Hormonal Acne in Singapore: Signs, Assessment and Treatment

20 Sep Hormonal Acne in Singapore: Signs, Assessment and Treatment

Posted at 13:24h in Acne, Blog by

By Dr Rachel Ho | Aesthetic Doctor, Founder, The Skin Longevity Clinic, Singapore

Breakouts that return around the same time each month can leave you wondering whether skincare is addressing the whole problem. A careful assessment can help separate a recognisable pattern from a hormone disorder that needs investigation.

Hormonal acne is a commonly used description of acne in which androgen effects or cyclical changes are clinically relevant1. Our main acne guide explains the wider treatment pathway; the focus here is how a suspected hormonal pattern changes the consultation.

What can suggest a hormonal pattern?

Monthly flares, persistent lower facial acne and a change after starting or stopping hormonal medication are useful details to discuss1. These clues should be interpreted alongside the examination and medical history, because the location of a breakout alone cannot confirm its cause2.

Record when new lesions appear, which areas are affected and whether there are changes in your menstrual cycle. Bring the names of contraceptives, fertility medicines, testosterone preparations or supplements you use, without stopping prescribed treatment on your own.

Can hormone levels be normal?

Acne can occur in women with no clinical or laboratory evidence of excess androgens3. A normal result therefore does not automatically rule out a role for androgen related treatment, although suitability remains an individual prescribing decision1.

Ask what a proposed blood test would clarify and how the result would change the plan. This is more useful than requesting a broad hormone panel without a specific clinical question.

When are tests or further assessment appropriate?

The international guideline for polycystic ovary syndrome describes acne alone, without hirsutism, as a relatively weak predictor of biochemical androgen excess2. Irregular periods, excess facial or body hair, scalp hair loss and a rapid change in symptoms provide additional reasons for assessment2.

History to mention Question for the consultation
Irregular or absent periods Does the menstrual history justify an endocrine or reproductive assessment?
New excess hair or scalp thinning Should these findings be evaluated alongside the acne?
A sudden substantial change Is there a reason to investigate beyond routine acne care?
Hormonal contraception Could it affect the interpretation or timing of proposed tests?
Fertility treatment or pregnancy plans Which treatment options remain appropriate?

Polycystic ovary syndrome, widely known as PCOS, was renamed polyendocrine metabolic ovarian syndrome, or PMOS, through an international consensus process in 20264. Dr Rachel Ho explains the terminology in her PCOS and PMOS article; an acne pattern alone remains insufficient to diagnose the syndrome2.

How is hormonal acne treated?

A hormonal component can be addressed alongside standard acne treatment, rather than making topical therapy irrelevant1. Ask which problem each proposed medicine is intended to address and whether the plan is suitable for your medical and reproductive circumstances.

Topical treatment

Retinoids, benzoyl peroxide and azelaic acid are among established topical acne options5. The exact combination should take account of sensitivity, previous response and pregnancy considerations5,6.

Bring the products you already own so useful steps can be retained where appropriate. Dr Rachel Ho’s azelaic acid guide explains that ingredient without replacing a prescribing review.

Spironolactone

Spironolactone may be prescribed for acne in suitable women, and the SAFA randomised trial found greater improvement than placebo, with the difference more apparent at 24 weeks than at 12 weeks7. Participants could continue topical treatment, so the findings concern a managed treatment plan rather than a promise of an immediate response to one tablet7.

Before prescribing, the doctor should review kidney health, other medicines and the need for laboratory monitoring; potential adverse effects include menstrual changes, breast tenderness and dizziness1. Spironolactone is avoided during pregnancy, making pregnancy plans an essential part of the discussion6.

Combined oral contraceptives

A combined oral contraceptive may be an option when acne treatment and contraception are both relevant1. Assessment includes factors such as blood pressure, migraine with aura, smoking and a history of blood clots1.

Discuss the reason for choosing a particular preparation rather than selecting a pill based on an online acne review. Coordinate changes with the clinician managing your contraception or fertility care.

What if the breakouts are deep or leaving scars?

Depth and scarring can change the urgency and intensity of treatment, even when a monthly pattern is present8. Our cystic acne article explains decisions for painful nodules and lesions beneath the skin.

For a broader picture of persistent breakouts in adulthood, read our adult acne guide. Keep the main treatment discussion centred on the lesions you have and the outcomes that matter to you.

Can a clinic procedure replace hormonal treatment?

Ask a doctor to explain whether the proposed procedure is treating selected lesions, a wider acne pattern or marks left after previous inflammation. A local treatment and a medicine acting on hormonal pathways have different purposes, so their roles should be considered separately1.

Our selective sebaceous gland ablation page provides procedure specific information. It should be read alongside the assessment of whether medical treatment remains necessary.

How should progress be reviewed?

The SAFA results illustrate why early and later reviews may answer different questions: tolerability can be assessed before the full treatment effect is evident7. Agree on the review interval with your prescriber and record whether new lesions, discomfort and treatment tolerance are changing.

Bring notes about missed doses, menstrual changes and any new medicines. Ask when maintenance will be discussed and what to do before making changes to contraception or planning pregnancy.

Hormonal acne treatment costs in Singapore

Ask for the consultation fee and clarify whether suggested tests, prescribed medicines and follow up are charged separately. A useful estimate should reflect the investigations actually indicated rather than assume that everyone needs the same hormone panel.

Contact The Skin Longevity Clinic to discuss an assessment with Dr Rachel Ho. Bring your cycle history, current treatments and reproductive plans so the consultation can address both acne control and medical suitability.

References

  1. Smith CA, Gosnell E, Karatas TB, et al. Hormonal Therapies for Acne: A Comprehensive Update for Dermatologists. Dermatol Ther (Heidelb). 2025;15:45–59. doi:10.1007/s13555-024-01324-8. Read the source

  2. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertil Steril. 2023;120(4):767–793. doi:10.1016/j.fertnstert.2023.07.025. Read the source

  3. Bagatin E, de Freitas THP, Rivitti-Machado MC, et al. Adult female acne: a guide to clinical practice. An Bras Dermatol. 2019;94(1):62–75. doi:10.1590/abd1806-4841.20198203. Read the source

  4. Teede HJ, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026;407(10545):2329–2339. doi:10.1016/S0140-6736(26)00717-8. Read the source

  5. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1–1006.e30. doi:10.1016/j.jaad.2023.12.017. Read the source

  6. Ly S, Kamal K, Manjaly P, Barbieri JS, Mostaghimi A. Treatment of Acne Vulgaris During Pregnancy and Lactation: A Narrative Review. Dermatol Ther (Heidelb). 2023;13:115–130. doi:10.1007/s13555-022-00854-3. Read the source

  7. Santer M, Lawrence M, Renz S, et al. Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial. BMJ. 2023;381:e074349. doi:10.1136/bmj-2022-074349. Read the source

  8. Eichenfield DZ, Sprague J, Eichenfield LF. Management of Acne Vulgaris: A Review. JAMA. 2021;326(20):2055–2067. doi:10.1001/jama.2021.17633. Read the source

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