Hormonal Acne vs. Other Types: How to Tell the Difference

I meet a lot of people at the end of their tether when it comes to their acne during my consultations. Something I hear again and again is “I’ve tried everything, but nothing works.” They’ve spent hundreds on trying different skincare, upped their medications from the GP over and over, tried cutting out dairy, or maybe it’s meat, or maybe it’s eggs - who knows?! It’s incredibly frustrating and disheartening.

Really, the answer lies in identifying the type of acne they have and treating it appropriately - often from the inside out. 

Most people assume acne is just one condition but there are actually several different types, each with their own causes and behaviours. That means that the way we approach them needs to be just as individual.

In this blog, I want to help you understand how hormonal acne differs from other common types, and why figuring this out can make all the difference when it comes to supporting your skin long term.

What Hormonal Acne Actually Is

Hormonal acne is something I work with a lot and it’s incredibly common, even though it’s often misunderstood or misdiagnosed.

It’s caused by internal hormone shifts, usually involving androgens like testosterone, fluctuations in oestrogen or progesterone, stress hormones like cortisol, or even insulin. It’s not limited to teenagers - in fact, most of my clients with hormonal acne are in their 20s, 30s, or 40s.

It’s particularly common after coming off the pill, during puberty, in those with PCOS, or when stress and blood sugar are out of balance.

From my experience, hormonal acne tends to appear as deep, sore breakouts around the lower face, especially the chin, jawline and neck. These breakouts often feel like they’re “under the skin” and can take longer to heal. Many of my clients describe them as the kind of spots that hurt to touch and never really form a head.

Skincare can help to manage these breakouts, but it rarely addresses the root cause which is why they often keep coming back until we look at what’s going on internally.

Other Types of Acne (and How They’re Different)

Of course, not all acne is hormonal. Here are a few other types I see often, and how they tend to behave differently:

• Bacterial acne is usually more superficial - things like whiteheads or pustules. It often responds well to topical products and is typically triggered by bacteria like C. acnes. You’ll often find it on the cheeks, forehead or back, and it’s more reactive to makeup, heavy skincare, or not cleansing properly.

• Fungal acne isn’t technically acne at all, but it mimics it. This tends to show up as small, itchy, uniform bumps often on the forehead or body, and doesn’t improve with acne treatments. In fact, some conventional products can make it worse.

• Congestive acne is mostly made up of blackheads, whiteheads and under the skin bumps. It’s common in people using rich skincare, wearing heavy makeup, or not exfoliating effectively. This kind of acne often improves with a simple, consistent routine and non-comedogenic products.

• Stress related acne is something I see all the time. When we’re under pressure, cortisol (our stress hormone) goes up which can trigger more oil production, inflammation, and slower skin healing. Many clients notice their skin breaking out during exams, deadlines, or busy emotional periods.

• Diet related acne is a big one. Blood sugar spikes, dairy sensitivity, or an inflammatory diet can all lead to flare ups. I often see this type improve significantly when we look at nutrition, gut health and hormone support. Not from cutting everything out, but by adding in the right things.

Signs Your Acne Might Be Hormonal

If you're not sure which category your acne falls into, here are a few patterns I look for when assessing whether breakouts are hormone driven:

• Breakouts mostly around your jawline, chin or neck

• Deep, sore spots that don’t come to a head

• Flare ups that happen around the same time each month

• Acne that got worse after stopping the pill

• Little to no improvement from topical products

• Oily skin that feels like it’s constantly congested

• Other hormone related symptoms, like irregular periods, mood swings, fatigue, or changes in hair growth

When I see several of these show up at once, it’s a strong indicator that hormones are playing a key role and that we need to take a more internal, functional approach.

Why Getting the Right Diagnosis Changes Everything

One of my clients, a woman in her late twenties, came to me after a long cycle of antibiotics and topical treatments from her GP that only ever worked short term. Every time she stopped them, her skin flared up again. After a proper assessment, we found that her acne was deeply hormonal and linked to blood sugar imbalances and post pill hormone fluctuations. No amount of spot cream was ever going to address that.

This is why it's so important to understand what your skin is really trying to tell you. Because using the wrong approach, whether that’s stripping your skin with harsh actives or taking medication you don’t really need, can often do more harm than good.

What Support Looks Like at MW Skin Studio

My approach to acne is unique for everyone. Whether you’re dealing with hormonal acne, congestive breakouts, or aren’t sure yet, we’ll work together to understand what your skin needs.

In a Virtual Skin Consultation, we’ll look at your acne type, medical history, menstrual health, nutrition, stress levels and lifestyle. From there, I’ll create a bespoke Skin Plan to guide you forward with practical, realistic support every step of the way.

If you’re ready for deeper, root cause work, my 12 Week Programme is the most comprehensive way to address chronic acne. It includes functional blood analysis, check-ins, supplement and skincare protocols, and a fully supported plan to calm your skin from within.

You Don’t Have to Guess Anymore

If you’ve been stuck wondering why your skin won’t settle, or if you’re using the right products or treatments, please know that it’s okay to ask for help.Acne is complex, but it’s not random. When we understand your type, we can finally start giving your skin what it truly needs.

Book a consultation online with me here.

Explore the 12 Week Programme here.

Let’s figure it out together - properly this time.