Written and medically reviewed by Dr Gerard Ee (MBBS, MRCS, Diploma in Practical Dermatology, Cardiff). I am the Founder and Medical Director of The Clifford Clinic. I have spent more than 14 years treating acne, and I was among the first doctors in Singapore to use AGNES and AviClear. The opinions in this article are my own clinical views, shared to help you make sense of your options. This article is for general education and does not replace a personal consultation. Last reviewed: June 2026.
Acne is not one condition, and hormonal acne is one of the patterns seen most often in adult women. It does not behave like teenage acne, which is exactly why the routines that once worked stop working. The approach starts with recognising the hormonal pattern, then deciding whether the driver itself needs to be addressed, rather than treating the surface alone.
My quick answer
Hormonal acne in women typically appears along the jawline, chin and neck, flares before menstruation and is driven by the skin’s sensitivity to hormones. Hormonal acne is not caused by skincare or by hygiene. Treatment starts with an accurate diagnosis and proper prescription topical skincare and may include targeted treatments such as AGNES RF or AviClear. If there are signs of an underlying condition such as PCOS, I would recommend further medical evaluation.
What I look for during your consultation
The history covers the timing of breakouts in relation to the cycle, menstrual regularity, and any other signs of a hormonal imbalance such as excess hair growth or sudden severe acne. Diet matters, including dairy and whey protein, which in my experience trigger breakouts in many people, along with stress and sleep, which both influence hormonal acne. Where the lesions sit and how deep they are is noted. The full picture, rather than any single sign, points towards a hormonal driver.
How I classify hormonal acne
Hormonal acne tends to favour the lower face, particularly the jaw and chin and worsens cyclically around the period. The lesions are often deeper and more tender than simple surface bumps. It is distinguished from comedonal acne, which is mainly blocked pores and from straightforward oily acne because hormonal acne is driven from the inside and frequently resists the products that clear other types.
When a woman tells me her breakouts sit along the jaw and flare before her period and that nothing she tries hellps, I start thinking about a hormonal driver. If there are also irregular periods or other signs of androgen excess, I will suggest looking into PCOS rather than just treating the skin. Treating the surface without addressing the driver is why so many people feel they are running in circles.
When I would consider treatment
Hormonal acne is treated actively, because it carries a real risk of deeper, scarring lesions. Medical skincare is the foundation. Where the acne keeps returning to the same areas, AGNES can shrink the specific overactive glands, and where the skin is generally oily AviClear suits better. Where a clear hormonal driver is present, management of that driver is coordinated as part of the plan. Marks left behind are treated later, with Vbeam for redness and Q-Switch for brown pigment.
When I would look deeper or refer
It would be a mistake to simply keep treating the skin if there are clues of an underlying hormonal condition. Irregular or absent periods, excess hair growth, unexplained weight change and sudden severe acne are reasons to investigate further, which may include blood tests and referral to a gynaecologist or endocrinologist. Addressing an underlying condition such as PCOS often makes the skin much easier to treat and it is not something to overlook.
Common mistakes I see
The most common mistake is months of facials and extractions, which do nothing for a problem driven from the inside. The second is ignoring diet triggers such as dairy, sugar and whey protein, which are worth attention without becoming a source of anxiety. The third is treating the surface for a year while never investigating a possible hormonal cause. And as always, squeezing deeper lesions only raises the risk of scarring.
What you can realistically expect
Hormonal acne rarely clears overnight. Skincare and targeted treatments take several weeks to work, and where a hormonal driver is being managed, improvement is usually gradual over a couple of months before it consolidates. This is normal. The most common reason for failure is stopping too early or switching approaches before any has had time to work, so I set clear checkpoints and adjust if they are not being met.
Treating the marks hormonal acne leaves
Because hormonal acne is often deep and inflamed, it tends to leave marks. These are usually flat red or brown marks rather than true scars, meaning there is no change in skin texture. Once the active acne is controlled, the marks can be treated, with Vbeam for redder marks and sensitive skin and Q-Switch for browner pigmentation. If genuine scarring has developed, I build a separate scar plan once the acne has settled, since active acne is always treated before scars. Protecting the skin from the sun with a light, non-comedogenic product helps prevent brown marks from darkening while they are being treated.
When to see a doctor
See a doctor if your breakouts cluster along the jaw and chin, flare before your period, and resist the routines that work for others, especially if there are signs such as irregular periods. Hormonal acne can persist for years and often does not settle without treatment and because it can scar, active treatment is usually advised rather than waiting.
Frequently asked questions
How do I know if my acne is hormonal?
Hormonal acne typically sits along the jawline and chin, flares before your period, and resists routines that work for other types. A consultation that includes history taking is the most reliable way to confirm it.
Does hormonal acne mean I have PCOS?
Not necessarily. PCOS is one possible cause. Clues such as irregular periods, excess hair growth and sudden severe acne may prompt further evaluation, but only proper assessment can confirm it.
What is the best treatment for hormonal acne?
It depends on the pattern. Medical skincare is the foundation, with AGNES for recurring localised lesions and AviClear for diffuse oily skin. If a hormonal condition is found, treating it makes the skin easier to manage.
Will hormonal acne go away on its own?
It can persist for years and often does not settle without treatment. Because it can scar, active treatment is usually advised.
Why hormonal acne resists ordinary routines
Hormonal acne is driven from the inside, by the skin’s sensitivity to hormones that fluctuate through the menstrual cycle. This is why it behaves so differently from teenage or comedonal acne, and why the cleansers and spot treatments that clear surface acne make little difference to it. The breakouts are often deeper, more cyclical and more persistent and they cluster where the skin is most hormonally responsive, along the jaw, chin and neck. Because the trigger sits below the surface, the most effective control often comes from calming that trigger as well as treating the skin, which is precisely the part that so many over the counter routines miss entirely.
Diet, stress and sleep
Several everyday factors influence hormonal acne and are worth attention. In my experience dairy, sugar and whey protein trigger breakouts in many people, and reducing them can help, without turning eating into a source of fear. Stress raises hormones that worsen acne, and poor sleep does the same, so both are genuinely worth managing alongside treatment. None of these replace medical care, but they make the overall picture easier to control. Ignoring them is a common reason progress stalls even when the clinical treatment is sound.
What the evidence shows
Hormonal treatment of acne in women is well supported by clinical evidence. Spironolactone, an oral medicine that blocks the effect of male-type hormones on the oil glands, has been shown in placebo-controlled research to improve persistent acne in adult women, with the benefit building over several months. The combined contraceptive pill is also an established option, shown to reduce acne over time, and clinical comparisons suggest that while antibiotics may work a little faster at first, hormonal treatment catches up over a few months. Clascoterone, a newer cream that blocks the same hormonal signal directly in the skin, has been shown in trials to outperform its inactive base and can be used in both women and men. Which of these suits a particular person depends on their health, their history and whether they are planning a pregnancy.
How hormonal treatments are used and monitored
Each hormonal option is used a little differently. Spironolactone is usually started at a low dose and increased gradually if it is well tolerated, and because it can affect fluid balance and potassium, blood pressure and simple monitoring are considered, especially at higher doses. It can make periods irregular, which is one reason it is often paired with a contraceptive pill, and it is not used in pregnancy. As an anti-androgen it has been found to work about as well as oral antibiotics for many women, without adding to antibiotic resistance, which is part of its appeal as a longer-term option. The combined pill needs the right formulation for acne and is avoided in women with certain risks, such as a history of clots or migraine with aura, so a proper health review comes first. Clascoterone cream is applied twice a day and is generally very well tolerated, which makes it a useful option for people who prefer to avoid, or cannot take, oral hormonal treatment.
Because hormonal acne can be a clue to an underlying condition, I look for signs of polycystic ovary syndrome, such as irregular periods, excess hair growth or sudden severe acne, and arrange the right tests or referral when they are present. Treating any underlying driver often makes the skin far easier to control, and it is the part of the picture that surface treatments alone can never reach.
Get to the root of jawline and premenstrual breakouts.The Clifford Clinic, 50 Raffles Place, Singapore Land Tower. Call (65) 6532 2400 or WhatsApp (65) 8318 6332 to arrange a consultation.
Related reading
- Acne Treatment Singapore: How I Choose (Dr Gerard Ee)
- Hormonal Acne in Women (Dr Gerard Ee)
- PCOS and Acne (Dr Gerard Ee)
- Hormonal Therapies for Acne (Dr Gerard Ee)
- AviClear (Dr Gerard Ee)
- Acne Treatment Singapore
References
- HealthHub Singapore. Acne. https://www.healthhub.sg/a-z/diseases-and-conditions/acne
- American Academy of Dermatology. Guidelines of care for the management of acne vulgaris. https://www.aad.org/member/clinical-quality/guidelines/acne
- Acne vulgaris. https://dermnetnz.org/topics/acne
- Spironolactone for acne in adult women: randomised controlled trial. BMJ. https://pmc.ncbi.nlm.nih.gov/articles/PMC10599794/
- Combined oral contraceptive pills for treatment of acne. Cochrane Review. https://www.cochrane.org/evidence/CD004425_effect-birth-control-pills-acne-women
- Antibiotics versus oral contraceptives in acne vulgaris: meta-analysis. J Am Acad Dermatol. PubMed. https://pubmed.ncbi.nlm.nih.gov/24880665/
- Topical clascoterone cream for acne: phase 3 randomised clinical trials. JAMA Dermatology. https://jamanetwork.com/journals/jamadermatology/fullarticle/2765025
- Management of acne vulgaris: a review. JAMA. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2021.17633
- Hormonal Acne in Women (Dr Gerard Ee) https://drgerardee.com/hormonal-acne-in-women/
Medical disclaimer: This article is for general education and does not replace an in-person consultation. Treatment suitability, results and risks vary between individuals. Please speak with a qualified doctor before starting any acne treatment.
