Hormonal Acne Routine Part 2: First Line of Defense

This post is a continuation of my Hormonal Acne Series:

Click to Read > Part 1: Philosophies

I have discovered the following about my own skin from years of trial and error and plenty of research. If you do not have the basics of skincare covered yet, then I'll respectfully say you have no business moving on to targeted acne solutions, especially not exfoliating actives. This is not to say that good skincare is esoteric and off-limits to beginners- rather that you need to be patient and careful to create a good routine, and those qualities do not just magically appear if you rush into things. Please use caution when introducing a new acne-fighting product. My routine is the result of years of experimentation, and I tweak based on my skin and other factors depending on the moment. The general philosophies and principles remain the same!

My inflamed cysts, a result of overactive oil glands, less-responsive skin-shedding, and other vagaries of my hormonally imbalanced body, need a hardcore intervention. For me, 15% prescription azelaic acid has been the most effective topical treatment. Better than tretinoin, better than BHA, better than benzoyl peroxide. It works to reduce the inflammation and incidence without excessively drying my skin. Unfortunately in the USA, it's only available from a doctor at the level I use it. Therefore I will recommend you ask your dermatologist if you can use the product. I don't think it's for everyone, but this excellent blog post by Snow White and the Asian Pear should explain why many people enjoy using it on their own skin.

The azelaic acid does for me what I've seen tretinoin do for many others. It shows cascading benefits the longer you use it. Like most acne treatments, this is not meant to be used on "spots." You apply it allover with the understanding that the skin is a system. Because the majority of acne-fighting ingredients are preventive as much as they are reparative, this usually works out best in the medium to long-term. I use my azelaic acid between 3 and 4 times a week, for consistent dosage without overdoing it.

There are plenty of hardcore acne actives- the aforementioned tretinoin and BHA may work better for your skin. The only way to understand what your skin likes best is to experiment carefully and observe the results with each chemical active.

Because of my dry climate and my own sensitivities, I have found that I need to keep strong actives to a maximum of two in my entire regular routine. That means I do not like to stack tons of potent acne-fighting actives. I find there gets to be a "crowding-out" effect whereby I try to fit in the actives to my weekly routine, which means I use them too frequently overall, and my skin grows aggravated and more inflamed and prone to acne, even though the purpose of the routine is to treat acne in the first place. Azelaic acid is the first of my current two. In the past I've mixed and matched other actives, but while the number two may seem arbitrary, for me I find no matter the ingredient, when I push it to three total, things get hinky. I'll talk about my second active in my next post!

In the photos above, I show what I consider to be a realistic expectation for what one chemical active should do for my hormonal acne. The left photo shows before starting azelaic acid, the right photo shows a month's progress. I do not expect this one product to control all aspects of my skin and perfect it. What I do expect is a reduction in the spread and aggravation of inflamed acne, leaving minor clogs and the occasional larger pimple as an acceptable compromise.

 There are blind spots that occur and issues that arise with this philosophy, which is why I compensate in other, gentler ways.

Continued in Part 3...


  1. I have been using azelaic acid 15% for more than a year but sadly for me it hasn't controlled my acne as well as desired. Now I'm doing a combo of azelaic acid 15% and tretinoin 0.025%

    1. I hope the current protocol is working better for you! AzA doesn't do it alone for me but really seems to control the deep nasty stuff I never could resolve with tret.

  2. Nice blog..! I really loved reading through this article. Thanks for sharing such a amazing post with us and keep blogging...
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