How To Treat Acne

Hello, I am Lee Dong-hee, director of Woahan Women's Clinic. Acne is often thought to occur only during puberty, but in clinical practice, adult female patients in their 20s and beyond make up a considerable share. Many complain of acne that recurs along the jawline and around the mouth, and breakouts that appear without fail before each period. Today, I will outline, based on evidence, why acne occurs, what makes hormonal acne common in women different, and treatment methods including PDT.

Acne arises not from a single cause but from four interlocking factors: excessive sebum secretion by the sebaceous glands that fill the pores, abnormal keratinization at the pore opening, proliferation of acne bacteria (Cutibacterium acnes), and the resulting inflammatory reaction. The American Academy of Dermatology (AAD, 2024) defines acne as a chronic pilosebaceous disease in which these four pathophysiologies act in combination.

It begins as a comedo (a tiny pimple) where the pore is blocked, but when inflammation is added, it progresses to red papules and pustules, and deeper still it becomes nodules and cysts. In clinical experience, leaving this stage untreated not infrequently damages the dermal layer of the skin and leaves acne scars. Because scars, once formed, are far more difficult to return to the original skin, the key is to calm inflammation with appropriate treatment from the early stages.

Acne in adult women is characterized by being strongly influenced by hormones. Unlike puberty acne, which spreads widely across the center of the face (T-zone) such as the forehead and cheeks, in adult women it tends to concentrate on the lower part of the face (U-zone) such as the jawline, around the mouth, and the neck, and is reported to repeatedly worsen and improve along with the menstrual cycle.

This is closely related to the action of the male hormone androgen. Androgen stimulates the sebaceous glands to increase sebum secretion, and when hormonal balance is disturbed, sebum is over-secreted and acne worsens. The Androgen Excess and PCOS Society (AE-PCOS, 2022) recommends considering an assessment of blood androgen levels in cases of newly developed acne in adult women.

In particular, if symptoms such as irregular periods, weight gain, and increased facial hair appear together with acne, polycystic ovary syndrome may be suspected. Polycystic ovary syndrome is a representative endocrine disorder that links acne, irregular periods, and infertility together, and in many cases improvement is slow if only the skin is treated. Acne can be a signal of a hormonal problem — this is the perspective from which a women's clinic views acne.

If recurring acne is hard to control with skin treatment alone, it may be necessary to look for the cause on the hormonal side. In the clinic, we first take a history of the relationship with the menstrual cycle, the location of the acne, and accompanying symptoms.

If judged necessary, hormone status is checked with a blood test. The AE-PCOS Society (2022) suggests measuring androgen levels such as total testosterone, free testosterone, and DHEAS with high-quality assays in adult female acne. If polycystic ovary syndrome is suspected, ultrasound and AMH testing may be added.

At Woahan Women's Clinic, we examine the root of acne through a hormone panel test that looks at the skin and the endocrine system together. Test items and costs vary depending on symptoms, so we will provide guidance after consultation.

PDT (photodynamic therapy) is a method that uses light and a photosensitizing substance to selectively reduce the sebaceous glands and acne bacteria. When a photosensitizer such as 5-aminolevulinic acid (ALA) is applied to the skin, this substance is preferentially absorbed by the sebaceous glands. After allowing it to penetrate for a certain time, irradiating with light of a specific wavelength acts selectively on the overactive sebaceous glands and acne bacteria.

According to the American Academy of Dermatology clinical guidelines (JAAD, 2024), among the various laser and light treatments, PDT is summarized as having the most evidence for acne. It is reported to be a useful option for patients who do not respond well to drug treatment or for whom systemic drug use is difficult.

However, because the photosensitizer can also accumulate to some extent in the epidermis and dermis, temporary erythema or pigmentation may appear after the procedure. For several days after the procedure, you should avoid sunlight and take care with UV protection. As the degree of response may vary from person to person, we decide whether to proceed after evaluating the skin condition and acne type.

PTT (photothermal therapy) is a method that uses heat to selectively reduce the sebaceous glands, and its operating principle differs from that of PDT. Heat-responsive gold microparticles are applied to the skin and made to penetrate into the pores, then a laser of a suitable wavelength is irradiated. The local heat generated at this time acts on the sebaceous glands as a target.

Compared with PDT, there are the following differences.

PTT is known to have a relatively lower possibility of pigmentation and less burden of photosensitivity because the microparticles are barely absorbed into the epidermis. However, for purulent acne, it may be difficult to expect as much effect as PDT. Which is suitable depends on the depth of the acne and the degree of inflammation.

Even after inflammatory acne subsides, red marks or pitted scars often remain. Ongoing acne and scars that have already formed require different approaches. Active inflammation is calmed with PDT, PTT, and the like, while remaining scars and pigmentation are improved step by step with separate skin laser treatment.

Quite a few people are also concerned about facial flushing, in which redness lingers for a long time after acne. For such complex skin changes, rather than finishing with a single procedure, results are better when you separate the inflammation stage and the scar stage and make a plan.

Because the laser applied for scar treatment varies depending on the depth and type of the skin, sufficient evaluation is needed before the procedure. Costs will be provided after consultation.

Everyday care is as important as clinic treatment. Here are the basic principles we often advise in the clinic.

• Cleanse gently twice a day with a low-irritation cleanser and do not rub excessively
• Do not squeeze acne with your hands. It is the most common cause of scarring and pigmentation
• Choose non-comedogenic (pore-non-clogging) cosmetics
• Use sunscreen consistently to prevent pigmentation
• Record the relationship between your menstrual cycle and breakouts and share it during consultation

One common misconception is the idea that "acne heals if you just wash well." Cleansing is basic, but for acne caused by hormones, surface skin care alone has its limits. If it does not improve with self-care and scars begin to form, we recommend a consultation that examines the cause together.

If your acne recurs in step with your menstrual cycle or concentrates on the jawline, checking hormonal factors together is the faster route. Through women's health care that examines the skin and the endocrine system in one place, we hope you can establish a tailored plan starting from the cause.

If you are curious about acne treatment and hormone testing, consult with us via chat

Written by: Lee Dong-hee Director · Obstetrics and Gynecology Specialist · View medical staff profile

First published November 21, 2023 · Last reviewed May 30, 2026

References: American Academy of Dermatology Guidelines of Care for Acne Vulgaris (2024), Androgen Excess and PCOS Society Committee Report on Female Adult Acne (2022), JAAD Review of Photodynamic Therapy for Acne (2024)

This article is intended to provide general health information and does not replace individual diagnosis or treatment. If you have symptoms, please consult through an examination.