysregulation that leads to acne can be broken down into a few broad categories:

1) high testosterone from PCOS (specifically the overweight and insulin resistant type of PCOS),

2) low estrogen from low body fat levels, chronic restriction, or living in an energy deficit,

3) low estrogen from menopause,

4) high progesterone from general hormone imbalance, possibly related to PMS,

5) any of these conditions worsened by stress or hypothyroidism, and

6) any combination therein.

The ultimate hormonal acne solution

The solution to all of these problems is to correct the hormone imbalance.  I have discussed methods of doing so above and elsewhere.

So to get rid of hormonal acne for good, check out my manual that has now helped several thousand women overcome their PCOS, or some of my work on hypothalamic amenorrhea.

For women with menopause, it may just “take time” or perhaps medical interventions are appropriate, depending on the severity of the problem.

Medication for hormonal acne?

There are drugs designed to help with hormonal acne.  Spironolactone and flutamide are the two primary ones that come to mind (though I don’t recommend taking either of them), as well as birth control.

The reason birth control pills are helpful for acne is because they enforce hormone regularity on a woman’s system.  The precise pill that is helpful for each woman varies by her particular condition– but in general, BCPs are comprised of estrogen and of progesterone. BCPs can for that reason 1) raise estrogen levels–which either corrects an estrogen deficiency or helps balance the activity of runaway testosterone–and they can also 2) restore proper balance between estrogen and progesterone, which is important for keeping progesterone levels within their proper parameters.

Some BCPs also contain anti-androgenic substances, such as drospirenone, which is an added benefit for women who are living with androgen excess (but poses some health risks).  In all cases, I do not generally recommend that women get on BCP, as it can cause worse hormonal dysregulation in the long run (sort of like handicapping a delicate hormonal system), and does not solve the underlying problem.

Flutamide acts in a similar way to spironolactone, but less effectively, and with more side effects.  So spironolactone is typically the drug of choice.

Spiro has been hailed by many acne sufferers as God’s gift to womankind: it decreases testosterone activity. For many women this begets truly miraculous effects. Yet one should step cautiously with spironolactone. If a woman’s primary problem is not testosterone excess, spironolactone will very likely do more harm for her skin than good.  (Check out the panicked discussion forums at acne.org to see what I’m talking about.)  Moreover, even for those who have testosterone excess as their primary problem, spironolactone merits caution for a variety of reasons.  First, spiro usually induces an infamous “initial breakout” which can last anywhere from weeks to months.  This isn’t always the case– sometimes women improve immediately. Sometimes they never really do (I never did: in fact, my acne got worse on spiro.) But the typical case is for women to see an initial worsening of their acne, followed by relief in the upcoming months, especially if they increase their dosages.

Secondly, spiro cannot be taken by pregnant women because it induces birth defects, so women cannot stay on spironolactone indefinitely. This is problematic because spironolactone acts as a band-aid on the hormone problem, and does nothing to fix it whatsoever. What spiro does simply is block testosterone receptors.  In most cases, if the underlying problem is not addressed while a woman is taking spironolactone, her acne will return once she comes off of the drug.  This is why I recommend that women only consider taking spironolactone if they want a “quick fix” while they work on their diet and exercise in order to improve their PCOS.

Finally, spironolactone has a couple of other health concerns.  First, it lowers blood pressure, since spiro is actually a blood pressure lowering drug proscribed “off label” for acne.  Secondly, it acts as a diuretic, so women on it need to drink water constantly, may not be able to consume alcohol anymore, may have dysregulated salt cravings, and may never actually be properly hydrated.  And finally, spiro acts as a potassium-sparing diuretic, such that women cannot eat potassium rich foods, lest they risk the chance of becoming hyperkalemic, which can lead to sudden death.  It hospitalized me. An imbalance of electrolytes in the blood is no laughing matter, so women on spiro should limit their potassium rich foods as well as get their potassium levels checked periodically.  Potassium rich foods include melons, bananas, potatoes, avocadoes, tomatoes, and leafy greens, among others.

For these reasons, spiro can help, but it cannot be relied on long term.  It does not get at the root of the issue–drugs rarely do–and the true path to hormonal help is diet and lifestyle modifcation.

As a final note, bio-identical hormone supplementation can be helpful for women going through menopause.  Estrogen patches can release small amounts of hormone into the bloodstream, and can lessen acne considerably. I do not think this is necessarily detrimental to a woman’s health, if it is in fact the case that her estrogen levels have simply dropped off during menopause.  However, it does, in my opinion, make it difficult for estrogen levels to rise and hormone balance to re-establish itself on its own. This is a decision best left to the individual and to her doctor.

In conclusion

Hormonal acne is terrible, and for many women can seem incessant, and never ending.  Girls are assured growing up that they will eventually out-grow their acne, yet many women see it persist throughout their twenties and thirties, and some actually do not even see the acne manifest until their twenties and thirties.  Some women do not even see acne appear until after the birth of their first children, as their progesterone and estrogen levels are flying all over the map.

There are downsides to medication, and large ones. Medication is only ever a band-aid, and it can be a band-aid that in the long run leads to more harm than good.  Playing with hormones is like playing with fire.  Sometimes things can go horribly wrong. For this reason, meds may be best left alone, depending on the circumstance and the level of risk a woman is willing to bear.


It is entirely possible as well as supremely healthy to cure acne from the inside out with good diet and lifestyle practices alone, many of which you can read about in my guide on weight loss, or my guide to overcoming PCOS. It may take experimentation and patience, but don’t all good things, in the end?


For an even more thorough blog post on the causes of acne and overcoming it, see another post on acne, here.

For my favorite resource out there on overcoming acne, see Seppo Puusa’s Clear for Life. 

For some of my favorite topical solutions to acne, check out the antioxidant cleansers, serumscreams and topical probiotics (my absolute fave!) I use.


So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.

Managing director of Paleo for Women and author of Sexy by Nature.


  1. Thank you for this post! I have been suffering with acne for almost a year now. I’ve read a bunch of stuff about acne (and how it’s gut related), but I’ve always felt it is hormonal for me. My acne does show up at the start of my period and right before I’m ovulating. I’ve had many crying nights because I can’t figure out how to fix it. I got some blood work done, and the doctor said all my levels of hormones were within the normal ranges. I’ve been paleo/primal for the past 3 years, and I’m pretty strict with what I eat; however a few things did change just before I got the acne outbreak. I started fasting every morning, decreased my carb intake significantly, and I stopped taking the BCP (after being on it for 6 years). Before taking the pill 7 years ago, I had a huge acne problem, but with the pill and severe topical medication, it went away. It didn’t resurface until last year. I’ve tried everything to fix it: Brewer’s yeast, omitting FODMAPS from my diet, no dairy, no nuts, CaveGirlEats oil cleansing, ACV in my hair (in case it was chemicals causing it)…the list goes on. I was skeptical about using what my dermatologist prescribed, but after 6 months of constant redness on my face (that no make-up could cover), I gave in. I took doxicycline for a month, and I started using differin gel. Until I saw this post, I felt like no research I found really described my situation. One thing I’ve never figured out is how to get a good night’s sleep. No matter what, I toss and turn (and wake up to pee midway through the night). I’ve tried complete darkness, a cold room, going to sleep extra early, and listening to rain with an app I have. Geez…I sound like a complete mess, but any advice would be awesome! Thanks again for having this blog and writing this post. 🙂

    • I do need to mention that I have seen some improvement lately with the reintroduction of breakfast every morning and switching over to all hormone-free meat/eggs/etc. After reading “It Starts with Food,” I made that change.

      • I have been consuming hormone free products for awhile and if anything my acne seems worse. Ever since I went of the pill I can’t even stand to see myself in a mirror. I hate my face. Nothing I have tried has worked.

        • Oh I feel for you.

          While I’ve not us been able to treat the cause of my acne (because I still don’t know why) I’ve finally been able to at least treat the symptoms. “The Acne Cure” is the book that helped. It’s a fairly simple protocol. I’d say in the month since I started it, 80% of my acne is gone.

          Good luck and hang in there.

      • You should look into doing a hormone test through saliva. Labrix Laboratories in the USA does one. Much different testing than blood. I won’t say much more ill just let you do the research, but if you do you’ll find the results MUCH different.

        • Too bad hormones travel through the bloodstream….

          • Actually, saliva hormone testing is considered by many experts to be much more reliable (there are studies published that demonstrate it better indicates bioavailable hormones- i.e. what actually get into your tissues/cells to be used). Sorry to nitpick, but people making comments like this, which likely deters others from the best testing, without being informed by the scientific literature, is a major pet peeve (Biomedical PhD here.:))

    • Hey Becky-

      There are a couple of things that help me with sleep.
      The first is to get yourself on a consistent schedule. Going to sleep every night at X and waking up every day at Y. If you get a crappy night of sleep, still get up at the same time. I find I can adjust these times a bit during weekends but generally try to keep the same times.
      Second is getting exercise during the day. Some people say that you shouldn’t do it too close to sleeping at night but I will sometimes go for runs at 8 and be in bed at 10:30 and that works really well. The goal is to tire yourself enough when you go to bed, your body takes over.
      Have you tried Calm’s Forte? I like it a lot and have found it helps to slow my thinking down just a little bit. I also love sleepytime extra (which has valerian root); I have that with a little bit of honey. You may have to pee in the middle of the night though (if you do, don’t turn any lights on if at all possible).
      Finally, I usually read before bed (a chapter a night) and by the time I finish I’m really tired…I literally read in bed laying on my side.
      If I’m really having trouble sleeping I load my ipod shuffle with two or three songs and play them on repeat until I fall asleep; I use headphones for this and when I feel myself drifting I take them out and sleep really well. They may repeat three times, maybe ten, and I would try something mellow instead of beyonce or whatever.

    • i’ve had all the same issues with my skin since puberty, as well as unrestful sleep. what I have found works very well for sleep problems is calcium magniseium in a gel capsul for fast absorbtion. take two capsuls an hr before bed time and after about a week you will notice your quality of sleep is greatly improved. hope this helps!

      • Cal Mag really works for me too!

    • I have tried all kinds of medications for my persistent acne from age 13 to current 24. Flutamide cleared it all but docs. do not want to prescribe it. So, I am currently on Spiro. for about 2 years now, and it cleared but now is beginning to come back now in abundance. Any ideas? Does Spiro. stop working and the body can become immune to it??

    • This post f*ckin SUCKED! No one asked for a long drawn out explanation of “WHY” with a preponderance of medical jargon. Everyone that came here knows WHY they have acne (i.e. due to hormonal imbalance) but want to know WHAT HERBS REGULATE/BALANCE HORMONES a$$hole! *smh*

      • Herbs to look into also consult a naturopathic doctor first.

        Herbs for women: Liquid Chaste Tree

        Estro Detox by AOR (for Estrogen build up) have a hormone test done first.

        Active probiotics. Synitol by Arthur Andrews

        Women’s 1 Daily by Innate

        Ortho Adapt Vegan by AOR (used for stress reduction and allowing the adrenal glands to heal).

        Most of these can be found on iHerb.com

      • Hmmm…the name of the article is “Hormonal Acne: Where It’s Coming From, and What to Do about It”. I’m quite certain the author explained just that. Maybe you were intimidated by all the big words.

      • I dont like the words you used, But i am agree and i really need to know how to cure it.
        I think it is veriouse ways he mentioned and first one is to get blood test! and choose your path from tehre …

    • To get a good nights sleep, use melatonin, which is a natural supplement. Our bodies make natural melatonin when we are in darkness, which prompts tiredness and deep sleep. In today’s lifestyles, we often are not in darkness before heading to sleep (tv, computers, phones, etc.). If you take one melatonin tablet before bed, you’ll get a restful sleep, and wake up feeling very refreshed. Only take one tablet. Taking two can leave one groggy the next morning. Melatonin is NOT a prescription. It can be purchased at most health food stores or pharmacies. It is very affordable … less than $10 a bottle. To find out more, just Google ‘melatonin’ …. there is a lot of information about it.

      • Yet exercise caution. Melatonin is a hormone, so your body can become insensitive to it over time. Personally I can take it for a few days without suffering ill effects, but if I try to take it for a few weeks (I have done this twice) I stop sleeping entirely in about the third week.

  2. Hi. I recently discovered your blog and podcast and I love love LOVE it! Thank you so much for all that you do.

    However, I want to make a small quibble with one bit in this blog. You say that ovulation “occurs precisely at the start of week three of the cycle” and this is most certainly NOT the case for all women. The perfect 28-day cycle is a myth. I don’t know whether every woman’s cycle “should” be 28 days exactly with ovulation occurring precisely at day 14. Maybe that’s how it is for everyone when hormones are in perfect balance. But that isn’t the reality. I ovulate around day 20-23 (and have ~35 day cycles) and some women ovulate around day 10-12.

    I just wanted to throw that out there.

    • No– you’re correct. I thought about that while I was typing it and didn’t change what I was saying for the sake of simplicity. But it’s important– and that’s fascinating because I almost never write anything for the sake of simplicity. 🙂 I’ll change it, that was lazy.

      • Interesting comment from Kaitlin, with whom I totally agree. Funny thing is, all my menstrating life I’ve had cycles anywhere from 28 to 38 days, this year I tried Paleo ( due to gluten intolorence) and besides ridding myself of bloating and discomfort, my period comes precisely every 28 days!! ( Starting February of this year)I have never been on the pill and am the mother of two and must admit that feeling great and knowing exactly when I’m ovulating and when I’m going to have my period makes me think maybe 28 days is the “natural” way. Also since eliminating wheat my period doesn’t bother me at all, I often run 8 miles on the first day of my period, whereas before I would have to rest for 3 days at least.
        This, and the elimination of bloating/gas pain is enough for me to continue on a Paleo/primal lifestyle.
        P.S. Stefani, you’re pretty darn awesome. Love my body most of the time ( and I’m average!) but still love to read your posts.

        • Catherine, did you also have acne, and if so, did it clear up when you went on the paleo diet?

  3. I really enjoyed reading this post. I’ve been thinking a lot about this topic over the past couple weeks since I’ve just been diagnosed with PCOS (although, I’ve *known* for years this was the case, just couldn’t convince my doctor to run some tests until recently). Acne, which again I’ve always known to be some sort of hormonal imbalance, has been an unfortunate part of my life since I was 9 years old (I’m now 31). Face (lower half), back, and when I was younger chest. tried every ineffective prescription known to man and then was put on BCP (Diane-35), which has an anti-androgenic progesterone in it – it was like a miracle for 10 years!! Then, I went off it to try to conceive and BAM, back came the acne.

    My question is this: I am seeing a reproductive endochrinologist. She’s done blood work (E1/E2, LH, FSH, testosterone & DHEAS), which all came back normal. I was kinda shocked at this because I have all the signs pointing to a hormonal imbalance and thought for sure the testosterone number would be elevated but it wasn’t. You may’ve noticed she didn’t test for my progesterone level. I’m wondering, is it possible, due to the PCOS and lack of ovulation (which would cause my progesterone levels to raise), that even though my other numbers are normal, that I could be estrogen dominant as a result of lack of progesterone? Can you help me make sense of this? Should I ask to have my progesterone levels checked too or is it almost a given that it’s low due to the PCOS? Obviously, this acne is caused by something. Thanks!

    • Hi Shantess, I’ve been doing a lot of reading on PCOS and found this thread and your comment. Have you found any relied yet? My situation seems similar to yours. I’ve had acne my whole life. I’m now 30. I have had a lot of tests and the outcome was high estrogen low progesterone and low testosterone. My LH and FSH came out fine too. That is the short story on me. I also have pelvic pain and and had surgery last year removing two cysts from inside my ovaries.

      • Estrogen is pretty powerful for high quality skin, but it needs to be in good balance with the other stuff. Low progesterone is almonst inevitably a result of stress, mental, physiological, or otherwise.

        Have you both considered gut healing protocols?

  4. Thank you for this well written piece on hormonal acne. I’ve been dealing with chronic acne for over 20 years now (I’m 33) with lots of horrible outbreaks of all types: black and whiteheads on the forehead and nose during puberty, cystic acne all over 10 years ago, and now massive breakouts around the jawline, chin, forehead, throat and neck. I was diagnosed with PCOS back in 2000 and though I’ve lost all of the weight, have normal cycles, ovulate, don’t eat sugar, stopped gluten years ago (now Paleo), etc I STILL have acne. Dairy or no dairy, diet or not diet, I have acne.

    At this point in my life I’m ready to go the drug route though I really don’t want to go there. I feel like I don’t have a choice.

    • systemic enzyme, vitamin E and zinc

      • for fibroids

    • Hi i feel for you carla. I i have a similar story in that my breakouts have been since very early teens. I started wearing a bra n the bacne that started from that is still there 26yo. Face chin etc much much better, under chin n nevck-horrendous. As much as we blame ourselves it is an allergy

    • Try a natural progestrone cream. Thats what helped me I had texts done that claimed my hormones were Fine but have continuously had cystic acné especially on my jawline & neck, mood swings, feeling angry for no reason , tried the list goes on. I finally went to a health food store & the owner suggested i try a natural progestrone cream after telling her everything i was & had been going through best advice i ever took i have noticed a big difference already in everything especially my skin bytw i am 36 & have beengoing through this for about 10 years all do to an hormonal imbalance hope this heloshemos helps i highly suggest you look into the cream.

  5. I wish people would talk more about uterine fibroids which are at least as common as PCOS if not more so, and what to do about it dietarily if anything. 90% of the time on paleo blogs the information is about PCOS and not fibroids. I would love to know if there is advice about it and if there has truly been success with regards to shrinking them with diet intervention. I’m at the point where I’m thinking about surgery but really REALLY would rather not.

    • I had a partial hysterectomy due to fibroids 8 years ago because I was bleeding EVERY DAY for at least a year. The doctor tried to treat this condition with birth control pills and iron pills because he said I was still very young. I ended up miserable, with no energy due to the daily loss of blood, and my quality of life was poor. I had to demand the surgery, and I must say it was the best decision. This is a condition that must be addressed quickly and women need to become better advocates for themselves.

  6. This was a graet piece – thank you for writing it! As a lifelong straight haired woman whose hair would not even take a perm as a teen… and is now curly haired after having two children… I can honestly say nothing about female hormones shocks me anymore!!

    I will say that I thought I had hormonal acne issues, but since going primal in my eating for the most part just under two months ago, my skin health has improved greatly and currently I’m at a place in my cycle that I should be terribly broken out… and there isn’t a problem spot to be found. I feel really grateful that I made these changes – AND that they’re having the (bonus) effect of skin health for me.

  7. This. This is exactly the information I have been looking for. Actually, when I found your blog yesterday I stumbled upon your mentioning of hormonal acne and googled it to read more. I read on multiple sites that hormonal acne often combines with facial hair growth, maybe that’s a marker that can help identify what kind of acne women have – and it may also be reduced when we get to restoring hormonal balance.

    Thank you for all the information here, over the next months I’ll be experimenting with my diet and see what, if anything, helps with the acne thing.

    A question about the dairy: is it only cow dairy that has an aggravating influence, or also dairy from goats and the like?

  8. Great piece. My GF has had trouble with acne, so I will be referring her to this article.

  9. I am 43, suffer from acne, not sure if it’s hormonal, but it definitely comes before a period, so maybe. I take 50mg of minocycline daily and this is the only thing that keeps me clear, mostly. If I miss a few days, I have a break out. My understanding is that minocycline helps with acne more from it’s anti-inflamitory properties. If you have never tried it, I would.

    Sleeping is also a problem for my and after taking Ambien for 9 years, I finally kicked the habit, almost. I started weaning myself off of it in January. I now take 1000mg L tryptophan, Magnesium (food based) and melatonin and 1.25 mg ambien. Yes, I cut a 10mg ambien into 8 pieces and take it. Ambien is the devil, it will make you sleep, but you will get adicted, so don’t do it. I think of all the things I take the Magnesium is really helping me sleep. I also eat fairly paleo and it has not made a difference on my acne.

    I share this because it’s been working well for me so far and maybe it can help someone else.

  10. Great post! The info is so helpful! More please on hormones!

  11. Stefani,

    Thank you so much for your blog and for all of this amazing information. I’ve been struggling with hormonal acne and PCOS for my entire post-pubescent life–and since I’ve been underweight and dealing with amenorrhea, it’s definitely been complicated getting any sort of medical help.

    I only discovered Paleo a few months ago (I’m a recovering vegan), and it’s been hugely helpful in healing *most* of the acne…but having read your posts, I’m finally seeing that there’s an even bigger picture out there.

    Thank you so much for your blog–you’ve inspired me to start one of my own. I’m hoping to someday be able to touch as many lives as you are.

    • Hi Kalia. Yes– eating paleo helped me, too, especially by cutting soy, dairy, and inorganic animal products. Yet the final nail in my acne coffin was about 10 pounds of weight gain.

      • It’s funny though…the weight gain doesn’t even scare me as much anymore, so much as the thought of going through the rest of my life embarrassed to show my face does.

        I’m looking at the adrenal/hormonal component now that I’ve been eating strictly Paleo for a couple of months and only seeing modest change…so thank you very much for all of the PCOS/thyroid info as of late–it’s convinced me to go see my gyn to start getting some answers…

  12. Thank you so much for this post! I’ve suffered from this exact issue for a long time, the persistent acne around the mouth. I’ve practiced a strict paleo diet including no dairy or sugar since January, and the problem has improved but not disappeared. I was very interested to see that you list insufficient carb intake as a cause of poor skin healing. What level of carb intake would you recommend, roughly, to improve skin health?

  13. I enjoyed your post, have you done any research on herbs like vitex and hormonal acne? I ask as I’ve had the most success with skin problems by not eating soy, maintaining my weight and taking vitex supplements, which are supposed to regulate hormones.

  14. Thanks for this post. I’ve been eating paleo for over a year, and I stopped taking HBC around that time. I got a hormone panel done and have really high testosterone, slightly high DHEA-S, normal estradiol, and rock bottom progesterone (tested on day 21 of my cycle). I tried progesterone cream in the luteal phase of my cycle and it delayed my period for 2 weeks, which worried me (so I’m not doing the progesterone cream again).

    Now, I’m starting to get more than the occasional dark hair above my upper lip, and I have more acne than I did as a teen. All the meat and eggs I eat are from hormone free animals, and I’ve been eating very well, so I just don’t understand why a year hasn’t been enough time for things to right themselves.

    I figure I’ll get my hormone levels tested again in another cycle or two, and see how things stand. I’m really at a loss for how to fix it.

    • Hi, I started taking natural progesterone cream in early June 2014 to balance hormones. Like you, it caused me to skip my period for 2 weeks and I also stopped taking it. When my period finally came around it was the worst and most painful I’d ever had. Then on top of that I started breaking out worse than I ever had before (worse than teenage years too) I have tried everything. I went to a nature path and got on some herbal remedies, work out a lot and changed my diet to Paleo as well. It is now October and there has been no change. I am curious to see if by now you’ve found a way to clear your skin? I hope you no longer suffer!

  15. You make very good points here, but I have to say from my own experience, going paleo 2 months ago has completely cleared up my skin. I am 34 and have struggled with acne, dry skin patches (most likely angular chelitis) and many other skin issues for as long as I can remember. They have ALL cleared up in the last 2 months. I have not even had a menstrual cycle related break-out, which might be a first for me. So, despite all the good science above, I have to say eating paleo has made a huge difference in my skin condition….as well as all the other obvious benefits.

    • That’s wonderful. The dysregulation I am talking about then does not apply to you.

  16. “Low carbohydrate diets: Having sufficient glucose stores is important for skin healing, and can speed the recovery of acne lesions.  Glucose is also helpful for preventing hypothyroidism.”. What is the evidence for this? Sources, please.

    In my experience (PCOS and acne into my 50’s) acne has completely disappeared on a low carb diet. I don’t even get a few little zits right before my period.

    ” The solution, then, is to eat an insulin sensitizing diet, to exercise, and to decrease stress. “.
    What do you then consider an “insulin sensitizing” diet?

    • Yeah– I’m going to have to google around to see if I can find some specific references. I think the primary idea behind that one (just a common trope in dermatological circles, et al) is that having low glucose supplies can dry up our skin, hypothyroidism is bad for skin quality, and all of the macronutrients are necessary for proper tissue regeneration. There’s probably a bit of cross contamination in any studies that exist… ie, is it just carbohydrate, or is it the vitamin content of fruits, et al, that make typical carbohydrate sources better for the skin? I want to go ahead and give fair due to each hypothesis, though, again, without the stats…
      Moreover, of course this isn’t universal, and I should have been more explicit about that. Bodies are always individual. Those of us under metabolic stress are the ones who face the most tenuous circumstances and who require the most overt nutrition… ie, “dosing” with carbohydrates.
      Finally, the amount of carbohydrate I am not saying needs to be 200 g, for example, each day. But perhaps as few as 30 or 50, depending, again, on the individual. The difference between VLC and LC is the most important step— getting out of starvation/fasting/ketosis mode, etc.

      I’ve been working on a post on what I believe is the best insulin-sensitizing diet. Erring on the side of caution, I’d call it a low inflammation (ie, paleo), lower-carbohydrate diet, with plenty of exercise and sleep, averaging 3 sq meals each day.

      • I look forward to that posting. I have been struggling with inflammation and even in trying to eat paleo it doesn’t seem to be making a significant difference, a subtle one but not enough for me to be feeling better.

      • “just a common trope in dermatological circles, et al”

        Hmm, a “common trope” of medical doctors is not convincing evidence to me. Another “common trope” of many medical doctors is the USDA pyramid. And when I google “low carb” and “acne”, most of the hits are from people exclaiming about how much low carb has helped their acne (not evidence or science, I understand).

        All I can offer is my N=1–skin smooth and soft as a baby’s not at all dry, slightly glowing. I’m eating low carb (40 grams total/day) “Paleo” style. I’m trying to keep it anti-inflammatory and supplementing with Vitamin D and Fish oil. Sure wish my skin was like this in high school! Clearly I’m not suffering for lack of a macronutrient (I do get my 40 g carbs from veggies and a daily square of very dark chocolate).

        On SAD and low fat diets my skin was a mess with acne all over my face, in my hairline, on my chest and back.

        Can you tell me more about the low glucose=hypothyroid claim? Are there studies?

        • It’s great that low carbs was your n=1 acne cure, but the amount of carbs one needs for sufficient healing and thyroid regulation is quite individual. Your 40 carbs might be another person’s 10.

          For the studies, you can find them on Google Scholar or PubMed.

      • Just wanted to say that I have been seeing a nutritionist for a few months now that recommended all paleo and gluten free diet etc. which i have done but my acne is still here. she says one approach to acne is to address the inflammation w products like inflammacore by orthomolecular.. Another approach for more hormonal acne is to do an estrogen detox with products by metagenics to get rid of estrogen dominance . I recommend doing any/all of this with guidance from a healthcare professional. I’ll let you know how things go…I am trying the estrogen detox first since I was on the bc pill for so long. Michelle

        • That’s very helpful Michelle, thank you!

  17. I’ve been taking spironolactone for years now, and it’s the only thing that has helped; not cleared up the acne in the mouth region completely, but helped a great deal. It also — oh joy! — got rid of the oil slick that coated my face a few hours after washing, and I can now go for several days without washing my hair, whereas before it was greasy at the 24 hr mark. Think of the time savings!

    My dermatologist tested my hormones before prescribing it, and they were normal. He shrugged and said that I was likely one of those who had an oversensitivity to androgens. Not too much androgen hormones, just oversensitive to it.

    I’ve lately begun to wonder if there is an overlap between my skin’s oversensitivity to androgens and my mild atopic dermatitis/eczema. The atopy is also a disorder of oversensitive skin…

    Atopic dermatitis seems to overlap with lots of stuff, like lactose intolerance (check!). And so many people say that completely cutting out dairy helps their acne… Although I’ve eaten paleo for some time now, I’ve been free with the aged cheese and heavy cream. Time to cut those out and see if the last bits of acne disappear.

    • Anne, I know everyone is different but I use to take spiro and thought it was the only thing that could help me with my oil control. I am doing alot of different things to control my acne but I found that regulating my blood sugar helped with the oil production plus keeping my stress levels down. Just thought I would share 🙂

      • Thanks for the info, Jessica; since reading your reply, I’ve gone on a bit of a reading spree myself about the insulin/acne connection, and am now lowering my carb intake. Being a very bad scientist, I changed all sorts of variables at once (no dairy, no wheat, add fish oil supplements, add vitamins and zinc, change moisturizers, reduce spiro), and so do not yet have clear results to my self-experimentation. I think the fish oil made my eczema worse (allergic reaction?), which confounded results; I stopped taking it and the crazy face flaking and redness on my chin immediately stopped. Anyway. I’m at Week 5 with no dairy, Week 1 of low carb, am having my period, and yet my skin looks pretty darn good. In a few more weeks I’ll return to post another update — I’m hoping by then to have established a stable routine that works for me.

        • Just wanted to follow up. It’s been almost 2 months since my experimenting began, and my skin seems to have reached a happy point. I stopped the spironolactone completely, and also stopped using the topical hydrocortisone my dermatologist had recommended (I’ve since come to believe that the hydrocortisone was EVIL). Dairy is limited to cream and butter; no wheat; almost no sugar; and I discovered that high histamine foods were causing some of the pimple-like spots on my face (thus the issue with fish oil mentioned previously; red wine is especially bad, causing a spot or two within a few hours). My hair is now oilier and needs washing more often, but my skin is much, much better — no longer super dry, the tone is more even, and I only get a little bit of minor acne.

          So anyway. Maybe this will help someone out there.

    • I have been suffereing with the worst cystic acne around my chin mouth, and sometimes forehead since my late teens. They are huge and sometime don’t come to a head. For the past two years I have been working in a medical spa and everyone of the 5 esteticians have tried to do what they learned to help me with no results. I have had peels, been on different topical solutions all with no results at all except my skin everywhere else is smooth. Sidenote: topical retin A makes it worst, I have no idea why. Last year I heard from a Allergan rep about spironolactone and she said it was for my kind of acne. At that time I did not have insurance and went to my general dr who put me on 25mg. From what I read you need to work up to 100, she would only give me 50. I saw great results, not complely gone but instead of (not kidding) eight cysts popping up only two. In July I got a new job and have insurance and went to a dermatologist he too would not bring my level up to 100 but gave me acuzone to to use in AM and told me to go on accutane, which I am againt….I was still getting one or two or three but remember these are huge and painful and ugly! So onto dermatologist #2 who said stop the spironolactone and go on minocycloaine which I was on years ago and it did nothing. I gave it a few months and then stopped everything. Everything flammed up again. I decided maybe I need accutane and went back to Derm #1 who I really dislike. I suffer with depression I told him this yet he set me up to start accutane out of my desperation but once I read the literature I will not go on this. So now I have an appointment with yet one more dermatologist who I had spoken to briefly last year and said she would have me on 100 mg of the spironolactone. As I sit here and type I have my entire jaw line is bumpy with cysts waiting to come up and they are painful, I just finished my period, I had new one come up the week prior to my period and now a week afer there are new ones, it just doesn’t stop. I started my spironolactone that I still have this week keeping it at 50 until I see her on Friday. I am 52, work in a medical spa and my new job is front desk at a private school. This acne is renewing my life. I’m sick of trying to cover it up. And in the spa they have me under a magnifying lamp. As far as skin care I’ve had access to the best and tried it all. Everything I put on is drying which makes me look tight and wrinkle when – I really have good skin. I did notice once stopping the spironolactone that my skin was oily which it wasn’t before and my face hair coming in more often. The only problem I have with spironolactone is I have IBS and it causes more stomach issues for me especially since you have to drink so much water, but I think that is better as it’s flushing. I will give you all an update when I see my dermatologist on Friday. I do not eat dairy, acutally I have a pretty poor diet because of IBS. Because I can’t do dairy I do eat alot of soy, if I give that up, what am I suppose to eat? My next step after seeing Dermatologist #3 is going to a nutrionist. There is one in my town who charge s $300 to a comprehensive anaylsis and puts you on a diet and supplements. I think along with getting on the right medication will do the trick. Thanks for listening girls. It’s nice to know I’m not alone in this.

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  19. This is a great article. I just recently came across your site, thanks to Sean at underground wellness 🙂 I think this site is going to be a great source of support for woman everyone. I am excited to see where it goes. I just wanted to make a comment about your article and my own acne struggles. I just recently have conquered my acne for the most part. I have learned that stress and what I eat DO play a big role and hormones as well. I agree with your article. I wasn’t able to over come my acne until I cut out certain foods (went on a paleo diet), found ways to reduce stress (meditation and exercise), get more sleep (7-8hrs), started taking supplements to support my liver, plus zinc and support for my adrenal glands plus started drinking this tea designed to balance woman hormones called hope for hormones. Also, regulating my blood sugar was a big part as well. My face was so oily I would go through up to 5 blotting sheets every 4 hrs. It was pretty embarrassing but by regulating my sugar levels my face has started producing less oil. I suffered from acne since I was 13 and I am 25 now. I just want woman to know there is hope! I’ve have tried all kind of things prescribed and over the counter but I have truly learned that the healing has to come from within and that everyone is different to some extent. What may work for one may not work for another. You have to learn and listen to your body. For all those woman out there still suffering from acne don’t give up!

    • I feel like giving up! Nothing is working.

      • No! You’ll get there, I promise. It’s a long road, but you are already walking it.

  20. I have been using spiro for a long time and its helps alot!!! it wasnt until recently that I found out that I have PCOS and hypothyroidism. I had stoped the spiro for a while and when I started using it again my acne got under control. I am 27 and still have to use RX grade acne topical treatments, but if it helps with the spiro ill use them!

  21. Very interesting….. do you have thought of what might be the cause of rosacea, adult acne? Thank you for a great webside

  22. Wow, this is a lengthy, greatly detailed article about acne. My sister suffers from chronic acne. I’ll link her to this blog post. Very helpful.


  23. Ive had chin only acne for 20 years off and mostly on. When I was a teenager, my doctor thought it was from playing the flute ( I have a raging nickel sensitivity), then it was hormones (bc did help, then it didnt, and it made me crazy), then it was toothpaste (been toothpaste free many years, it is great, try it), proactiv worked a few years, then it didn’t. My hormones have always been good (PCOS is not even on the radar) but Ive been breastfeeding for 18 months (still no period) and I don’t have an oily face. The sebum of my chin never seems to make it to the surface. I’m terribly sensitive to products (hair products, moisturizers with silicon & sunscreen break me out badly). I had been pretty clear, but started making my own yogurt at home. I flared up major & can’t get it under control. Suggestions?

    • Perhaps you have a dairy sensitivity? I’d try getting rid of grains, legumes and dairy and see if that helps.

      I recommend liver for the skin– it’s almost toxically high in vitamin A, which is well known to be a powerhouse for calming acne.

  24. Thank you. I will try that

  25. I’ve had chin acne for the past 10 years, starting in my late teens. When I was on the pill, my acne would clear up. That was pretty much the only reason I went on the pill. But recently I discovered the paleo diet and now my acne is clear while being off the pill. miracles of miracles!!! Even though my acne presented itself on my chin, and it was horrible painful cystic acne, I believe that it was related to my diet, specifically gluten. The pill did alleviate my symptoms, but so did changing my diet. I don’t think people just all of a sudden have “hormonal” acne. OUr diets must impact our hormones, right? It has to be related, otherwise how do I explain my clear skin? THanks!!

    • Oh, well, yes. Of course our diets affect our hormones. 🙂 DEFINITELY. Diets also are inflammatory or not, which can make a small amount of hormonal fluctuation appear drastic on our skin.

      And it’s also complex… perhaps all people with hormonal acne ALSO have gut issues or food sensitivities… it is a complex web of forces.

  26. I love your site, thank you for all the info! I am struggling with my acne at the moment (well forever really). I am 27 and have been on every medication around since teenage years including Roaccutane. Horrible stuff. I have followed a paleo type diet for just over a year. I kept small amounts of dairy in for most of that period but have recently cut it completely. I think at Christmas time this year is when i got really inflammed and awful cystic acne around my chin and it hasn’t really gone away. I clear up one lot of spots and then another one starts up. It is so depressing – so many nights crying. I even wore full make up on the beach as I am so embarassed about my face. I am starting to wonder should I get my hormones checked. I am a crossfitter, not under weight (54kg for 5’5 height) but my job can be quite stressful. Do you have any tips for supplementation or foods to avoid? Thank You

    • Yes, the foods I mentioned. 🙂 You mentioned inflaming up at Christmas– that would indicate to me that any “cheating” that happening was probably problematic for you. Did you eat sugar? Grains? Dairy? All three of those things can be pretty largely implicated in hormonal acne. If you haven’t removed those foods, I would try it and see what happens.

      I would also recommend getting your hormones checked.

      Stress could still be your biggest factor (it is one of mine).

      I highly recommend organic animal products if you can get your hands on them, and for skin quality, in my opinion, liver is the absolute best food.

      • Thanks for the reply. Yes there was a bit of cheating but I got back on the wagon pretty quickly. I think it must be a combination of everything. Maybe some yoga or meditation is in order! I will need to find a way to sneak liver into my food! Thank you

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  28. Just wanted to say thanks for approaching this topic. I get so very frustrated with conventional dermatology. They just want to peddle their creams, lotions and antibiotics. They absolutely will not listen to my suggestions that diet plays a role and even minimize the role of hormones. I have had cystic acne for more than 25 years. I’ve been down the accutane road. I’ve done antibiotics, every cream known to humanity and even some crazy treatments I found on acne.org. I’ve been DF for 5+ years and Paleo for 1. Still. Breaking. Out. Sigh. Getting off dairy and gluten helped tremendously, but I long for the day when I can wake up and the first thing I do is not feel my face for new cysts. Keep fighting the good fight.

  29. interesting conversation

  30. All through out high school I had fairly clear skin, until last year at 19 (my 1st year at college) things took a turn for the worse. Like a lot of women I figured my skin would clear as soon as soon as I left high school, but I found the opposite. I’ve tried everything: 3 step cleansers (which I’d feel guilty buying with my college budget), masks, and am now using 100% organic cleaners. I’ve change my eating habits from milk to almond milk, and to eating many leafy greens, and avoiding any processed food. My acne is getting worse though plus I have horrific scars. It is mostly concentrated in 2 patches around my mouth and cheeks, but is also on my forehead a bit. I feel so ugly, and depressed. I just set my first dermatologist appointment, but it’s not for another month and a half. I’m planning on going on birth control pills this next month, hoping that might help.I’ve heard of the oil cleansing method, but am too scared to try it without a professional opinion.Should I get my hormones checked before I go on the pill? I don’t know what to do any more. The information here is more accurate than anything thus far I’ve checked out, but now I’m nervous about the b/c.

    • Don’t change anything before you see your doctor. The doctor will then see the problems as you are coping with them. 6 weeks may seem like a long time to wait, but let the doctor guide you rather than you spending energy and money on more stuff that won’t help. Changes done through them will be understood and if you do it on your own, they will retest any way. If you do make changes, take great notes so you can share any changes to your condition with the doctor when you arrive, but your goal is to discover the cause and find a cure, not just put a band aid on a long term problem. I’ve been dealing with this issue for 40 years and now in menopause, it is still an issue if the doctor changes my hormones. Ladies you must learn to know your own body and own your own cures, even if they are in conjunction with great medical care.

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  32. So, I have been Paleo for over a year now, and I have never had much of a problem with my skin, but these past few months it has been worse than when I was a teenager. I have written this off as a hormonal imbalance caused by going off the pill 5 months ago but it continues to get worse. I am getting desperate to get some relief, it is unbearably stressful for someone who is used to perfect skin to deal with big painful cystic acne. My diet is in check and well balanced, I exercise regularly, and yet the problem keeps getting worse. Could you please offer any advice? Riding out the storm is becoming unbearable.

  33. Thanks so much for this article. I really appreciate the balanced perspective when you exlain options but also the downside of trying each. I wish doctors/dermatologists have been this informative with me during my battle with acne. I’ve had to figure it out on my own through trial and error. Still fighting the good fight!

    • In addition, I have found that letting my body naturally work out its hormones is the best approach. When I eat right, get regular exercise, and a solid, regular sleep schedule, my skin is at its best. Also, a daily vitamin helps as well as a mild, non-soap cleanser.

      The birth control I have tried either makes me spot-bleed or feel depressed/irritable. Either way, its not something I’m willing to live with. There are other alternatives.

      When I was going off birth control, I hit up my local Herb Bar to buy supplements to help my hormones balance out. Along with the regimine above, my skin really improved. I do get an occasional breakout but its over in a week and I’m back to my “happy” skin.

  34. Thanks for the great info! I believe I suffer from hormonal acne also and it is nice to finally not be sold something that’s just a quick fix! I started getting painful cystic acne right when I went to college at around age 19. I was a late bloomer in high school but never had huge acne problems, just the occassional ‘OMG zit’ that would go away in a few days. In the first year of college I was getting cystic zits on my jaw line, around my mouth and on my cheeks. I have tried everyging since then (I am now 26): tetracycline, creams, lotions, and Nicomide. I don’t notice one thing that causes my skin to break out but I eat try to eat healthy and exercise (hit yoga was a nightmare for my acne though) and I am about 130 lbs. I do notice I breakout around the cycle days that you mention. Nicomide which was essentially B vitamins, folic acid, and zinc, is what helped my skin the most but now this has been discontinued. I have been eating a lot more eating dairy recently and taking probiotics and I think it’s improving my skin. Ahhh!!! Why arent there any conclusive studies on this? I dont get it? It most definitely is related to what you eat and your hormones though. Anything else is just masking the issue. I don’t know if this was a helpful post but I wanted to share this with everyone. Currently my regimen us 1. A healthy diet, organic meat, diary, nuts, not a lot of sugar, organic fruits, veggies, lots of water 2. Daily probiotic, niacinamude (500g) 3. Topical arnica gel and a little ice with flareups 4. A lotion with Vitamin B in it . Also I am looking to get on the pill for the first time but maybe I should have my hormone levels tested first? Then once I’m on the pill have them tested again?

  35. This is a wonderful blog. I am 21 years old and throughout my teenage and highschool years I have never had a problem with acne. And now i have huge cystic acne on my chin and between my eyebrows. Sometimes even if the cyst isnt flared up I can feel deep under the cysts that may flare up. It is almost as if I have extra sebum (if thats what it is called) under the skin of my chin, just waiting to come out. What do you think this is a problem of? It sucks really and it breaks my heart to hear other stories of other women feeling this way. Because i know what its like.

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  37. I find this blog very helpful. I’m 48 years old and have always had acne issues with my skin. I too have tried many things (facial soaps/wash, Proactive, Tretinion cream and others, series of Accutane for years and bcp, to no avail). I’m African American, oily skin, with somewhat sensitive skin. In my early years my acne appearance appeared “normal”; rash looking breakouts on forehead and cheeks. As I got older my acne changed; breakouts more so around jowl line, chin and around my mouth. Oddly enough the breakouts tend to like the right side of my face, go figure? 🙁 Some of the breakouts are puss filled, but some are blood filled, hard and tender to the touch. They tend to reoccur in the same place and I hate them, as I think they are so ugly, especially around my mouth and chin! At present I have a bump just below my mouth on my right side that is finally going down/away. This bump has been around for about a month. When I put pressure on, it was filled with blood, not puss.

    Thank you for writing on this topic and responses are comprehensive and helpful. I must say my diet has never really been the best, but do eat better than I use too. I’m also dealing with mild depression and my job is very stressful, I struggle with balancing my job and my life. I’ma athelete and have always been an active person, but for the past 2 years my diet and exercise have been so inconsistent! My lack of activity has increased and sleep patters changed (sleeping moore). My diet, my mental/emotional health and my physical health is all tied together with my total well being and right now I’m ready to make some changes! I eat a lot of nuts, dairy and wheat, so I will cut them from my diet. I will work on my depression, get up early, go to the gym, and leave the job at a reasonable hour. One day, just one day hopefully my acne problems will be “NO MORE!”

    Thank you for you blog and thank you for listening.

  38. To minimize and treat your acne use a daily maintenance program that is natural. Acne is a chronic genetic and hormonal condition that can last for years, but if you use a natural treatment that works to correct the source of your acne it can not only treat the blemishes you have, but also future outbreaks you don’t have yet.

  39. This is the first article I’ve ever read that talks EXACTLY about the kind of acne I’m dealing with.

    The sad part is my diet is already paleo-based. And I exercise and meditate everyday. I avoid prescription drugs like the plague, but I’m desperate enough now to consider spiro.

    I’ve been using a saw palmetto supplement the past few weeks, since that can naturally mirror what spiro does, but no difference yet.

    It’s frustrating to eat this healthy, not use chemicals, maintain a healthy life style… and have acne this bad. I watch people eating McDonalds with gorgeous skin. It’s very unfair.

    • No kidding, Suz. To keep the acne at bay, I recommend eliminating dairy and phytoestrogens, and perhaps limiting your saturated fat as well. Hormones are made out of saturated fat, so if your hormones are out of balance then your saturated fat may be fueling the fire, so to speak. But each woman is different, so I cannot guarantee anything in terms of whether this might work for you. It’s also not a permanent fix, obviously, but something you can use as a placeholder while you try and get your hormones in line.

      Are you overweight? If so, the exercise may be helping. If underweight / normal weight, and especially if under significant stress of any kind, then the exercise may be hurting you.

      I highly recommend going off of soaps and refraining from picking, too. It’s very hard at first (and gently picking at the big ones — I can hardly blame you) — but after a little while I think it becomes easier to not pick and to remember that picking blocks healing.

      I think eating liver helps, too.

    • I have suffered for years with cystic acne. Have been on every perscription and non perscription topical antibiotics, birth control….I worked in a medical spa and had every estethican trying to control it by peels and products.I can say I am totally cycst free after being on on Spironolactone. I needed to get up to 100 mg for it to really kick in and it has. I also did an extensive research on what I was using as far as makeup and skin care and trigger ingredients. What I am using now is inexpensive and working. If you want nmore details feel free to email me privately czaccone@me.com.

  40. Thanks Stefani. I started researching the liver option today.

    I am slim, so I keep the exercise pretty moderate.

    Interesting about the saturated fat, since I feel eating paleo provides much more saturated fat than my previous (largely vegetarian) diet. Will have to experiment with that.

    As for soaps, I’ve gone back to using baking soda to cleanse my skin and lemon juice to tone. Cheap and both certainly work as well as any of the “miracle” cleansers out there!

    Michelle’s post on estrogen detox was interesting too, but disheartening because those supplements are so expensive. Sad that the spiro will cost $10 after insurance but those supplements would be well over $100 combined. But that’s another discussion. 😉

    • I think if testosterone is definitely the issue, spiro’s got a chance at working. For me, it capitulated the worst skin and most traumatizing insomnia I have ever experienced. But I think that’s because of how enormously sensitive I am, and also that my problem was not really high testosterone, but rather low estrogen.

      • Bloodwork is normal… but I’m learning that bloodwork isn’t reliable in terms of DHT. Who knows.

        Since I have thinning hair along with the chin acne, I still think testosterone is the culprit. Seeing the derm next week. Thinking of asking for topical spiro first. The oral version really would be my last stand.

        Rereading this article (it really is the best report on the web for this problem) I also wanted to ask about adrenal fatigue. I have a child with developmental disabilities, and his sleep issues kept me on 3-4 hours of broken sleep a night for *years*. I often wonder how my adrenal glands were over-taxed, and if I am paying the price now. But now that my diet is pure, I’m sleeping and getting exercise… could that really be the issue two years later? And is dessicated adrenal the answer?

  41. Thank you for this article and to readers for their comments. I’ve spent 2 hours crying in bed because my lesions (yes lesions they are way to big and deep to call zits) are so bad. I’ve been to the dermatologist today for my 5th Blu U light treatment with zero improvement. I asked him to put me on spiro and he refused and said only people in their 50’s would be prescribed it, I am 28 and my acne is getting worse by the month. Yet he offered me accutane for the 3rd time which I refused since the last time I tried it 3 years ago after 6 weeks I had thoughts of driving my car off a cliff. Instead I went to my doctor and begged him to put me on Diane since Yaz does nothing for me anymore. I will start it in 2 weeks I am praying for a miracle I am so depressed I don’t want to work or exercise or do anything. I have tried diet modification which doesn’t seem to make my skin better or worse. Last summer I went 3 months without a single blemish even though I was drinking beer and smoking cigarettes and not too concerned with my diet. In October it made its comeback and is now at it’s worst in years. Very upsetting since I work at a high end store surrounded by gorgeous girls my age with crystal clear skin. Has anyone had success with Diane as opposed to Yaz??

  42. Great Post, Stefani. Very Informative! A little bit about me –

    – 30 years old
    – Severe Cystic Acne. My skin is actually really dry and sensitive unlike many acne sufferers who have oily skin.
    – Hypothyroid (TSH 8, Currently on Synthroid to keep levels between 0-1)
    – PCOS (Testosterone of 50, irregular periods, normal weight)
    – My acne is classic hormonal – multiple cysts along my jawline that rupture and bleed sometimes while I’m at work. I work in a high profile corporate job that involves dealing with a lot of clients, so need to wear makeup every day (really do want to have more barefaced days! Sigh)
    – I was on Accutane for 5 months in the summer of 2012. It cleared me up, but my acne came back during the holidays. I suspect it was all the insulin spiking crap I was eating.
    – Supplements – Vit B12 and Vit D. Fish Oil makes me break out, so I eat multiple servings of salmon each week.

    I’ve been on BCPs, spironolactone and metformin and have tried a ton of topicals. They all make a temporary difference, but make me feel awful long term. I have sworn off drugs for now. Just so frustrated right now

    I am currently on day 15 of paleo now and seeing significantly less inflammation. Fingers crossed. I will report back at day 30.

  43. I too have been a cystic acne sufferer for 17 years now, I’m 30. I have tried every acne cream known to mankind, minocycline, BC pills with no improvement. I built up a resistance to minocycline so I would not recommend prolonged use of this antibiotic. I recently got blood work done and was found to have a gluten, dairy and egg allergy. I have completely eliminated the dairy from my diet, and am trying to reduce the sugar, gluten and egg products that I consume. My acne has improved significantly (about 80% clear) however, I still get the occasional nasty cyst (but it is usually after consuming some sort of sugar). I struggle with eliminating fruit from my diet so I am trying to eat only fruits low in sugar. The blood work also suggested hypothyroidism, which can also cause acne. I never considered hypothyroidism as I am not overweight, although many of the other symptoms were present (sensitivity to cold, low mood, fatigued). I have started thyroid medication along with a probiotic. I am not even a week into the medication/probiotic so it is too early to know if this is going to help. What I have learnt is that cystic acne is caused from inside your body and although there are treatments to temporarily control it (minocycline, accutane) it is best to determine the root cause and treat that. My acne has been humiliating to me, non-acne sufferers do not understand. I could deal with a little pimple now and then but when you have painful 1″ swollen parts of your face that last for weeks on end it lowers your self confidence. I wish everyone luck on their journey to clear skin – I will re-post if any improvement is seen from taking the thyroid medication/probiotic.

  44. Love this write up!
    I have just come off 2 years of bio identical progesterone (with a tiny amount of pregnenalone) troches which was balancing my oestrogen dominance. Previous to the troches I would bloat, sometimes up to 2 sizes, literally could not do up my trousers etc, acne, mood swings, cramping etc, during the 2 years it was amazing, all my terrible symptoms reduced by 90 to 95%., except I gained 5 to 6 kg (I’m an Aussie) which would not budge no matter what I tried. So now I have stopped under my endocrinologists advice and he says my body should now know what it needs and try to replicate the progesterone levels I was giving it with the troches. It has been 3 weeks, I have already lost 2.2kg (awesome) but I have an acne breakout, pretty bad one too. I don’t want to go back on the troches as I don’t want to go through the weight gain. In your opinion how much will a paleo diet help in my situation? I have stopped diary, taken prescribed probiotics and krill whilst being on a very healthy diet before, I think it helped mildly. I really just want to make sure I give my body and hormones the best chance to get on top of it before it gets out of control. Thanks.

  45. Thankyou for this post. Im doing alot of research into this topic.From the information in your post I have a hormonal imbalance of some sort as I experience acne always areound the chin/mouth. Always flaring mid cycle when im likely to be ovulating and interestingly at the end of my period. Iv come across starflower oil as something that ‘normalises hormones’ my understanding is that the GLA it contains is what the body needs in order to make hormones. Yet it is an omega 6 something you say to aviod as this will aggrevate the inflammation. Can you shed any light on this for me please? thanks!

  46. How do I get help? Ive been suffering with acne since my teens, and Ive tried everything under the sun. Next to never eating anything ever, I dont know what to do. Food is my enemy .. No matter what I eat, dont eat, I still suffer. The only time my skin seemed to clear up was during my pregnancies, only to return with a vengeance :(( Allergists wont see me because they dont believe acne is a reaction of a food allergy. GYN’s only prescribe birth control, which hasnt helped either. And doctors have had me a slew of medicines, none which have worked. Anything that has sort of helped, only helped for a short time. Is there a way of life for acne sufferers?? I dont even know where to find a doctor willing and able to finally research and cure my acne :_((

    • There’s a number of things that can still contribute to acne — stress, restrictive eating, low body fat, high body fat, too much exercise, and especially nutrient deficiencies. If you have gone long periods with poor diet or with eating few foods — in addition to being so stressed out — it can be a significant factor in acne. Plus using facial scrubs and lotions, etc. I recommend HIGHLY checking out Liz Wolfe’s Skinterventions http://purelyprimalskincare.com.

      I’ll be writing a review of it as soon as I can, too.

      • Thanks Stefani! I will check it out! Yes, I dont even know how/when/what to eat anymore 🙁 Keep me posted!

    • I feel for you dee bee. 🙁 My acne also cleared up during pregnancy, which for me signifies that a hormonal imbalance was corrected by the pregnancy. The questions is, how? Have you seen an endocrinologist? My internist wants me too; that’s next on the list. I was supposed to see my dermatologist Wed (after many weeks of waiting) to get on spiro. She canceled the appointment. I was upset, but I’ve decided it’s a sign that I should try alternative means one more time. My chiro put me on a host of Standard Process supplements to support the thyroid and adrenals. I will let you know if it works.

      • Hi Suz, Thank you! Hmmm, endocrinologist heh? Maybe I will look into that – definitely keep me posted! I was researching hormonal replacement therapy, but I doubt that is my answer, so I dont want to invest all that money. Plus, there is no guarantee .. rite now Ive given up caffeine, dairy, gluten, wheat, soy, bread, fried foods, flour, sugar, oils (except organic virgin coconut) and pretty much processed foods altogether – I truly feel it must be my diet, but I just cannot get thru the day without consuming something Im not supposed to have, be it certain fruits, vitamins, spices (I just found out cayenne pepper is another no no) or something w/a hidden ingredient in it – dairy seems to be in everything, even bread! Im learning about organic meats now, too, but know very lil .. Im looking for a moisturizer that doesnt break me out because Ive started using tea tree oil & its kind of drying. I also just read here about the apple cider vinegar (braggs), but i am not convinced that doesnt break me out either. Im curious about the effects of green tea too since it contains caffeine (these types of oxymorons confuse me to no end!) Im rambling, so Ill end there ..

        • I’m on bio-identical hormone replacement right now — not expensive. But unfortunately not helping the acne. 🙁

          As for foods, I’ve done what you are doing. The only food I’ve found that directly impacts the acne is sugar. I still maintain the gluten-free/dairy-free/chemical-free diet because it’s good for my general health… But again, has not impacted the acne.

          I agree that it’s all so confusing. I did just order a (decaffeinated) green tea supplement to see if it helps. And I’m going to keep up with DHT Blocker, even though I haven’t seen results yet. Between that and everything my chiro has me on, I’m a walking vitamin.

          I am using Balm of Gilead as a moisturizer because there’s no chemicals in it. What I realized a while ago is this: it doesn’t matter what cleansers/moisturizers I use on m face. None work on the acne. So I might as well put good stuff on my aging skin. All the Australian Scents products are very good and natural.

          Acne is so demoralizing. Good luck and we’ll keep trying to find answers!

  47. Hi Suzanne, Ok for now hormone replacement is on hold, because I cannot exactly afford it, especially since the doctor is focusing on symptoms other than acne. I see moderation seems to be the key with whatever foods I eat, but I also feel there is something either w/my metabolism or my digestive system, as mine is neither quick nor effective (at this point). Of course, I am craving all the foods I have restricted from my diet and notice clearer skin when, like you, I avoid sugar, but also by avoiding dairy and breads. I just purchased no no Skin & am trying this out now. I will keep you updated as to whether or not it works.

  48. I’m strongly considering taking spiro. I’m working on my diet and have been dairy and sugar free for a while which has helped some but a recent breakout has left me incredibly frustrated and I’m considering using spiro while I work on my diet. Will spiro cause me to lose muscles mass or make it more difficult for me to maintain body comp/gain muscle? Have any ladies here noticed decreased strength/muscle?

    • I don’t think so

  49. I just want to pop back to say that I finally managed to clear (get under control) my cystic hormonal acne 2 months ago after a few years of bad flares. I did it by accident…
    I started eating more CARBS! ha
    I went on holiday and ate some more sweet potatoes and rice than normal. I was never very low carb but just usual paleo with minimal fruit. I decided to keep eating this higher intake of carbs as I started to feel really good and my workouts and energy was better. After about 6 weeks I realised that I hadnt had any new cysts.
    Over 2 months later and I am still clear. I am so happy! Try it out ladies, it is a simple change which may help.

    • yay!

    • Congratulations! Paleo Diet is not carb free, but carbs from natural sources like vegetables and fruits instead of processed carbs like cookies and flours. For those of you who haven’t tried Gluten Free, there are many gluten free flours to bake and cook with that are not low carb or low calorie which can often make a big difference because our bodes do need a certain amount of carbohydrates to have a healthy metabolism. BTW-my favorite flour is sorghum, its not gritty like rice flour.

  50. I believe the thyroid may play a role in female hormonal acne. I’ve always had clear skin, was diagnosed with thyroid cancer at 24, had thyroid removed and radioactive iodine. I take levothyroxine as I have to too survive and keep my TSH at a suppressed range at all times, bordering on hyperthyroidism (if I had a thyroid).. Since all of this I started getting adult acne. But the last few months it has been the worst I have ever seen, cysts all over the jawline that are painful and red. Tried doxycycline and Epiduo, nothing is working. I might try dairy next. I’ve been tested for coeliac disease also and had a gut biopsy as I have Hashimoto’s thyroiditis and it’s linked, but come back negative. It’s destroying my life and my face!

    • I also have Hashimoto’s and horrible acne all over my body-face, neck, jawline is really bad, chest, back, shoulders are the worst. I am on bioidentical hormones and they have switched them 5 times to get rid of the acne, nothing is helping. I’m taking DHEA 5mg/Pregenolone 25mg, .75mg Anastrozole, 4000 mg Vitamin D, enough B, 2000mg of liver for iron, Jarrow Acidophilus, and 50 mg of T4. I was taking T3 til a couple days ago and have done T3/T4 mix. Also Progesterone cream from day 15-28. I start breaking out as soon as my period ends, that first 2 weeks is bad, then it starts to clear and gets way better as soon as I have my period, but never really is gone. I went from being one of those people always complimented for my skin to being unable to leave the house without thick makeup on my face and body, its disgusting. I was on birth control for 18 years, and on and off spironolactone for years, hence those things gave me clear skin, and I got off of both when I was diagnosed with Hashi’s. Last blood test 3 weeks ago: day 20 of cycle: My LDL levels are abnormal but I don’t know what those are, my DHEA is low at 59.4, TSH is high at 5.63, Cortisol is sorta high at 14.2 (am), Esstradiol is 73.3 (my dr says that all of my hormone has to do with my estradiol being off?), vitamin D is low at 42, Progesterone is 5.5, Ferritin 77, Free T3 3.4. I sleep 10-12 hours a day, eat only organic, veggies, fruits, nuts, meat, and no cow dairy (I eat occasional goat cheese or coconut dairy). Any idea why I would be covered in horrible acne that seems to be getting worse? I am at my wits end. I can’t even get a job due to how bad it is, I stay inside, it hurts my skin.

  51. I’m 26 and have had horrific acne since 13 which I suspect is hormonal . . . the huge cystic breakouts every month on chin and around mouth about a week before my period (which can happen anywhere from 25-38 days apart). Forehead has always been perfectly clear and smooth (which is hilarious because i’ve always had long bangs), checks get blackheads/ whiteheads and the occasional pimple, but nothing like my chin, jawline, mouth, and neck which never gets a chance to heal.

    I’ve tried just about every prescription and OTC product, clinical facials and scrubs, etc. Diet & exercise help somewhat but do not stop the breakouts. Going gluten-free helped the most but is too expensive to maintain. I eat pretty healthy and have for years— organic-only animal products when I do use them, no dairy (except occasional yogurt), not too much sugar.

    I suspect high testosterone/ low estrogen b/c I am underweight and very lean (fat does not like me one bit and it’s truly impossible for me to ever gain weight no matter what I eat or don’t exercise)— 5′ and just under 100 lbs. Never had any sleep problems and always get 7-9 hrs, no other real health complaints, just can’t shake this hellish cyclical acne! I’ve had an interest in bioidentical hormone treatment as it’s the one thing I’ve never tried, but cost is an issue right now as I am recently out of work and uninsured. Does this even sound like something that could be of help in my situation? Thanks all for any info/ advice anyone could share . . .

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  53. This is one of the best articles I have read on hormonal acne.

    I know all of this very well, as I have been experiencing it all my life, and in my early 40’s (now 52) my dermatologist suggested spironolactone… Well for me it was a mircle drug. My skin cleared up immediately, and so did my depression. I was diagnosed for many years as biopolar, but I was not biopolar, it was the affects of the excessive production of androgen. I wonder how many women are suffering from depression, not knowing that it could be their androgen levels. When I began my spironolactone, I was also taking yasmin, working out, and very slim. My skin was fabulous, but the closer I got to menopause, the acne got worse, and of course several years ago, my doctor suggested I not take the yasmin any longer, because of the risk, and needing lower level doses of hormones, as well. Then stress from a divorce, I sometimes feel as if I am back to where I began, but I can be thankful, that I don’t have the depression although the acne is somewhat persistant, but nearly as bad as it once was. I still feel that spironolactone is an amazing drug to treat hormonal acne. I do have PCOS. Also, there is more than one organ that produces androgen, so it can be a battle sometimes. I find I am at my best when I eat the least. We don’t need to consume much food to be healthy. I think people are under the wrong impression about diet. I felt my best at 110 pounds. Now I am 120 and I feel miserable. It hardly takes any amount of food for me to gain. I am only 5’3″ and small framed, so I need less calories. Diet is very important as well, to control androgen levels, as the article stated. The most important thing I have learned about dietint, is to keep it under control and never stray, because once your body gets use to fats, and sugars, it starts craving it. When you eliminate it from your diet, you are happy without it. I was a nurse many years ago, and I research everything to help my acne, it was so sad that it was not until my early 40’s that I was finally free from it. I hope other women can find their cure much sooner. Great Article.

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  56. Hello, I’m a licensed Esthetician and I was diagnosed with PCOS at 30. I took metformin, changed my eating and lost 50 lbs. I didn’t have too much acne then. I am now 42 and I have cystic acne and hormonal issues. I never really took my PCOS seriously until recently, I understand what is going on with my body now. I have many diagnosed allergies including dairy intolerance. I have recently taken sugar and whites out of my diet hoping it will help with acne and hormones. I exercise regularly, take vitamins and supplements and I know all of the skin care secrets but nothing that I do is helping. It is very embarrassing and not good for business to walk around like this all of the time. I’m going to see the dr. next week. I don’t even know where to start. It seems like food is my enemy… I also have a sensitivity to many things and products. Any and all advice that you can give me would be much appreciated. Thank you for your time.

    • HI Kim, I am 38 and also have suffered from cystic acne the last 3 years on and off. I finally have discovered the trigger. It’s legumes! I discovered they create phyto-oestrogens reducing my oestrogen levels and make testosterone dominant (self diagnosis from a lot of reading and evaluating my symptoms). I also find many legumes eg cannelini beans, borlotti beans, lentils and similar are hard to digest and this constipation contributes as well to the cystic acne. Do you eat many legumes at all? Perhaps dairy is working in the same way for you. Have you tried spearmint tea? It reduces testosterone in the body. I purchased some when I had persistent cystic acne (beofre I discovered that its legumes that sets it off), and I found the spearmint tea did infact help. I had about 3 cups a day. It gave me headaches after about a week but it was worth it as it got rid of the cystic acne on the chin area. Where is your acne located? Is it chin area only? I find that reducing heavy foods at night so that your bowel has less to work with overnight helps a lot too.
      Recently I have been diagnosed with allergies as well. They dont know what it is so I am doing multiple tests and elimination diet. What are your allergy symptoms? I started the cystic acne years before these new allergy symptoms. Hope to hear some more on your case. It must be so hard working in the skin industry having cystic acne. Its hard enough in other industries. Try the spearmint tea (make sure it is not Pepermint as its a completely different thing).
      Best wishes, Laura

    • Peri-menopause is when my acne was at its worst. Talk to your ob-gyn, but it sounds like your androgen levels are high. Endocrinology may also help, but you really need someone who specializes in wellness and not just make sure that the lab numbers are in order.

  57. I have been taking DIM. It was really regulating my cycles as i have long cycles but i think i over did it with DIM. Yes I get acne but the DIM eventually caused a full T-zone breakout. I stopped DIM, try to stay away from dairy and make sure I eat more dark greens. I also thoroughly clean my face and use toner and bezoyl peroxide face masks. That has helped. Im not in the clear yet but hopefully my changes will at least minimize the acne. Currently however my cycle
    Is crazy- very spotty for the past two months.

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  59. I have been on high dose birth control since i was 17. 6 months ago a doctor switched me to lo loestrin fe, a much lower hormone pill. Since starting this pill i have had THE WORST acne of my life. The past two years have also been extremely stressful, but until i started this pill i didn’t have this much skin trouble. it’s cystic and terrible. I don’t know what to do because i have to have a birth control pill, and i was excited about having a lower hormone one because eventually within the next couple of years, i’d like to stop taking birth control all together. But i can’t figure out how to clear my skin. I have a pretty clean diet and i exercise. I have stress but i manage it pretty well.. i’m not sure what to do!

  60. My dr just had me start progresterone cream 2x a day for days 8-26 because I have polyps/fibroids he is trying to shrink so I don’t have to have surgery. My face looks terrible I’ve been doing the cream 10 days, I’m also terribly moody 🙁 I read Dr Lees book and he says there is an adjustment period. Thoughts?

  61. Excellent article. Just what I was looking for!!! Thank you also to those who post helpful information.

    I’ve been Paleo for almost two months and in terms of acne have only seen a touch of improvement. I knew my acne was hormonal as I have PCOS but I was hoping Paleo would be the answer. I only in the past few days have been suspecting flaxseed and low and behold your article mentions it’s Phytoestrogenic. I have to do more research, but years ago my reproductive endocrinologist told me to take Flaxseed oil though she said lignin free, which I don’t because I grind the whole flaxseed and add to my smoothie. So maybe this is my trigger the lignins. I’ll eliminate it for a while and see the results and then what happens with a reintroduction.

    Again, thanks for a wonderful and extremely informative piece!!

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  64. Thank you so much for such a detailed article on a subject there is so little medical knowledge. Talking to your primary care or ob/gyn on these topics is useless, I’ve already found. I have had hormone problems since 13 with severe painful cramps (vomiting, etc) endometrosis and uterine fibroids and went on the BCP at 19 and was on for years. I went off 2-3 years ago and have been taking natural progesterone, Calcium/Magnesium, Zinc, and many other supplements and have been cramp free! But hormonal migraines and acne have been real issues. When going on diet that eliminates gluten, corn, sugar, dairy, I found my headaches and skin were improved. Now my skin is getting worse and starting to get cramps and Im now taking IC3 to metabolize excess estrogen along with the progesterone. I had been taking Estrium powder and it worked great but was very expensive. Your article has really helped me see that my estrogen now seems too low, progesterone possibly too high, and testosterone is the culprit I haven’t been able to address for my skin issues. This will really help me try to fine tune my own hormone treatment as I know getting off the BCP was a great decision.

    Thanks so much for writing this!

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  66. Hi I’m 21 years old and miserable. I had horrible acne in my middle school days somewhat normal teenage acne. 16-20 years old I still had acne but it cleared up and was manageable. I am now 21 and I have huge cysts everywhere. I’m very athletic build and retain muscle easily. I eat clean and excersise daily. My body is now fighting off the antibiotics so my last thing to try is birth control I do believe I’m high in testastrone. But if this birth control does not work I’m honestly going to give up I cannot live like this anymore I feel hideous and in pain, I’m getting severely depressed and can’t stay focused anymore. I do not have health insurance. Do you think the birth control having estrogen and progesterone will help me?

    • It definitely could! That could be a wise step while you try and heal your gut from the antibiotics

  67. Hi,

    Could you please respond.
    I am so desperate right now but I think I am starting to understand what is causing my acne.
    I have typical hormonal acne which is on my jawline, chin and recently, i started getting sometimes on my upper side of the nose.
    I know it is weird because there is some pus but if i decide to pop it, it will first become really big and then i would have scars that will never leaves. My face is scarred right now.
    I went to see a gynecologist because i was on the birth control implant for 3 years and then diane 35 for 6months and I used to be on BCP before but I had 2 abortions so I decided to use a more efficient birth control soluton for me. After stopping the pill almost a year ago, i had no menstruations for few months. We are trying to conceive and i started to remember and read about the PCOS. I am sure I have it but my doctor said I have no cyst. But I know I used to have some. Also, he did me some blood test and here is the weird thing. It seems that i have normal estrogen level but high progesterone and high testosterone. Usually, i read that progesterone is low on PCOS? Right?? I have a feeling that if i ever found a solution, it will treat both pcos and acne. But I want to be a mother and one of my biggest wish is not to have those cyst on my faceanymore. I am ashamed when i looked at my husband because i am afraid he would be disgusted as I am. I decided to start a low carb diet because i am understanding that high sugar dier can have an impact on PCOS. I barely eat diary but sometimesi would put some butter and i gues i have to stop. I think i am starting to develop some eating disorders because i am now afraid anything would cause my acne.
    Please tell me why my progesterone is high and my testosterone too!!! please, i am so depressed right now! oh i am french so please forgive me my English mistakes.

    • Ordinarily, yes, progesterone is low in PCOS – but it seems as though your problem is hormonal hyperdrive in all realms. .. Except note that it totally depends what time of your cycle you did your bloodtest as to whether or not your levels are too high. For example, if you took the test while you were ovulating and you did not know it then your measurements will be off. Make sure to talk about that with your doctor or at least know they looked at your hormones in the context of your whole menstrual cycle.

      Testosterone, yes, that is definitely contributing to the cysts.

      I understand completely the whole ‘acne fear’ phenomenon — it is something many women I work with have experienced and something I did to great extent, as well. Do not give in to it. I promise you, it does more harm than good. Read the post I link to below to see more specifically how certain foods can work for or against you.

      Progesterone itself can be somewhat acne-generative, so that may be a part of your acne problem, and completely independent of food. Check out the post I recently did on acne – http://paleoforwomen.com/all-you-need-to-know-about-acne-in-3000-words – for how I would recommend approaching that monster.

      Hope that helps!

    • You sent me an email, right? I’ll post a quick reply here for others. Yes, progesterone is not normally elevated in PCOS, though not unheard of. Important caveats to watch for are when you got your tests done on your menstrual cycle, which can change the results, a pituitary issue that your doctor may want to think about (though normally the “pituitary” or “tumor” issue is prolactin), or general hormonal hyperdrive, which may be the case. The elevated progesterone is likely a factor in your acne, as it can cause inflammation, and testosterone as well. So working through PCOS from a testosterone / insulin -based standpoint, working on stress, and double checking those test results are all good steps forward.

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  69. Interesting things to consider. Ever since I went off the pill at age 30 and let nature take it’s course my cycle has been about every 17 days or so. Such a pain! I’ve also had acne for about 30 years, nearly my entire life. I’m ready for it to go away now.
    Think I’m due for some blood work and more dietary changes (haven’t had dairy for almost 3 years now). I keep thinking there something else I can be doing for myself. Glad to know I’m not along but it still sucks nevertheless!

  70. I’ve been following the paleo diet for a year now, also eliminated toxic cosmetics and cleaning products yet continue to suffer from hormonal acne. I recently had blood work done on thyroid and my T3 is low (while TSH and T4 are in normal range). Are there any suggestions for natural remedies to treat low T3? I feel like I’ve come a long way with lifestyle changes on my own but not sure what else I can do.

    • If you know you do not have Hashimoto’s, being sure to eat or supplement with plenty of iodine and selenium (abundant in seafood), eat iodized salt, and eating saturated fat specifically can be a great help

      • I don’t have insurance I feel so alone and no one can help me, Im on birth control NOtHInG is helping me at this point. Saturated fat for low thyroid is good? Iv always thought I had a thyroid problem as well. I feel like I have tried everything I just want it to stop

  71. Thanks for this post, one of the best-informed and well-written explanations I have seen. I have had PCOS for 10+ years and have been on spironolactone for 5. The spirono really does help – really. But I am still having persistent chin breakouts, to the point where I now am noticing pitted scarring across my chin and jawline. I am doing really well with a Paleo diet other than dairy, which I am finding tough to cut out. But I realize now I need to do it to get these stupid breakouts to stop. Thanks so much for the great information in this post.

  72. Really great point about DHEA being contributing factor in helping cause acne. I really loved the article, but I disagree about the stress causing acne. Increased cortisol levels means lower testosterone impact to me, so stress to me is not factor is acne. I also have the clearest skin when running a ketogenic diet, if anything carbs to me can cause androgen issues.

    • stress most definitely causes acne. absolutely 100%

      • yes, absolutely 100%

  73. Pingback: Paleo for Women | The Little Adrenal Gland that Almost Could: Or, How Stefani Lost and is Regaining her Sanity

  74. I love this post I’ve been battling acne outbreaks since I had my second child (2011). I have gone to the dermatologist who prescribed solodyn, crèmes and soaps nothing has really worked. I’m beginning the pill this week, but now I’m not so convinced if it will help as I have read many people complain about how they break out with the pill. I’m waiting on my blood results to see if it has anything to do with my thyroid levels, hoping for a quick fix!

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  76. Thank you so much for this article! It was really informative. I have been dealing with acne for the past year or two. And has also had amenorrhoea for about the same time. I have tried cutting so many things from my diet but it never really made any difference. Recently, after a blood test, I found out my estrogen levels are a bit low and after reading this article it has given me hope that if I can balance my hormones maybe I will get my periods back and also get rid of this skin stuff! Thank you so much!! I will post an update if I am successful!

  77. Great article by an armchair derm until you get to the part where medication (spironolactone) should be used as a stop gap measure until you control it with your diet!! There is no correlation between cystic hormonal acne and diet.

    Please- there should be some way to ban uneducated people from making medical points on blogs!

    • This comment is ridiculous. Just saying.

      • diet may not be the main cause of hormonal adult acne but it most definitely can effect it 🙂

      • Stefani, don’t get defensive. If the issue is hormonal, food only causes a secondary issue because the nutrients in the food are all turned into or moved by hormones to work in our bodies. The food is secondary, not the primary issue if the acne is hormonal. I have training in nutrition education, but I don’t pretend to be a dietician or a professional nutritionist, even though I do design my own recipes. I also have thyroid and acne issues, but just because one thing worked for me, doesn’t mean it will be the same for every person. A good researcher is not afraid to hear dissenting opinions and study both sides of the argument to learn new things and more about the issues, even if they disagree with some one else’s conclusions.

        • of course. nonetheless, I believe that food is a primary driver of hormones – therefore we appear to believe very similar things.

  78. Acne is the most annoying thing in the world. I have suffering from this for a long time. I have tried many medicines and supplements but results were same. I then tried natural herbals and now it is way better difference than before.

  79. Really excellent information – I fully intend to read information and posts here again. It is so difficult as many have mentioned, hairloss and severe cystic acne have troubled me.

    I have always thought that even though one may have endometriosis does not necessarily follow that circulating levels of oestrogen are high. I always had a feeling about this.
    Also thought that if the thyroid is impaired then the body cannot keep up, hence endometriosis, ageing, etc. My guess.

    It is all so complex, and although blood tests can sometimes be useful, my experience is that in the UK NHS system that’s all that counts. Now they don’t even do blood tests.
    Now we are all offered Prozac and told that depression is responsible for all our ills.

    What really is required is more “joined up thinking”. I am battling severe cystic acne, hairloss and fatigue whilst in my early 50’s. I confess that I almost feel defeated.
    Thank you for all of this information, and I look forward to reading and digesting it!
    Kind Regards

    • Fiona,
      Your thoughts are spot on to what my current doctor has told me. Don’t feel defeated take your symptoms to a doctor who specializes in hormone wellness, not necessarily a traditional endocrinologist, and share your symptoms. I discovered thyroid was the cause of my depression, reproductive, body temp and weight gain issues and skin issues. Individual specialists will treat the symptoms, but not put the whole body into the scope unless you bring all of the symptoms to the table. When I fixed the “regulator”, the other issues began to get better as well, but it is a long journey without help. I now have energy, pretty hair, and a much more optimistic view of life and I am hormone free, and feel better than I did in my 40’s. In my 50’s I still hate zits, and have to watch what I eat to keep insulin in check and have struggled with these issues for many years before any one believed me, but new guidelines for thyroid make diagnostics a little easier and having documentable proof of weight gain and change of life style due to lack of energy or depressed attitude will help.

  80. I have the acne problems for years. But these are some new tips for me. Lets see if my acne gets better. What me helps is the juice of red melons. Press it out and put it on your face for 10 minutes. I do this every second day, and helps to get of the acne for I would say 20 percent

  81. I have had hormonal acne for years with it only getting worse the past few years (my late 30s). After researching ad nauseum for a cause/link I came upon this blog about 9 months ago. Since then I eliminated flaxseed from my diet and my hormonal acne has cleared up. I only break out when I stray/cheat from the Paleo diet. Thank you so much for the info!!!

  82. It can be chocolates, candies, some sweets or any other stuff in line
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  83. waoo amazing blog and important information any type . i love it

  84. I’ve heard that drinking and applying bentonite clay has helped some people of their acne.It merits your research because it can balance your system.Look up Living Clay.

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  89. Funny that you say that the cure to hormonal acne is good diet and exercise?

    I have a great diet rich in (fruits and veggies, lean meat, and whole grains), and exercise 5-6 times a week, and have been doing so for the past 6 years. YET my hormonal acne continually to gets worse and worse. So, regardless of the diet and/or exercise acne will not be cured unless you stop it INTERNALLY.

  90. Thanx for this post! I have suffered from hormonal acne, and its friend irregular (painful) periods ever since I went into puberty. When I reacher adulthood it stopped manifesting primarely on my face and has largely moved to my shoulders and back, with facial acne that is nothing compared to what I suffered as a teen. Oral anti conception proved indeed useful to attack it and regulate my hormones, but has the nasty side effects of making me feel low, slow and out of sync with my body. I just feel less alert and kinda listless on it, so I stopped the treatment. Now I feel on general much better, but the acne is still there. Are there any treatments of hormonal acne that do not involve taking in estrogen?

  91. Thank you so much for posting this. I’ve been struggling with this type of acne ever since I went off birth control. 🙁

    • I know, it’s the pits. You’ll get through it. 🙂

  92. Pingback: I finally bought a book! + HA update | Hannah the healthnut

  93. That is so true,dairy really gives you acne!Last summer i drinked only milk that comes from farms,and as soon as summer ended i started getting acne on my neck and near ( under) the chin and jawline,it was quite strange.I love to read about nutrition,and about a month ago i bumped into a book that cleared out my mind.As it says on the site milk from gestant cows is rich in female hormones ,no wonder i got think awful acnea ,i drinked a lot of milk so my body couldn t held it in.Two days ago i eated a yougurt ,and as soon as i ate it i started feeling unwell,and itching pimples started to come .My face isn’t having much problems,i don t have a severe case of acne,but it s itchy and hurts most of the time,especially those on the neck (they grow big and it’s hard to make them heal).That’s why i think it’s the best if you try to let go of the dairy products,they are not as heathy as they seem,and as i heard almond milk is the best.So why not ? I m thinking of getting away from the meat and turn into a flexibal vegetarian (eating fish most of the time).

  94. I just have to say thanks for this article. I’ve had acne since I was 13 and into adulthood (currently 31). I’ve tried a lot of different methods over the years with little success. Recently, I started to understand that I’m treating the symptoms and not the cause and wasn’t sure where to start. I’d been considering eliminating dairy, but I wasn’t even sure if that was a good place to start over other dietary habits, or if it was something that would effect my acne for until I read this article and the break downs you provided.

    So I decided, what the heck, I’d cut dairy completely for 6-8 weeks as a trial run. It wasn’t going to kill me or harm me in any manner and it was probably the easiest thing for me to cut out of my diet. I knew dietary changes may temporarily cause clearer skin, so I knew I needed to stick to it very strictly for the 6-8 weeks. After 2 weeks I saw marked improvement and it has remained that way for the last 4 months. My skin is less oily, the breakouts around my mouth, jaw, chest, and back have virtually stopped, and general under the skin build up I’ve had is clearing out, and I am much less inflamed. The build up is taking time to clear out, but that is to be expected. I still do get some breakouts, but now, because I don’t have a constant breakout I can identify direct causes, such as monthly cycle or stress. Also, when those types of breakouts happen they are less intense, less inflamed, and clear out a lot faster.

    I’ve allowed cheese back into my diet in conscious amounts (I love cheese and can’t find a decent replacement), but otherwise I no longer really consume dairy. Thanks again for this post that helped push me to finally make a move!

  95. This blog is excellant. I mainly have a constant rash like breakout along my jawline and upper neck area. I am taking amour thyroid for hypothyroidism. I have been glutenfree for over a year now because of digestive issues. I have struggled with deppression since puberty. I have never had any problems conceiving (two beautiful kids) , and I have a regular cycle. But at age 31, I still have acne!! I occasionally get the small cysts but it is mostly rash like whiteheads. My doctor recently told me that I have an intolerance to glucose and that my endocrine levels are abnormal. She of course has prescibed me a new injectable medicine for my sugar cravings. I also have been off birthcontrol about 3 months, at the time I thought that it was sunblock breaking me out. I am thinking I will go sugar and or dairy free…but I would like some suggestions…is this hormone based at all or probably just the devil sugar? And do I have to give up fruit? I lost 40lbs last year doing crossfit and gluten free…the past three months I have gained 14…too much sugary greek yogurt and chocolate and not exercising!!!!
    !!! Thanks for any advice

    • I’d probably eliminate the dairy and the sugar simultaneously… they both can cause insulin and male sex hormone levels to rise… both of which can cause acne.

      Don’t give up fruit! Even if you decide to moderate your intake you definitely don’t have to give it up.

  96. I have no idea what the intent of this article was, since it didn’t really say what’s effective for treating hormonal acne. All the things it says to keep away from (food-wise) I do and nothing has changed. I eat healthy, 90% of the time organic and cook everyday, and don’t consumer processed food at all, exercise and sleep well, but nothing has helped.

  97. Great blog!! acne mainly comes from stress and hormonal changes. harmone is a main reason to generate acne prone skin.Acne is most common among teenagers, with a reported prevalence of 70 to 87 percent.

  98. Beautiful presentation. Understanding the type of acne on one’s face is the first step to knowing how to treat them. It also saves a lot of time. Starting treatment without proper diagnosis may see someone try many different types of medications for a lengthy while.

  99. Along with my aging skin, I’ve been battling some nasty cystic acne for way too many years. I’ve also been using Citrus Clear like you mentioned – I’ve been using this daily for the last 2 weeks and all’s good! No breakouts and no dry skin. The Citrus Clear cleanser doesn’t irritate my skin. It doesn’t foam as much as I hoped it would but that’s not a deal breaker.

  100. Great article! I’ve seen so many on gut health and acne but in my experience it has been hormonal too. Since going off bc after being on it for 10 years I had really bad cystic acne around the chin/neck area. Of course bc made my skin amazing but did nothing to address my underlying hormonal imbalances from underfueling and overexercising/stress. I definitely fit into #2. I worked with a holistic practitioner over 2 years to help support hormones with cleansing, supplements, bio-identical hormones (pregnenelone, DHEA, progesterone, licorice), stress mgmt, etc. etc. but what finally kicked my cycle into working on it’s own again was a small amount of bio-identical estrogen lotion at the time I was supposed to ovulate. I did that for several months and then I was able to ovulate on my own and my acne is so much better. Still get occasional acne near my period, but for the most part it is much better.

  101. Any advice on how to treat acne while breastfeeding? I have tried everything, but my face is still broken out extensively. People stare, and I have had children ask what’s wrong with my face. It seems that my only option is to wean and take antibiotics. Any other ideas?

    Thank you for your time.

  102. How frustrating! I don’t have a low carb diet, I take birth control, I exercise regularly, and there is no way I can minimize any stress until after I finish college. I have nasty acne (not cystic) and it spikes a week before my period, so by the time they finally begin to heal, they come right back. it’s really painful and embarrassing. I have VERY oily skin, do you have a moisturizer you’d recommend that isn’t $40?

  103. Can you explain why some people recommend a supplement called Estroblock for hormonal acne?? I can’t figure out whether I should take it or not.

    • I think no. Estroblock is intended to block ‘toxic estrogens’ which is funny because estrogen is estrogen. Plus, estrogen is great for your skin. So, no. Definitely no.

  104. Thank you. I am having painful cystic acne 9 months after my last IVF cycle. I received doses of both estrogen and progesterone. I had pretty clear skin before this, now my skin gets acne. I don’t like it.
    There is something to be said about leaving your face alone. When I touch my face I seem to break out even more. Is cystic acne supposed to itch? I have eczema too. To the normal eye, my skin looks okay, but I get all up in that mirror and investigate the heck out of the breakouts.

  105. I am a 38 year old white woman. I live in the desert SW, I’m very physically active, eat a clean diet, drink plenty of water, and I’ve had acne for probably 26 years now. I have 4 children, and my skin was its clearest actually while I was pregnant, but began to break out immediately after the birth of my babies. My acne tends to be large, painful cysts, deep in my chin that can last for weeks and weeks. My face literally hurts all day long and throbs when I have a cyst. There are two things that have worked for me. Pantothen. Which is high doses of Vitamin B5 and pantothenic acid, if I recall. If you read up on this, you might decide to go this route. I had zero side effects from the Pantothen. It helps your body flush out excess oils and my face was immediately less oily when I started to use it. I don’t use Pantothen anymore, but what I have been doing, that has worked MIRACLES for me, is twice a day, I put colloidal silver on my face. I buy it in a bottle from Vitacost.com. There have been no side effects and I’ve been using this for almost 9 months. The colloidal silver kills the P. Acnes bacteria on the surface of this skin, without drying out the skin. Acne needs oil and bacteria to be produced, and by killing the acne bacteria, it’s eliminating one part of the equation. I get maybe 1 cyst a month now, compared to almost daily new ones sprouting up.
    Also, I use 100% organic, cold pressed jojoba oil and rosehip oil. You can get good ones from Leven Rose or Mountain Rose Herbs. Research how these essential oils can be beneficial for your skin at a very deep level.
    I’ve spent thousands of dollars over the years. My social life has been destroyed. Acne has controlled my life for way too long. For awhile there I was doing rhoussal clay masks mixed with Apple Cider Vinegar – which definitely deep cleans the pores and helps you purge all the gunk out, but it left my skin very dry and aged….and at almost 40, fighting aging is quite important to me!
    So, colloidal silver and essential oils are what I recommend. They may not CURE the acne from inside, but you know what….if it alleviates the problem and makes me look good and feel good with no side effects, at this point, that’s all I want. And it’s budget friendly. I no longer feel like hiding in my house or wearing makeup to run to the store, or avoiding social situations based on how my skin looks.

    • Thanks for sharing, love! Great to know about your B5s, will have to look more into that.

  106. hello I was wondering if you can help, i have developed super bad acne all over my neck, its not big cysts, its just red and sore and it wont go away. there aren’t alot of spots but it still stays the same. I was really worried about dairy & gluten etc, but I just cant think when focusing so much on food ALL the time. I do eat a lot of nuts. My diet isnt tiptop but I eat healthier than most people I know! I haven’t been diagnosed with PCOS but i have had a cyst on my ovary as i had a problem with eating. My periods are regular now, (now have the coil too) but my skin on my jawline and neck is SO bad. Can you recommend anything!


  107. Have been using Citrus Clear for just over a week. I have hormonal cystic acne and I think there is a limit to what any topical treatment can do. That said, Citrus Clear’s Control Wash seems to stop my spots getting worse and it’s very gentle on the skin, unlike some prescribed treatments. I’m pleased with the results and will keep using this, as it is the only thing I have found that does treat my spots but doesn’t make my skin dry and itchy. I would recommend this to anyone with problem acne, and over any topical treatment a doctor would prescribe.

  108. i had acne scaron my face from my child hood also. Unfortunately, Mederma does not work for my skin because it is very sensitive. I tried about 3 different facial scar screams, and the one that worked the best was the Dr Max Powers Scar Cream. I have sensitive skin, and this stuff did not itrritate it. It was easy to use every day. I have been using for one month now, and the scars are fading. My skin looks much better

  109. Pingback: Best Way Cure Hormonal Acne – Health Care

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