For some women, persistent acne stems from an overproduction of hormones called androgens. Excess androgens stimulate oil glands, leading to breakouts. Doctors may suspect hormonal acne if it appears for the first time in adulthood, flares up before menstruation, or is accompanied by irregular cycles, excessive hair growth (hirsutism), or elevated androgen levels.
Hormonal therapy might be recommended for adult women and teenage girls whose acne resists antibiotics or topical retinoids. Once identified as hormonally influenced, treatment often involves a combination of therapies. Consult your doctor before starting any new treatment.
Oral Contraceptives: Birth control pills, containing estrogen and progestin, are commonly prescribed for hormonal acne. Low-dose estrogen helps suppress androgen production in the ovaries. Newer progestin agents are less androgenic than older versions. While only some are FDA-approved for acne, experts agree that low-dose contraceptives generally improve acne. Consult your gynecologist for the right formula. Some women may experience melasma (skin discoloration), which can be treated with topical bleaching agents.
Anti-Androgens: Doctors may prescribe anti-androgens alongside oral contraceptives. These drugs inhibit androgen production and prevent existing androgens from causing excessive oil production. Spironolactone, a blood pressure medicine with anti-androgenic properties, is effective for acne. Side effects can include breast tenderness, menstrual irregularities (if not on oral contraceptives), headache, and fatigue. As a diuretic, it may cause frequent urination.
Important Note: Spironolactone is teratogenic and can feminize a male fetus. Use another form of birth control if sexually active and not taking oral contraceptives.
Corticosteroids: Small doses of corticosteroids like prednisone may reduce inflammation and suppress androgen production. However, corticosteroids can sometimes worsen acne, so they are most effective when combined with oral contraceptives.
If you suspect hormonal acne, consult your doctor promptly. It requires a different treatment approach but is highly treatable.
For moderate to severe acne, doctors may prescribe topical remedies and oral antibiotics. Common oral antibiotics include tetracycline, minocycline, doxycycline, and erythromycin.
How Antibiotics Work for Acne
Like benzoyl peroxide, antibiotics reduce breakouts by curbing the production of P. acnes bacteria and decreasing inflammation. This process takes time, so be patient. Acne isn’t “cured” when breakouts subside; the medication is working. If you stop taking it, acne will likely return. Doubling the dose won’t speed up clearing; it may increase irritation and slow progress. Taking oral medications more often than prescribed won’t help and increases the risk of side effects.
Where to Get Antibiotics
Consult a dermatologist for moderate to severe acne. Discuss your options and allow treatment time to work. Keep your doctor informed of your progress so they can adjust the treatment if needed. Don’t stop taking medication without your doctor’s approval.
Common Antibiotic Side Effects
Side effects may include photosensitivity (increased sunburn risk), upset stomach, dizziness, hives, lupus-like symptoms, and skin discoloration. Some women experience vaginal yeast infections, treatable with over-the-counter or prescription antifungals. Tetracycline is not prescribed for pregnant women or children under 12 because it can discolor developing teeth. Doxycycline is also used for Lyme disease, so long-term use could theoretically lead to resistance.