Hormonal acne treatment without birth control

Why hormonal acne can be treated without the pill

Hormonal acne is ordinary acne in which hormones play the bigger part, mainly androgens such as testosterone. Androgens push the oil glands to make more sebum, the oil and dead skin cells plug the hair follicle, and bacteria and inflammation turn the plug into a spot. The combined birth control pill works on the hormone levels that feed that chain, the NHS explains. Every other step can be treated directly, which is why the pill is one option among several rather than the only one.

If you want the full background first, this explainer on what is hormonal acne covers the signs and the cycle pattern in more depth.

Hormonal acne treatment without birth control: on the skin

Retinoids

Clear pores and treat blackheads, whiteheads and some pimples, and can lighten dark spots after acne. Adapalene is sold without a prescription; tretinoin, tazarotene and trifarotene need one (American Academy of Dermatology).

Benzoyl peroxide

Reduces acne bacteria and works best together with another treatment. For adults, the AAD suggests starting with a 2.5% product to avoid dry, burning skin.

Azelaic acid

Opens clogged pores, works on bacteria and calms inflammation, and also treats the dark spots acne can leave.

Clascoterone

A prescription cream and the first FDA-approved medicine that treats the hormonal causes of acne in both males and females, for moderate to severe acne from age 12 (AAD). DermNet explains that it blocks androgen receptors in the skin, which lowers oil production and inflammation.

Use one product as directed for 6 to 8 weeks before you judge it, and spread it over the whole area that breaks out rather than single spots, the AAD advises.

Hormonal acne treatment without birth control pills: spironolactone

Spironolactone is a blood pressure medicine that dermatologists have prescribed for many years to treat acne in women. When other treatments don't work, it can clear deep, tender acne on the lower face, jawline or neck, and the AAD says it can be prescribed without the pill, for example from age 35 or when a blood clot or stroke makes the pill unsafe. Women often notice fewer breakouts and less oiliness within a few weeks.

Two things to know. It is not a contraceptive, and if you could become pregnant you still need birth control while taking it, because it can cause serious birth defects (AAD); the NHS says it is not usually recommended in pregnancy. And it is not used for acne in men, because of side effects such as breast growth. Your dermatologist will order blood tests before you start and see you every 4 to 6 weeks while the dose is raised.

Other prescription options

• An oral antibiotic for moderate to severe pimples, prescribed for the shortest time needed, usually several months, and always with another medicine such as benzoyl peroxide (AAD).
• Isotretinoin for nodular acne that hasn't responded to other treatment. People who can become pregnant must take extra precautions, including pregnancy tests and a monitoring program, so it is not an option that avoids contraception.
• In-office help: a corticosteroid injection for one large, painful breakout, a chemical peel, or laser and light treatment for mild to moderate acne.

Hormonal acne treatment for men

For men, hormonal acne treatment without birth control is simply the standard plan, with the same skin options: retinoids, benzoyl peroxide, azelaic acid and clascoterone, which is approved for males as well as females. Spironolactone is the exception, since the AAD says it is generally only a treatment for women. For severe or scarring acne, an antibiotic or isotretinoin from a dermatologist is the usual next step.

Food and daily habits alongside treatment

Diet will not replace treatment, but it can sit next to it. The AAD says small studies suggest a low-glycemic diet may reduce acne, though other studies found no link, and some studies tie cow's milk to more breakouts, while no studies have found that yogurt or cheese do. For meal ideas built on these findings, this guide to a hormonal acne diet turns them into everyday plates without strict rules.

With PCOS, MedlinePlus notes that anti-androgen medicines can help with acne and extra hair growth, but they can cause problems in pregnancy, so a provider may pair them with birth control. That makes a doctor's visit the right first step if you also have irregular periods or new facial or body hair.

Choosing between the options

Start with one skin treatment and give it time; most hormonal acne treatment without birth control begins there. If breakouts are deep, keep coming back along the jaw, or leave marks, see a dermatologist about clascoterone or spironolactone. Not sure your breakouts follow a hormonal pattern at all? A photo analysis of your skin can point to the likely cause.

Back to the hormonal acne guide