3 Ways To Treat Acne After Going Off Birth Control

Going off birth control can be a significant change for your skin. Quitting hormonal contraceptives can lead to pimples, skin inflammation, or a decided uptick in oil production. 

"Your skin can really go haywire," said Ava Shamban, MD, a board-certified dermatologist and founder of Ava MD in Los Angeles, Calif.

Skin Changes When Going Off Birth Control

What's behind that upheaval? The synthetic hormones, progestin and estrogen, in birth control create a stable environment for your skin by decreasing the amounts of natural substances that can cause acne.

When you stop taking birth control, you disrupt that peace. But here's the good news: For most people, that chaotic period for your skin is temporary, explained Dr. Shamban. For others, once their natural levels return, those hormones may cause acne.

Basically, it all depends on you and your hormones. How long it lasts can vary, but you can probably expect to see your skin normalize within months. That transitional time, however, can be like a "hormonal roller coaster" for your skin, noted Dr. Shamban.

Eager for a speedy exit and a return to clear, consistent skin? Here are three strategies to help get your skin under control after going off birth control.

Prepare Beforehand

Don't wait until you stop taking the pill—or after your first breakout occurs—to manage your skin. Steven Q. Wang, MD, board-certified dermatologist at Hoag Memorial Hospital Presbyterian in Irvine, Calif., recommended a holistic approach two to three months before you quit your oral contraceptive. 

"You have to figure out your way of life, from stress levels to what you eat," said Dr. Wang. Keep stress low, get enough sleep, and drink lots of water. And watch what you eat, too. 

Reduce Your Stress

Stress causes our body to produce hormones called androgens that stimulate oil glands and hair follicles which can lead to acne. If you suspect you may be under high levels of stress, here are a few options to try to manage it:

• Get regular exercise
• Try meditation or muscle relaxation exercises
• Get enough sleep
• Avoid consuming too much caffeine

Monitor Your Diet

While there isn't any evidence that foods like chocolate, milk, sweets, or high-fat foods cause acne—if you find that eating them, or any other foods, triggers your acne, you may want to avoid those foods.

Research shows that a low-glycemic diet that includes vegetables, fruits, beans, and oats, can help to reduce acne because it reduces spikes in blood sugar which can cause inflammation in your body. "Try to have an anti-inflammatory diet with high omega-3s and fruits and vegetables, and minimize any fried food," noted Dr. Wang. "If you can control inflammation internally, [probiotics] can help mitigate some of the skin inflammation."

Institute a Skincare Routine

While you wait for your hormones to return to their normal levels, it is essential to begin a consistent skincare regimen.

Most likely, you're familiar with the basics of caring for your skin. But if years or even decades of consistently clear skin have made you complacent, here's a quick refresher:

• Wash your face with lukewarm water and use your fingertips. Get rid of makeup and the environmental contaminants that your face was exposed to by cleaning your skin with a gentle, non-drying cleanser in the morning and at night. Avoid using a washcloth or sponge.
• On the go? Don't let oil linger on your skin. You should also wash your face after sweating, especially if you were wearing a hat or helmet, which can further irritate the skin. No time for a post-workout shower? Try running a salicylic acid pad over your face, added Dr. Palm.
• Don't touch your face. Resist the urge to squeeze pimples and pick at your skin because this can cause more irritation, scarring, or infection.
• Check labels. Ensure the packaging on your cleansers, moisturizers, makeup, and hair products says "non-comedogenic," meaning they contain ingredients that won't clog your pores.

Apply Topical Medications

Topical medications can treat whiteheads, blackheads, pimples, and acne nodules or cysts. But treatment can vary depending on a few factors:

• What type of acne you have and where it is located
• What treatments you have already tried
• When the breakouts started
• Your age

Topical Retinoid + Benzoyl Peroxide

The first line of acne treatment is typically a topic retinoid (such as tretinoin, adapalene, or tazarotene) combined with benzoyl peroxide.

Retinoids, a derivative of vitamin A, decrease oil production, treat acne, and reduce signs of aging. And benzoyl peroxide, which kills acne-causing bacteria, is an active ingredient in many drugstore skin cleansers.

However, you should talk to your dermatologist before using benzoyl peroxide. Because benzoyl peroxide is more commonly associated with adolescent acne than the type of hormonal acne that birth control causes. And benzoyl peroxide can also cause mild dryness, redness, and scaling if used at a higher concentration.

Benzoyl Peroxide + Clindamycin Gel + Topical Retinoid

Dr. Palm recommended a combination of benzoyl peroxide and clindamycin gel (a bacteria-fighting antibiotic) in the morning and a topical retinoid in the evening.

However, avoid retinoids if you've gone off birth control because you're trying to get pregnant. Instead, your dermatologist might prescribe a topical dapsone for hormonal acne at night. Since this is a newer acne treatment, the effects of topical dapsone on pregnant people aren't well understood but animal studies haven't shown any adverse effects.

Salicylic Acid Cleanser + Azelaic Acid + Retinol

"If your skin is sensitive, using a gentle salicylic acid cleanser—along with [a prescription] azelaic acid in the morning and a very mild retinol at night with a lightweight moisturizer—can be quite effective," added Dr. Shamban.

A salicylic acid cleanser, which you can find at drugstores, removes the dead skin cells that clog pores, leading to whiteheads and blackheads. Retinol is a type of retinoid, available over the counter and not quite as powerful as retinoids.

"If your skin is oily," explained Dr. Shamban, "you can do the same except add some benzoyl peroxide in the morning and a higher-strength retinol at night."

Choosing the Right Combination

Those combinations of topical treatments and cleansers are generally effective for acne, whether or not it's a reaction to quitting birth control. However, it's important to consult your dermatologist to determine your skin's best course of action.

"If breakouts still persist, I am a proponent of considering oral treatment with the anti-androgen spironolactone," said Dr. Palm. As with birth control pills, that prescription medication will create a hormone balance that favors acne-free skin.

Of note, keep in mind that spironolactone can cause birth defects. So, if you're going off birth control and using spironolactone, make sure you're also using another reliable form of contraception.

A Quick Review

Fluctuating hormone levels due to going off birth control can cause an influx of unwanted stubborn acne.

However, there are steps that you can take to prevent or minimize a crop of stubborn pimples on your face. Modifying your diet, establishing a careful skincare regimen, and speaking to your dermatologist about topical prescription medications, like retinoids and clindamycin gel, can help get your skin under control after going off birth control.