Ever stare at your breakouts and wonder, “Why is this happening?” You’re definitely not alone. Acne can be confusing and frustrating—especially when you’re not even sure what kind of acne you’re dealing with.
The truth is, not all acne is created equal. Some breakouts are triggered by your hormones going wild, while others are caused by bacteria partying on your face. So, how do you tell the difference? And once you figure it out, what can you actually do about it?
Let’s break it all down in a simple, no-fluff guide to help you learn how to tell if acne is hormonal or bacterial—and how to build the right skincare routine for your skin type.
What’s the Difference Between Hormonal and Bacterial Acne?
Let’s start with the basics.
Hormonal Acne
This type of acne is driven by changes in your hormones—things like menstruation, puberty, pregnancy, menopause, or conditions like PCOS. Hormonal acne tends to:
- Flare up around your period (for women)
- Pop up on the lower part of your face (chin, jawline, neck)
- Feel painful or cystic (deep under the skin)
- Be more stubborn and cyclical (it keeps coming back)
Bacterial Acne
This acne happens when bacteria (mainly P. acnes) clog your pores, often because of sweat, dirt, oil, or poor hygiene. Bacterial acne tends to:
- Show up anywhere on your face or body
- Include whiteheads, blackheads, and small red pimples
- Respond faster to topical treatments
- Be more influenced by external factors like dirty pillowcases or skincare products
How to Tell If Acne Is Hormonal or Bacterial
Here’s where it gets interesting. You don’t need to be a dermatologist to spot the signs—though seeing one definitely helps. But you can use some clear clues to figure it out.
1. Look at the Location
- Hormonal acne: Usually around your chin, jawline, and sometimes neck.
- Bacterial acne: Can appear on your cheeks, forehead, back, shoulders, or even your butt.
2. Think About Timing
- Hormonal acne: Shows up right before your period or during hormonal changes.
- Bacterial acne: Often tied to things like sweating, touching your face, or a reaction to products.
3. Feel the Texture
- Hormonal acne: Deeper, cystic, and sore.
- Bacterial acne: More surface-level—whiteheads, blackheads, and small pustules.
4. Consider Your Age and Hormonal Triggers
- Teenager? You might be dealing with a mix, but hormones are likely the main driver.
- Adult woman with irregular cycles or PCOS? Hormones are probably the culprit.
- Just changed birth control or had a baby? Ding ding—hormonal again.
- Frequently sweat or wear heavy makeup? Bacteria might be the bigger issue.
What Causes Hormonal Acne?
Hormonal acne happens when your body’s natural oil production (aka sebum) goes into overdrive, often due to:
- Increased androgens (male hormones like testosterone)
- Menstrual cycles
- Stress (yep, it messes with your hormones)
- PCOS or other hormonal imbalances
- Pregnancy or postpartum hormone shifts
- Starting or stopping birth control
These hormones increase oil production, which clogs pores and creates the perfect storm for breakouts—especially deep, painful ones.
What Causes Bacterial Acne?
Bacterial acne shows up when your pores get clogged with oil, dirt, or dead skin—and then bacteria joins the party.
Common culprits include:
- Touching your face constantly
- Sleeping on dirty pillowcases
- Not washing your face after sweating
- Using pore-clogging skincare or makeup
- Wearing tight hats or helmets (hello, forehead pimples)
Basically, when your pores get blocked and bacteria multiply, inflammation kicks in—and bam, breakouts.
Still Not Sure? Here’s a Quick Acne Type Quiz
Answer these questions to get a better sense of what you’re dealing with:
- Do breakouts get worse right before or during your period?
→ Likely hormonal - Are the pimples deep and painful?
→ Likely hormonal - Do you often get whiteheads or blackheads across your cheeks or forehead?
→ Likely bacterial - Do breakouts happen after sweating or working out?
→ Likely bacterial - Are pimples mainly on your chin and jawline?
→ Likely hormonal - Do your breakouts flare up after using certain products?
→ Likely bacterial
How to Treat Hormonal Acne
Hormonal acne is tricky because it’s often tied to internal imbalances, meaning a good skincare routine is only part of the puzzle. Tackling it means looking at both what goes on your skin and what’s going on inside your body.
Skincare Tips for Hormonal Acne
These products and habits help manage oil, unclog pores, and reduce inflammation—without aggravating sensitive skin.
Use a gentle cleanser with salicylic acid (BHA)
Salicylic acid dives deep into pores to remove excess oil and dead skin—ideal for preventing breakouts before they form.
Try:
- CeraVe Renewing SA Cleanser
- La Roche-Posay Effaclar Medicated Gel Cleanser
Use once or twice a day. If your skin is sensitive, start with once daily or every other day.
Apply a retinoid to boost cell turnover
Retinoids like adapalene (the over-the-counter kind of retinoid) help keep pores clear and reduce inflammation. They’re also great for fading post-acne marks.
Try:
- Differin Gel (Adapalene 0.1%)
Start 2–3 nights a week and increase as your skin adjusts. Always apply at night and use sunscreen during the day—retinoids make your skin more sun-sensitive.
Spot-treat with benzoyl peroxide when needed
Even with hormonal acne, surface breakouts can still happen. Use benzoyl peroxide to kill acne-causing bacteria and calm red bumps.
Try:
- Clean & Clear Persa-Gel 10
- Paula’s Choice BPO Treatment (2.5% or 5%)
Use sulfur-based masks weekly for cystic breakouts
Sulfur reduces oil and inflammation without being too drying—perfect for those deep jawline zits.
Try:
- Peter Thomas Roth Therapeutic Sulfur Mask
- Sunday Riley Saturn Sulfur Spot Treatment Mask
Keep your routine simple and consistent
Too many actives at once can irritate hormonal skin. Stick with a few key ingredients, give them time to work, and resist the urge to switch products constantly.
Lifestyle + Medical Support for Hormonal Acne
Skincare is important, but hormones often need a little extra help. If you’re breaking out regularly around your period or dealing with painful cysts, it’s time to look at the bigger picture.
Track your menstrual cycle
Noticing a pattern? Breakouts that pop up 7–10 days before your period are classic hormonal signs. Apps like Flo or Clue can help you predict when your skin might act up so you can tweak your routine early.
Reduce stress (seriously, it matters)
Stress increases cortisol, which can throw your hormones out of whack and lead to breakouts. Small changes make a difference:
- Go for a daily walk
- Try meditation apps like Calm or Headspace
- Prioritize 7–8 hours of sleep
Balance your diet
While food isn’t the sole cause, some people notice that high-sugar or dairy-heavy diets trigger flare-ups. Try:
- Eating more anti-inflammatory foods (leafy greens, fatty fish, berries)
- Reducing processed sugar and dairy for a few weeks to see how your skin reacts
Talk to a doctor or dermatologist about hormonal treatment options
If your breakouts are severe, persistent, or affecting your confidence, don’t wait.
Medical options include:
- Birth control pills: Certain formulations (like those containing drospirenone or norgestimate) can regulate hormones and reduce breakouts.
- Spironolactone: A prescription medication that blocks androgen (male hormone) activity—commonly used off-label for adult female acne.
- Oral retinoids (Accutane): A powerful option for severe cystic acne that hasn’t responded to other treatments. Comes with strict monitoring but can be highly effective.
- Hormone testing: If you suspect a condition like PCOS, a doctor may recommend a hormone panel to dig deeper.
How to Treat Bacterial Acne
Bacterial acne tends to respond better to surface-level treatments, which is good news—it’s often more manageable with consistent skincare and hygiene tweaks.
Skincare Tips for Bacterial Acne
Use a cleanser with benzoyl peroxide or salicylic acid
Benzoyl peroxide kills acne-causing bacteria, while salicylic acid clears out clogged pores. You can alternate or use both—just not at the same time.
Try:
- PanOxyl Acne Foaming Wash (10% BPO)
- CeraVe Acne Control Cleanser
- Neutrogena Oil-Free Acne Wash (Salicylic Acid)
If your skin gets dry, use benzoyl peroxide in the morning and a gentle cleanser at night.
Moisturize every single day
Drying out your skin leads to more oil production, which feeds bacteria. Use a lightweight, non-comedogenic moisturizer that hydrates without clogging pores.
Try:
- Neutrogena Hydro Boost Gel-Cream
- CeraVe PM Facial Moisturizing Lotion
Exfoliate 1–2x per week with chemical exfoliants
Avoid harsh scrubs. Instead, opt for AHAs (like glycolic or lactic acid) or BHAs (salicylic acid) to dissolve dead skin and clear pores.
Try:
- The Ordinary Glycolic Acid 7% Toning Solution
- Paula’s Choice Skin Perfecting 2% BHA Liquid
Over-exfoliating = irritation = more acne. So go easy!
Use a gentle clay mask weekly
Clay absorbs excess oil and pulls out impurities—great for preventing new breakouts.
Try:
- Aztec Secret Indian Healing Clay (with apple cider vinegar)
- Innisfree Super Volcanic Pore Clay Mask
Hygiene Habits That Actually Help
Bacterial acne thrives in warm, sweaty, or dirty environments. Small changes can go a long way:
- Change your pillowcase 2–3 times a week – even daily if you sleep on one side only.
- Shower ASAP after sweating – letting sweat and bacteria sit on your skin = breakout city.
- Wipe down your phone regularly with alcohol wipes.
- Avoid tight headwear and helmets that trap sweat and bacteria on your forehead.
- Double cleanse if you wear makeup – first with a cleansing balm or micellar water, then with your usual face wash.
By understanding whether your acne is hormonal, bacterial, or a mix of both, you’ll finally be able to customize a routine that works for your skin—not someone else’s.
Can You Have Both Hormonal and Bacterial Acne?
Absolutely. In fact, many people do. Hormonal shifts can increase oil production, which clogs pores, and that sets the stage for bacterial overgrowth. It’s like a tag-team match happening on your face.
If this sounds like you, you might need to:
- Manage your hormones with help from a medical provider
- Use topical treatments that address surface-level breakouts
- Keep a consistent, gentle skincare routine to avoid making things worse
Skincare Routine Based on Your Acne Type
Hormonal Acne Skincare Routine
Morning:
- Gentle foaming or gel cleanser
- Niacinamide serum (calms inflammation)
- Oil-free, non-comedogenic moisturizer
- Sunscreen (SPF 30+)
Evening:
- Cleanser with salicylic acid
- Retinoid cream (start slow!)
- Lightweight moisturizer
- Optional: spot treatment with benzoyl peroxide
Bacterial Acne Skincare Routine
Morning:
- Cleanser with benzoyl peroxide
- Light moisturizer (gel or lotion)
- SPF 30+ sunscreen (look for non-comedogenic)
Evening:
- Cleanser (salicylic acid or tea tree based)
- Exfoliant (2–3 times a week with AHA/BHA)
- Spot treatment on active pimples
- Moisturizer to support skin barrier
What NOT to Do (for Either Type)
- Don’t pop or pick pimples – it can make both types worse
- Don’t overload your skin with products – more isn’t always better
- Don’t use alcohol-heavy astringents – they can dry out and irritate your skin
- Don’t skip moisturizer – even oily skin needs hydration
- Don’t assume all acne is “just from dirt” – it’s often internal
When to See a Dermatologist
If you’ve tried over-the-counter treatments for 2–3 months with little improvement, it’s time to see a pro. A dermatologist can:
- Prescribe stronger treatments
- Diagnose underlying hormonal issues
- Customize a skincare plan for you
The Bottom Line
Understanding how to tell if acne is hormonal or bacterial is the first step toward getting your skin under control. Once you know the why behind your breakouts, you can choose a skincare routine that actually works—and stop wasting time (and money) on products that don’t.
Whether your acne is hormonal, bacterial, or a combo of both, you’ve got options. Be patient with your skin, stay consistent, and don’t be afraid to get professional help when needed.
Your skin’s not the enemy—it’s just trying to tell you something. Now you know how to listen.