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From the Treatment Room: A Derm Nurse's Take on Hormonal Acne

Writer's picture: Terri MillerTerri Miller



As I sit here on a quiet Sunday evening, reflecting on another busy week in the dermatology clinic, I can't help but notice a common thread in many of my recent patient conversations: hormonal acne struggles. Just this past week, I saw everything from a stressed college student dealing with painful cystic acne to a new mom experiencing postpartum breakouts. Let me share what I've learned from the treatment room and the real solutions that have worked for my patients.


What I'm Seeing in the Treatment Room

This week was particularly eye-opening. Sarah*, my first patient on Monday, came in frustrated with deep, painful chin acne that flares up like clockwork every month. Then there was Michelle*, a high-powered executive who developed adult acne after coming off birth control. Their stories might sound familiar to many of you, and they highlight something I've observed time and time again: hormonal acne isn't just a teenage concern—it's something that can affect us at any age.

*Names changed for privacy


The Patterns I've Noticed

After years of working with patients, here are the most common patterns I see:

  • That dreaded chin and jawline pattern (I call this the "hormonal U") that almost every patient points to during consultations

  • Deeper, more painful cysts that seem to appear overnight, especially during period weeks

  • Stubborn post-inflammatory hyperpigmentation that lingers long after the breakouts heal

  • Simultaneous combination of dry patches and oily areas that make traditional acne treatments tricky


What's Actually Working for My Patients

The Game-Changers I've Seen

I had a breakthrough moment with a patient this Thursday when she came in for her follow-up. After months of struggling, her skin had finally turned a corner. Here's what made the difference:

  • Simplified morning routines (many of my patients were over-cleansing)

  • Strategic use of benzoyl peroxide (but not how you might think)

  • Careful integration of retinoids (starting slow has been key)

  • Moisture barrier support (this is where most people go wrong)


The Reality Check

Let me be honest—what I see in the treatment room isn't always what you see on social media. Those quick-fix solutions? They rarely work long-term. Instead, here's what I've found brings lasting results:

  • Consistent, gentle routines over aggressive treatments

  • Understanding your personal triggers (I have my patients keep skin diaries)

  • Working with your hormonal cycle, not against it

  • Patience (I know, not what anyone wants to hear, but it's the truth)


From My Treatment Room to Your Bathroom

Morning Routine I Actually Recommend

Based on what's working for my patients:

  1. Gentle, non-foaming cleanser (save the active ingredients for later)

  2. Simple hydrating toner (if needed)

  3. Light, non-comedogenic moisturizer

  4. Mineral sunscreen (non-negotiable!)


Evening Routine That's Showing Results

What I'm seeing work consistently:

  1. Double cleanse (especially if you wear makeup or sunscreen)

  2. Treatment product (rotating between benzoyl peroxide and retinoids)

  3. Barrier-supporting moisturizer

  4. Spot treatment only on active breakouts


Real Talk: The Mistakes I See Every Week

After a particularly busy clinic day this Wednesday, I jotted down the most common mistakes I was seeing:

  • Over-exfoliating in an attempt to "dry out" acne (please don't!)

  • Skipping moisturizer because skin is oily (this actually makes things worse)

  • Using too many active ingredients at once

  • Not giving treatments enough time to work before switching


Beyond the Skin: What We Need to Discuss

Something I've noticed in my treatment room lately is the emotional toll of hormonal acne. This week alone, I've had three patients break down during consultations. It's crucial to address:

  • The impact on mental health

  • Realistic treatment timelines

  • The importance of support systems

  • When to seek additional help


What I Wish Every Patient Knew

After a week of back-to-back consultations, here are the key messages I find myself repeating:

  • Hormonal acne isn't your fault

  • Treatment takes time and consistency

  • What works for someone else might not work for you

  • The goal is progress, not perfection


Looking Forward: The Hope I See

Just yesterday, I saw a patient for her 3-month follow-up, and her progress brought tears to both our eyes. It reminded me why I love what I do. While hormonal acne can be stubborn, I've seen countless success stories in my treatment room. The key is finding the right approach for each individual and sticking with it.


Your Next Steps

If you're struggling with hormonal acne, here's what I tell my patients:

  • Start tracking your breakout patterns

  • Take photos to monitor progress

  • Be gentle with your skin and yourself

  • Consider professional help if over-the-counter treatments aren't working



Remember, what I see in my treatment room every day confirms that you're not alone in this journey. While each person's path to clear skin is different, there's always a solution waiting to be found.



 
 
 

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