Hormonal vs. Bacterial Acne: Here's How to Tell Which Type You Have

Pretty much everyone experiences an irritating bout of acne at at least one point or another—it's one of those inevitable things in life. But for some, acne can be a frustratingly common occurrence. If you're one of those people who can't seem to calm your breakouts no matter what you try, one step that can be really helpful is knowing what causes your acne to flare up in the first place.

All sorts of factors—like shifts in hormone levels, bacterial buildup in your pores, and even inflammation—can cause acne flare-ups. To help you get to the bottom of any issues that you're experiencing, we reached out to three board-certified dermatologists to find out how to tell if acne is hormonal or bacterial. Keep reading to learn all about hormonal vs. bacterial acne, so you can figure out which you have and find a targeted treatment.

What Is Hormonal Acne?

Hormonal acne is triggered by hormonal fluctuations that happen at various times throughout life, such as ovulation, menstruation, pregnancy, menopause, or if you have a medical condition like polycystic ovary syndrome (PCOS).

Hormonal acne often appears as deep red and tender cysts. It's very common in the lower parts of the face, so you might notice it along your jawline, chin, neck, or cheeks.

"Hormonal acne is caused by the skin’s sensitivity towards male dominant hormones called androgens—testosterone being a major culprit," Shirazi says. "Androgens stimulate oil glands to overproduce oil, which feeds acne-causing bacteria, causing them to overgrow [and] clog pores."

What Is Bacterial Acne?

Bacterial acne isn't exactly a true form of acne on its own, but acne can be caused by a combination of bacterial overgrowth, inflammation, and increased sebum production, Madfes says.

Shirazi explains that bacterial acne is an inflammatory reaction surrounding the pores and hair follicles, caused by a combination of bacteria and other factors. "Fungal and bacterial organisms are normal skin inhabitants and make up our natural skin microbiome, similar to the gut microflora," she says. "When there's an imbalance or disruption of that microbiome climate, it triggers acne."

How to Tell if Acne Is Hormonal or Bacterial

Start by considering if there are any patterns to when your acne is at its worst. If your acne tends to flare at certain points during your menstrual cycle or at other moments when your hormones could be imbalanced, then there's a good chance you're dealing with hormonal acne.

"A lot of acne is caused by hormonal imbalances, but occasionally the condition is made worse by bacterial problems, which can manifest as blackheads, lumps that resemble cysts, or obstructions in your hair follicles," Chacon says. Ultimately, the best way to determine what type of acne you're dealing with is to see your dermatologist. This will give them a chance to see your acne, conduct a thorough exam, and learn your medical history.

Your dermatologist also might suggest a blood test to learn more about your hormone levels, and/or they might look into the composition of bacteria that's in your pores. "Studies highlight the importance of maintaining a balanced microclimate," Shirazi says. "If you have bad bacteria that’s counteracted by good bacteria, then it keeps the bad guys in check and prevents bacterial acne. Hormones play a role, as they also influence the microclimate."

Treatment Options

To treat acne, you have a lot of options. Some of these include topical anti-inflammatory medications, birth control pills, retinoids, oral and topical antibiotics, glycolic acid, salicylic acid, and benzoyl peroxide.

Treating Hormonal Acne

If you discover your acne is hormonal, the good news is that's the first step towards finding the treatment that works best for you. A few of the most common options, some of which may work together in one regimen, are below.

• Birth control pills: Beyond their namesake ability to prevent pregnancy, birth control pills can help stabilize your hormone levels and reduce testosterone. Derms routinely prescribe them for acne and period regulation for this reason.
• Spironolactone: This medication, which is often used as a diuretic for various health issues, is sometimes prescribed to stabilize hormones and reduce testosterone levels. "Spironolactone is a water pill but works great for hormonal acne by preventing androgens like testosterone from stimulating oil production, which means fewer clogged pores and acne-causing bacteria," Shirazi says.
• Consistency in your skincare routine: Your overall skincare routine is important and allows your skin to better manage hormonal fluctuations. Chacon suggests washing your face each day in the morning and evening and using sunscreen daily. "Any acne product should only be used in a pea-sized quantity," she says. "Applying too much might irritate and dry up your skin." 
• A simple routine and moisturizer: Consider keeping your skincare regimen simple, too. "Don’t overdo it with too many products, and moisturize regularly to maintain a healthy skin barrier," Shirazi says.
• Non-comedogenic products: Consider sticking to non-comedogenic products if you want to reduce your chances of having blocked pores, Chacon says.
• Topical treatments: Consistently using topical medications like retinoids and benzoyl peroxide, as well as exfoliants like salicylic acid, can keep inflammation levels down and prevent clogged pores and bacterial overgrowth.
• Lifestyle factors: Dermatologists also recommend paying attention to lifestyle factors like getting enough sleep each night, keeping stress to a minimum, drinking lots of water, and trying not to consume too much dairy or sugar if it seems to exacerbate your acne. "Recent studies show dairy can potentially worsen acne flares by stimulating testosterone in some people," Shirazi tells us. "The worst culprit, surprisingly enough, is fat-free dairy and skim milk because removing the fat from dairy concentrates causes them to absorb faster, resulting in hormonal spikes that trigger acne."

Treating Bacterial Acne

Bacterial acne requires a slightly different treatment approach from hormonal acne, but you still have options. Check a few out below.

• Benzoyl peroxide: This common acne-fighting ingredient is a powerful antiseptic that kills bacteria and helps remove buildup in pores, Shirazi tells us.
• Retinoids: These can help by blocking different inflammatory pathways involved in bacterial acne, Shirazi says. They also help renew the skin, remove pore-clogging buildup, kill acne-causing bacteria, and reduce excess oil production. While the most powerful retinoids are available by prescription only, you also have over-the-counter options, such as Differin.
• Antibiotics: Sometimes, antibiotics are the right option to treat bacterial acne. "There are times when the inflammation is deep and more severe [and] therefore acne-specific antibiotics such as doxycycline or seysara are necessary to not only reduce the bacteria, but also reduce the inflammation," Shirazi says.

What About Fungal Acne?

Fungal acne is often confused with bacterial and hormonal acne. It technically isn't acne, but instead is an inflammation and infection of the hair follicles caused by a type of fungi or yeast called malassezia. A common name for this condition is pityrosporum folliculitis, and it causes small, red, and itchy bumps on the forehead or temples. Treating fungal acne involves topical and oral antifungals, Madfes tells us.

The Final Takeaway

A combination of factors can cause acne, including hormones, bacterial buildup, and inflammation. Hormonal acne tends to flare based on hormonal fluctuations, so it might be worse at various points of your menstrual cycle as well as during pregnancy or menopause. Bacterial acne is usually related to inflammation, excess sebum production, and an imbalance of the skin microbiome. Whether you have hormonal or bacterial acne, it's helpful to know what's causing it in the first place so you can explore the right treatment options.