How do I know if my acne is hormonal or stress?

Acne is a common skin condition that affects people of all ages. It can be frustrating trying to figure out what's causing your breakouts. Two of the most common culprits behind acne are hormones and stress. But how can you tell if your acne is hormonal or stress-related? Here's what you need to know.

What Causes Acne?

Before diving into hormonal and stress acne, let's review what causes acne in general. Acne forms when hair follicles get clogged with excess oil and dead skin cells. This allows bacteria to build up inside the follicle, leading to inflammation and breakouts.

The main factors that contribute to acne include:

• Excess sebum (oil) production
• Buildup of dead skin cells
• Bacteria growth
• Inflammation and swelling

Anything that leads to changes in these factors can trigger acne. Hormones and stress are two big contributors. Keep reading to learn how they impact acne differently.

How do hormones cause acne?

Hormones, especially androgens like testosterone, stimulate oil glands and affect acne development. Hormonal changes related to puberty, menstruation, pregnancy, menopause, and other factors can trigger acne. Here's how:

Puberty

Acne often starts during puberty because hormone surges spur oil production. Teen acne is typically worst around the beginning of periods.

Menstrual cycle

Right before your period, progesterone levels peak while estrogen dips down. This imbalance can increase oil production and worsen breakouts.

Many women experience premenstrual acne flares or “period pimples” due to these monthly hormonal shifts.

Pregnancy

Pregnancy brings major hormonal changes that expand oil glands and boost sebum production. Acne often flares up during the first trimester.

Menopause

As estrogen levels decline in menopause, androgens become more dominant. This can trigger acne in middle-aged women.

Medical conditions

Medical conditions like polycystic ovarian syndrome (PCOS) and adrenal hyperplasia cause hormonal imbalances that spur acne.

Medications

Certain medications like corticosteroids, anabolic steroids, and lithium can alter hormone levels and lead to acne.

Signs your acne is hormonal

If hormones are behind your breakouts, you may notice these characteristics:

• Flares before/during periods
• Persistent jawline and chin breakouts (along the "hormonal zone")
• Deep, tender cysts and nodules rather than whiteheads/blackheads
• Breakouts improve with oral contraceptives or anti-androgens
• Acne onset or flares during hormone-changing events like pregnancy, menopause, etc.

What about stress acne?

Stress impacts our bodies in complex ways. While stress alone doesn't cause acne, it can worsen factors like oil production and inflammation. Here's what happens:

Our bodies release cortisol and other stress hormones. These ramp up oil production which can clog pores. Stress also sparks inflammation, making breakouts redder and more painful.

High stress weakens the immune system. This allows acne-causing bacteria like P. acnes to overgrow and trigger breakouts.

Stress leads to unhealthy behaviors like poor sleep, eating inflammatory foods, and picking/touching the skin. This can all worsen acne.

Signs your acne is stress-related

If stress is behind your acne, you may notice:

• Breakouts during stressful life events – new job, exams, trauma, etc.
• Acne improves when stress is reduced with relaxation techniques
• More inflammatory acne – red, painful pimples rather than non-inflamed blackheads/whiteheads
• Increased picking and touching that spreads breakouts
• Flares across the face rather than only in the “hormonal zone”

Can it be both hormonal and stress acne?

For many of us, it's not completely one or the other. Hormones and stress often interact to worsen acne.

For example, high stress levels disrupt hormone balance. This hormonal imbalance then triggers breakouts.

Plus, fluctuating hormone levels during events like PMS and menopause cause increased sensitivity to stress.

The hormonal and stress response systems are interconnected in complex ways. As a result, hormonal acne can be aggravated by stress, and vice versa.

How can you tell the difference?

While hormonal and stress acne may overlap, there are some key differences:

Location

• Hormonal acne shows up along the jawline and chin area.
• Stress acne appears more randomly all over the face.

Timing

• Hormonal acne follows a monthly pattern or flares during hormonal events.
• Stress acne crops up during stressful times then fades when stress decreases.

Types of breakouts

• Hormones trigger more deep, cystic breakouts.
• Stress leads to a mix of inflamed pimples, whiteheads and blackheads.

Other symptoms

• With hormonal acne, you may have other signs like irregular periods or thinning hair.
• Stress acne may be accompanied by headaches, insomnia, fatigue, irritability.

Root cause differences

• Hormonal acne is driven by internal hormonal factors you can’t control.
• Stress acne is often caused by external lifestyle triggers that can be changed.

Paying attention to these nuances can help clue you into whether hormones or stress play a bigger role in your breakouts. But when in doubt, seeing a dermatologist is your best bet.

When to See a Dermatologist

Wondering if you should make a dermatology appointment? Consider it if you have:

• Moderate to severe acne that hasn’t improved with over-the-counter products
• Painful cysts or nodules
• Acne leaving scars or pigmentation
• Confusing symptoms where the cause is unclear

A dermatologist has the expertise to diagnose your acne type, rule out underlying conditions, and create a tailored treatment plan.

They may order blood tests or take a medical history to determine whether hormones are contributing to your breakouts. If so, they can offer hormone-regulating medications.

For stress acne, they can suggest lifestyle changes while also providing professional skin treatments to clear up the damage.

Getting properly diagnosed is key to finding your best acne treatment option.

Lifestyle Tips to Improve Hormonal and Stress Acne

While you’re waiting for your dermatology appointment, there are some general healthy habits that can improve acne from hormonal and stress causes. Try these tips:

Reduce sugar and refined carb intake: A diet high in sugar and refined carbs hikes insulin levels, which increases oil production and inflammation. Cutting back may improve acne.

Take targeted supplements: Supplements like omega-3s, zinc, vitamin D, and adaptogenic herbs can balance hormones and manage stress levels. Ask your doctor if any are right for your needs.

Lower stress levels: Practice daily de-stressing techniques like breathwork, meditation, journaling, yoga, or listening to music. Make time for relaxing hobbies too.

Get enough sleep: Poor sleep increases cortisol and throws off hormone balance. Aim for 7-9 hours per night, and adopt good sleep habits like limiting screen time before bed.

Stay hydrated: Drink plenty of water throughout the day. Dehydration can impair hormones and worsen acne.

Workout regularly: Regular exercise reduces stress hormones and rebalances hormones. However, intense workouts can spike cortisol and testosterone, worsening breakouts.

Avoid irritants: Overwashing, scrubbing, and using harsh ingredients will worsen irritation. Stick to gentle face wash and non-comedogenic moisturizer.

While these tips won’t cure hormonal or stress acne overnight, they can help get to the root of what’s causing your breakouts. Be patient and consistent with lifestyle changes while exploring medicated treatments too.

Professional Treatments That Can Help

For moderate to severe cases of hormonal or stress acne, professional treatments are often needed in addition to lifestyle measures. Here are some options to discuss with your dermatologist:

Oral contraceptives: Birth control pills like Ortho Tri-Cyclen and Estrostep help balance hormones and are FDA approved for acne treatment.

Androgen blockers: Spironolactone, flutamide, and cyproterone acetate block androgens like testosterone to reduce hormonal acne, especially in adult women.

Retinoids: Prescription retinoids like tretinoin (Retin-A, Retin-A Micro, Renova) regulate oil production and exfoliate clogged pores.

Antibiotics: Oral antibiotics like doxycycline and tetracycline work by reducing inflammation-causing bacteria. Often used short-term along with topical treatments.

Corticosteroids: Injections like cortisone shots help shrink large, painful cysts and nodules by reducing inflammation. Results are temporary so frequent use is limited.

Light and laser treatments: Photodynamic therapy, blue light therapy, and pulsed dye lasers destroy acne-causing bacteria while shrinking oil glands. Often used alongside other acne treatments.

Chemical peels and microdermabrasion: These professional treatments remove dead skin to keep pores from getting clogged while also decreasing acne marks and scars.

Stress management counseling: Getting counseling from a therapist, psychologist, or other mental health professional can help develop healthy stress coping strategies.

Discuss any concerns and medical history openly with your dermatologist so they can recommend the safest, most effective treatments for your situation. Be patient as it may take some trial and error.

The Takeaway

Figuring out if acne is hormonal or stress-related – or both – can be tricky. There’s often overlap. By paying close attention to timing, location, and types of breakouts, you can start piecing together the puzzle. An experienced dermatologist can help confirm whether hormones or stress play a bigger role.

While the root cause differs, there are shared lifestyle measures like a healthy diet, stress relief, and exercise that benefit both hormonal and stress acne. Professional treatments can also be tailored to address the specific factors driving your breakouts.

With consistent care of both your skin and overall health, you can get to the bottom of your acne issues and craft an effective treatment plan. Don’t hesitate to reach out to a dermatologist, who can help diagnose the cause and find solutions to clear up your acne once and for all.

Frequently Asked Questions About Hormonal and Stress Acne

What's the difference between hormonal and stress acne?

The main differences are the location of breakouts, timing, and root causes. Hormonal acne appears along the lower face/jawline, follows a monthly pattern, and is driven by internal hormonal changes. Stress acne occurs randomly all over, flares during stressful times, and results from external lifestyle factors raising cortisol.

Can hormonal acne appear after stopping birth control pills?

Yes, some women experience “post-birth control acne” after stopping oral contraceptives. The pill suppresses natural hormonal fluctuations. So when you stop taking it, androgens can rebound and overproduce oils, leading to breakouts.

Does pregnancy acne go away after giving birth?

Pregnancy acne is common during the first trimester as hormone levels rapidly change. Breakouts usually improve in the second and third trimesters as hormones stabilize. After delivery, it takes 6 weeks to 3 months for hormones to balance back out and acne to clear up.

How are hormones and stress connected to cause acne?

High stress levels disrupt your endocrine system, causing spikes in cortisol and other hormones like testosterone that increase oil production and inflammation. Stress also triggers unhealthy behaviors like poor diet, lack of sleep, and skin picking that worsen acne.

Can vitamins or supplements help hormonal acne?

Certain supplements may help balance hormones naturally. Omega-3 fatty acids can reduce testosterone and regulate menstrual cycles. Chasteberry provides mild progesterone-like effects. Saw palmetto blocks testosterone receptors. Always check with your doctor before taking new supplements.

Does stress make all types of acne worse?

Stress doesn’t directly cause acne, but it can worsen underlying acne that’s already present for multiple reasons. Stress hormones like cortisol increase oil production, inflammation, and sensitivity to androgens. Plus stress weakens immunity and leads to unhealthy behaviors that exacerbate acne.

Can food trigger hormonal acne?

Diet doesn’t directly cause hormonal acne, but eating high glycemic foods like refined carbs and sugars can worsen it. They trigger inflammation and meddle with insulin, a hormone that influences testosterone activity and oil production. A healthy, anti-inflammatory diet improves hormonal balance.

How can you tell if your acne is fungal?

Signs your acne may be fungal include itchy red bumps/pustules on the forehead, cheeks, and jawline. Fungal acne often resists traditional acne treatments. See a dermatologist to diagnose fungal acne, which requires different medications like antifungal creams or oral antifungals.

Can natural treatments help stress acne?

Reducing stress through natural relaxation techniques like meditation, yoga, deep breathing, biofeedback, or aromatherapy may calm the stress response and improve stress-triggered acne. Massage and spending time in nature are other ways to naturally destress.

When should you consider prescription treatments?

See a dermatologist about prescription options if you have severe, persistent acne or if over-the-counter washes, gels, creams etc haven’t controlled your breakouts after 2-3 months. Moderate to severe hormonal and stress acne often requires prescription strength topical or oral medication.