Female Adult Hormonal Acne (FAHA)

Acne vulgaris is the most common skin condition treated by Dermatologists with statistics showing approximately 80% of people age 11 to 20 years old being affected. However, acne is not a condition of teenagers only. Frequently, acne affects adults, particularly women. Medical studies have shown that 1 in 8 adult women aged 24-44 will have symptoms of acne, either persistent from prior years or new onset.1  Female adult hormonal acne (FAHA) is a common subtype of acne Dr. Liu encounters and treats in his medical practice.

What does FAHA look like?
FAHA typically present as large, tender inflammatory papules and/or cysts which often last for several days to weeks. Patients often describe them as “tender boils” or “deep cysts that won’t surface to the skin.” The breakouts classically concentrate on the lower face involving the “beard” area of the face, chin, jaw, and neck areas respectively. FAHA can be more diffuse, involving the entire face and/or the chest, back, and shoulders. Some patients report flares around their menstrual period. Other associated symptoms may include:

  1. Oily skin tone of the face, neck, chest, back, and/or scalp
  2. Hair thinning on the top of the scalp
  3. Excess hair growth (hirsutism), especially in the beard area
  4. Irregular menstrual cycles and/or infertility
  5. Brown or red blemishes from the breakouts
  6. Indented, pock scars from the breakouts

If you are experiencing acne, hair thinning, hirsutism, and irregular menstrual cycles, you may have polycystic ovarian syndrome (PCOS). Coordination of care between your Dermatologist and an Endocrinologist or Gynecologist is advised.

How is FAHA diagnosed?
FAHA can be diagnosed through a detailed medical history and skin examination by your Dermatologist. On occasion, hormone laboratory panels may be ordered. However, FAHA is frequently clinically active with normal hormone blood work. Dr. Liu typically asks his patients the following questions:

  1. Where on your face and/or body do you experience breakouts?
  2. How often do the breakouts occur?
  3. What makes the breakouts worse?
  4. What alleviates the breakouts?
  5. Are you experiencing any other symptoms?
  6. Do you take any hormone therapy, non-prescriptions supplements, and/or prescription medications?
  7. What previous treatments have you tried?
  8. What is your daily skin care regimen?

Why is this happening to me?
Androgens are a family of hormones present in both males and females which stimulate oil glands in the skin. Patients with FAHA exhibit excessive androgen effects on the oil glands of the skin, which lead to clogging at the root of hair follicles. The clogged pores become inflamed and manifest into deep, tender pimples on the skin, frequently lasting for weeks and potentially permanently scarring the skin if not treated promptly.

What can be done about the acne?
There are several therapies available to manage the skin changes, including topical medications, systemic medications, and laser/light procedures. Your Dermatologist can formulate a therapeutic regimen to fit your individual needs.

What can be done about the scarring?
Scarring can manifest as red blemishes, brown blemishes, and indentations of the skin (pock scars). Although it may take several weeks to months, red and brown blemishes often resolve; however pock scars are often permanent. A combination of topical creams, laser therapies, fillers, and/or surgery can significantly improve acne scarring.

See Dr. Liu Discuss Female Adult Hormone Acne on The Doctors Show


See the Follow-up Results After Medical and Laser Therapy


  1. Goulden V, McGeown CH, Cunliffe WJ. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br Jo Dermatol 1999;241:297-300.