Hormonal acne

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Hormonal acne

Hormonal acne can be very embarrassing, but what do we know about it ? Here are the best articles from the net I have read concerning hormonal acne, causes, effects, and treatment. Various points of view are exposed, and may help you to make yours :

Hormonal acne

hormonal acneAcne is not just a teenage problem. Many women are surprised and distressed to still be affected by acne in their 20s, 30s, occasionally their 40s and/or at the time of menopause.

This type of acne usually begins in the early 20s and can affect individuals who were blemish free during their teenage years.

Unfortunately, because acne is such a visible condition, hormonal acne has a detrimental affect on a person’s self-confidence, mood and well-being. Even mild acne can have a big impact on older women.

Adult acne is not the same as teenage acne which is usually more severe in the oilier facial areas including the forehead and central face. Hormonal acne more prominently involves the jaw line and chin area, then extends down the lower face and neck. These skin areas are more sensitive and easily irritated by topical agents.

Hormonal acne ranges in severity.

It may be confined to a few small red papules and pustules on the chin which appear during the premenstrual phase of your cycle, especially if you are stressed. Others have more severe acne with deeper, tender nodules that can appear at any stage of the menstrual cycle and can result in permanent scars. These lesions appear on your face and neck as well as your trunk and shoulders.

Adult females with persistent oily skin will usually have normal hormone levels and skin that will age well. Testing is worthwhile in females with persistent ‘seborrhoea’ (the medical term for overly oily skin) as some will have hormonal changes warranting treatment.

Hormones (and stress) are also responsible for acne that flares up during the first half of pregnancy or the peri-menopausal period.

Causes

Hormonal acne is thought to result from the interplay of:

*sex hormones, such as progesterones, oestrogens and testosterone
*hormones such as insulin
*chemical substances produced by the body during stressful periods and/or illness

Female hormones, produced mainly in the ovaries, include oestrogen and progesterone. Women aslo produce low levels of testosterone and androstenedione. These cause male-like effects and are known as androgenic hormones.

The upside of these hormones is they maintain muscle and stimulate your libido. The downside is that they also stimulate oil production in the skin which can result in dilated pores, oily skin, acne and excessive body or facial hair

Skin and sun care

Pore clogging or irritating skin care products will aggravate adult acne. If you’re acne prone, products labelled ‘non-comodegenic’ or ‘oil free’ are more suitable for you.

These should feel light and spread easily on the skin as opposed to more heavy products that give the skin a greasy or coated feeling. Definitely avoid using vitamin E cream or sorbolene containing products on your face (these are both oils).

In summer:

*go for a face cream with an SPF of 12 to 15 (or 20 in those with a very fair complexion) rather than 30 for your everyday skin care.
*when spending prolonged time in the sun use an SPF 25-30 either in a gel or spray formulation and/or a light gel/cream or lotion (labelled oil free and ‘non-comedogenic’)
*face creams and sunscreens containing the ingredients Mexoryl SX and Mexoryl XL (ecamsule) provide excellent broad spectrum UV protection without clogging or irritating pores. Similarly, skincare products and sunscreens using ‘Helioplex technology’ are also suitable for hormonal acne sufferers

Stress

hormonal acneStudies have shown that women who work in competitive environments under stress can overproduce male hormones. High levels of these male hormones trigger acne outbreaks in adult females.

Many women juggle jobs, friends, family, financial commitments and many other life stresses which make their adrenal glands produce more cortisol hormones, which can set off acne. Also, acne itself can cause stress!

Polycystic ovarian syndrome

Acne can also be a symptom of polycystic ovarian syndrome (PCOS) a common, treatable condition affecting up to one in ten women. See your doctor to rule out this as a cause of acne.

You should consider being tested for insulin resistance and diabetes if you have any of the symptoms mentioned above or if you:

*Have polycystic ovaries
*Family history of diabetes
*Irregular periods; and/or
*Despite diet and exercise, you are having trouble loosing excess body fat

Excess weight

Adult women who have excess body weight are more prone to acne.

Surplus fat converts the female hormone (oestrogen) into hormones that behave like male hormones (androgens) and promotes acne through various ways including increasing the production and composition of sebum (natural oil that prevents skin from drying out)

Extra sebum mixed with dead skin cells clogs pores. Inflamed or irritated pores contribute to formation of whiteheads or blackheads that turn into pimples.

Obesity also makes female acne more resistant or difficult to treat.

Insulin resistance

Metabolic abnormalities, such as high insulin levels, also play a role in female adult acne.

Insulin is important for tightly regulating the body’s levels of sugar and storage of fat. People with abnormally high levels of insulin are prone to developing diabetes.

The harmful effects of high insulin levels include over-stimulation of the ovaries, which can lead to ovarian cyst formation (e.g. polycystic ovaries), menstrual cycles of variable duration, infertility and higher levels of hormones with testosterone-like effects.

The pill

Some contraceptive pills including high dose progesterone pills, the ‘mini’ (progestogen only) pill and contraceptive implants can also cause acne by boosting sebum production, while all other pills usually help improve acne (some more effectively than others).

Fertility and acne

For females with acne and polycystic ovarian syndrome, metformin can be beneficial not only for acne but also for increasing fertility and therefore the chance of falling pregnant.

Unfortunately, most other treatments used to assist fertility in females trying to conceive either traditionally or by in vitro fertilisation may temporarily worsen acne.

Treatment

For mild hormonal acne, treatment is similar to that of mild teenage acne however more gentle products are usually preferable.

Over the counter products containing salicylic acid microgel complex, benzoyl peroxide (2.5 – 4.5 per cent to minimise irritation) or an acne wash containing Montaline C40 may be enough to treat mild cases of acne.

If that doesn’t work, a doctor can prescribe either a topical retinoid that keeps pores open and prevents inflammation, or a combination treatment such as Epiduo (retinoid + benzoyl peroxide) or Duac (antibiotic + benzoyl peroxide).

If you’re still not seeing a response or if the acne is more severe, an oral antibiotic works well. However as this type of acne can be very persistent, hormonal agents can be very effective and are another safe option.

Severe acne of all types usually improves with the prescription drug isotretinoin (eg, Roaccutane).

The treatment of hormonal acne

hormonal acne treatmentWhat can be done for female adult acne? The good news is that plenty can be done!

Adult acne will usually respond to acne treatments used for teenage acne including medicated creams, gels and oral antibiotics.

If you have more severe acne, if your acne fails to respond to topical therapy or if you can’t tolerate topical treatment, there are other alternatives. The combined oral contraceptive pill, plus or minus anti-androgens such as spironolactone, may help achieve longer-term acne control.

Checking hormone levels

Most adult females with acne have relatively normal levels of androgens (testosterone) and only about 10 per cent will have abnormally high levels of androgens – including females with polycystic ovarian syndrome.

The regularity of your menstrual cycle is one of the best ways to assess how well regulated your hormones are. If your period is regular, an abnormality in your hormone levels is unlikely.

You should consider checking with your doctor about possible hormonal abnormalities if you have acne accompanied by any of the following:

*Abnormal menstrual cycle, such as a significant variation in the time to your period or in its duration
*Extremely oily skin, excessive facial or body hair growth, or thinning or loss of scalp hair
*Failure of your acne to improve well with treatment
*Darkening of skin on the side of your neck and armpits or
*A male rather than female pattern of fat distribution – in other words, more fat on your torso or belly rather than on your hips

Obesity and insulin resistance

A useful treatment for females with hormonal acne and insulin resistance/high insulin levels is a low dose of metformin, a drug normally used for diabetes. This treatment has many advantages. It not only reduces androgen levels and improves acne but also normalises insulin levels and helps with weight loss and the prevention of diabetes.

Patience is required because the beneficial effects of metformin take time. If used on its own, it can take three to six months before an improvement in acne is seen. This improvement is likely to continue for more than a year. Moreover, metformin’s beneficial effects on weight and metabolism, plus its ability to delay or prevent diseases such as diabetes and bowel cancer, can be life-long.

For rapid acne control, metformin is best used in combination with other acne treatments such as topical creams and lotions during the first three to six months.

‘Low androgenic’ combined oral contraceptive pills (including Loette and Microgynon 20) normally have beneficial skin effects in females with acne. These can include a reduction in the oiliness of skin and pore size (starting after one cycle), fewer pimples less often (this may take three cycles to start but improvements continue for up to six to nine cycles), and a reduction in excessive body hair (after three or more cycles). These beneficial effects are often lost or greatly reduced when taken by females who are overweight or obese.

Combined oral contraceptives

hormonal acneThe heartening news is that no matter how mild or severe your acne, the combined oral contraceptive can often be effective.

The combined oral contraceptive regulates the menstrual cycle and has direct and indirect anti-androgenic actions, which can help in controlling acne.

As with any medication, combined oral contraceptives have varying benefits and side effects.

For more severe and difficult to control acne, combined oral contraceptives containing cyproterone acetate have the best proven benefits in female hormonal acne.

However, it is important to know they carry a slightly higher risk of some side effects including venous thrombosis (e.g. deep vein thrombosis) and embolism (e.g. blood clots that travel through the veins and heart).

The oral contraceptive pill also has a number of medical benefits such as reducing the risk of uterine or endometrial cancers.

If you have mild to moderate acne, you may want to opt for other combined oral contraceptives which also have proven benefits in hormonal acne but have a lower risk profile.

Combined oral contraceptives (Loette, Microgynon 20ED) that contain low doses of oestrogen and levonorgestrel (100mg) have a lower side effect risk ratio, including a lesser risk of venous thrombosis. However, breakthrough bleeding is a more frequent side effect of such lower dose pills.

Common side effects of combined oral contraceptives include mood changes, nausea, weight gain, menstrual spotting and breast tenderness. If you smoke or have high blood pressure, you increase your risk of important side effects such as blood clots and strokes.

Combined oral contraceptives have a slow onset of action so your doctor may suggest a combination of a combined oral contraceptive and other acne therapies, such as a topical retinoid, during the first 3-6 months to improve acne control.

Other combined oral contraceptive pills with proven benefits include those containing Cyproterone acetate (Brenda 35ED, Diane 35ED, Estelle 35ED, Juliet 35ED). Those containing drospirenone (Yasmin), desorgestrel (Marvelon) and gestodene (Femoden and Minulet) are also of proven benefit.

It is generally wise to steer clear of progesterone-only contraceptive pills – also known as minipills – as they are likely to worsen acne. Similarly, contraceptive implants can make acne worse.

Spironolactone

An advantage of spironolactone is that you are likely to see benefits sooner than with a combined oral contraceptive.

You may notice a reduction in skin oils after the first month. By the end of the second month, your acne should begin to improve and continue to do so for another few months.

There can be side effects such as irregular or heavy periods and breast tenderness but these are eased or prevented if you also take a combined oral contraceptive. Spironolactone is taken daily at doses of 50-100mg for acne.

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Suffering From Hormonal Acne? Here’s What You Can Do About It…

One of the toughest types of acne to get rid of is hormonal acne. This is because acne is not really the main problem, but simply a symptom of a more serious internal health problem or imbalance. It’s an obvious sign that your body’s crying out for help. That’s why topical skin care products (no matter how amazing) or contraceptive pills or eating ‘pretty healthy’ often still don’t work against stubborn hormonal acne.

My own struggle with acne was primarily due to hormonal imbalances, and it took me a while to figure out hormones, how they relate to acne, and how to eventually cure my own acne. So I know how frustrating it can be when you feel like you’ve tried everything; you’re eating super healthy organic food, taking helpful supplements, using top quality natural skin care products, you’re exercising and meditating daily, you’re detoxing regularly etc…..and you still can’t get rid of your acne completely! I was once at that stage and it just made me feel hopeless and just want to give up :(.

hormonal acneSometimes, despite your best efforts, you may need some extra help, some more info and a different approach, when it comes to hormonal acne. It’s really helpful and important to not only figure out whether your acne is hormone related (and not just due to toxicity due to years of an unhealthy lifestyle) but also figure out exactly how your hormones are unbalanced, what kind of imbalance it is, how it came to develop in the first place, and what specifically can you do to balance your hormones and regulate your sebum production for your unique situation (since everybody’s health, body, and acne situation is different).

Plenty of times I’ve been to the doctor or dermatologist to try and find out more about my hormonal acne, only to be put on the contraceptive pill (which only made my hormonal balance worse and made me break out even more when I tried to go off it). I felt like it was so difficult to find any real answers, and I spent a lot of years doing my own research, looking through forums, testing things on myself until I finally managed to re-balance my hormones and clear my skin. So I want to share with you what I’ve learnt about hormonal acne in the hopes that it will help you too :).

We all know that one of the main contributors to acne is overactive oil glands in your skin that produce excess sebum (oil) that then collects in your skin, blocking hair follicles and pores. This forms plugs that prevent the normal drainage of oil and also causes dead skin cells to become trapped. Bacteria in your skin then feed on the excess sebum which causes an infection which results in a pimple.

So you can understand why many doctors and dermatologists say excess sebum is the cause of acne. But really, it’s not. Excess sebum is just another symptom of a bigger problem within your body that’s causing it. Instead of getting rid of the symptom (excess sebum) by using harsh drugs and chemicals, we need to actually fix the root cause of excess sebum and acne.

2 Main Causes of Excess Sebum:

Toxins
Excess Hormones (androgens)

Excess toxins that your body has to expel through the skin can be caused by:

Sluggish digestion, poor kidney and liver function
Candida overgrowth
Bad diet (junk food/low quality food)
Chemicals in food and environment
Allergies and Food Intolerances

Hormonal imbalances (particularly excess androgens) also increase sebum production. Hormonal imbalances can be caused by:

Emotional stress
Physical stress
Environmental synthetic hormones (e.g. xenoestorgens in plastic)
Hormones in animal produce/food
Contraceptive pills
Genetic predisposition
Bad Diet, Poor Nutrition

As you can see, a lot of the root causes of hormonal imbalances are diet, lifestyle and emotional health related. These causes result in certain types hormonal imbalances that I’ve found to be common in acne sufferers:

Adrenal Stress/Fatigue with elevated Cortisol levels
Estrogen Dominance (Low Progesterone)
Hypothyroidism
Insulin Resistance
Polycystic Ovarian Syndrome (PCOS)

How Hormonal Imbalances Result In Acne

A lot of you already know that the main group of hormones that help to control sebum production is androgens (male hormones). In particular Testosterone, and even more specifically a type of Testosterone called DHT (which is formed when Testosterone is converted to DHT by an enzyme called 5 Alpha Reductase).

It’s really helpful to realize that hormones are like a team that all work together. They ALL impact each other in different ways. So even though ‘excess androgens’ is what causes increased oil production there can be different reasons why you have excess androgens in the first place. For example, you may be lacking in other hormones that usually balance out androgens and so your androgen production may be a little out of control. You could also have a hormonal imbalance that causes an increase in the enzyme 5 Alpha Reductase so you may have an increased amount of Testosterone being converted to DHT resulting in more oil production and more acne. I don’t want to get too technical, but I guess my point is, different people have different reasons to why they may have excess androgens, and any imbalance in your other hormones can send your androgen levels out of whack too.

The type of hormonal imbalances and their root causes probably need an article each to explain how you can tell if you’ve got a problem with it and what specifically you can do about it. So I’ll write an article on each in the future. But here are a few general things you can do to help balance your hormones overall:

hormonal acne1) De-stress!

Please don’t underestimate the impact this has on your hormones and acne. Any time you’re stressed your adrenal glands pumps out Cortisol that contributes to increased androgens and increased acne.

2) Eat a Low GI Organic Diet

Cut out all bad food, especially stimulants and sugar. Eat low GI, healthy organic food. Cut down on fruits too (even though they’re good, don’t eat too much because the sugar can be stimulating and add stress).

3) Eat plenty of Essential Fatty Acids

Essential fatty can help reduce the production of androgens and balance hormones. People with acne have been shown to have deficiencies in EFAs. You can also apply topically to your body, face and hair for added benefits.

Flaxseed Oil (15-60ml per day)
Omega 3 Fish Oil (5ml per day)
GLA from Evening Primrose Oil (5ml per day)
Sunflower Seeds
Pumpkin Seeds
Grape Seed Oil
Extra Virgin Olive Oil
Avocadoes
Olives
Nuts
Seeds
Coconut Oil

4) Make sure you’ve got enough of these Vitamins and Minerals

Vitamin C
Vitamin B’s (especially Vitamin B6)
Zinc
Magnesium
Vitamin A

5) Herbs that help to balance hormones

Licorice
Rhodiola
Schisandra
Ashwagandha
Holy Basil
Chasteberry (Vitex Agnus-Castus)
Maca
Burdock
Milk Thistle

6) Natural Anti-Androgrens

Green Tea Extract
Saw Palmetto
Nettle
Spearmint Tea
Pumpkin Seed Oil
Emu Oil
Soy Isoflavones
Beta Sitosterols
Alzelaic Acid

These are just some general herbs and important vitamins and guidelines of things that can be very helpful for balancing your hormones overall. Make sure to do your own research to make sure something’s right for you.
The most important thing you should do first is to go and get your hormones tested with a saliva test (more accurate than a blood test). It’ll give you a better picture of what you need to work on, and like I said earlier, I’ll be writing more articles that go into detail on some of the things above that will give you more specifics and hopefully help you :)

Remember, if you’re suffering from hormonal acne and nothing you’ve tried seems to be working, please don’t give up. It may take a while to re-balance your hormones again, but once you do, it will be soo worth it!

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Hormonal factors key to understanding acne in women

SAN DIEGO (March 16, 2012) Information presented at American Academy of Dermatology’s 70th Annual Meeting by Bethanee Jean Schlosser, MD, PhD, FAAD, assistant professor of dermatology and director of Women’s Skin Health at Northwestern University, Feinberg School of Medicine.

OVERVIEW:
Teenagers are the age group most commonly thought to struggle the most with acne, but dermatologists are finding that late-onset or adult-onset acne is becoming increasingly common in women in their 20s, 30s, 40s and even 50s.

Although there is no one single cure that works in all patients with acne, dermatologists can recommend patient-specific treatment regimens to control acne and minimize future breakouts. In women, hormonal therapies are commonly used to treat acne safely and effectively.

HOW HORMONES INFLUENCE ACNE:
Primary causes of acne

*Excess sebum, or oil gland, production (influenced by hormones).

*Skin cells that shed become abnormally sticky and accumulate, or clog up, in the hair follicle (influenced by hormones).

*Increased number of the acne-causing bacterium Propionbacterium acnes, or P. acnes.

*Skin inflammation.

The role of androgens

Androgens, the male hormones present in both men and women, can contribute to acne flares by overstimulating the oil glands and altering the development of skin cells that line hair follicles in the skin.
The majority of women with acne have normal androgen levels, but hormonal testing is recommended for females who have acne accompanied by excess facial or body hair, deepening voice, or irregular or infrequent menstrual periods.

TREATING ACNE IN WOMEN:
Factors to consider

*Therapy must be tailored to the patient’s specific type and severity of acne: mild, moderate or severe.

*Pregnancy considerations must be taken into account when prescribing acne medications because several oral and topical medications should not be used when trying to conceive or during pregnancy.

*Adult women may be more likely to have dry skin as they get older, and topical acne medications may cause more skin irritation in patients with dry skin.

*Some adult women with acne also may show signs of rosacea (another common skin condition characterized by redness and inflammation), which would make some topical acne medications harder to tolerate.

Topical retinoids

*In acne patients of any age, dermatologists consider topical retinoids (medications that contain vitamin A derivatives) first-line therapy by for mild-to-moderate inflammatory acne accompanied by blackheads and whiteheads.

*Dr. Schlosser noted that topical retinoids also are the preferred        therapy for overall long-term prevention of new acne.

Hormone therapies

hormonal acne skin care*Combination oral contraceptives (also known as “the pill”) have been found to effectively clear acne in women either when used alone or in conjunction with an anti-androgen medication, such as spironolactone.

*Many different oral contraceptives have been shown to be effective in treating acne. Oral contraceptives approved by the U.S. Food and Drug Administration (FDA) for the treatment of hormonal acne contain ethinyl estradiol plus either the progestin norgestimate, norethindrone acetate or drospirenone.

*These oral contraceptives work together to alter levels and activity of hormones that can trigger acne.

*Patients must be carefully screened before using any hormonal therapy for acne because there are numerous contraindications (or factors that increase the risks of a particular medication). Contraindications for use of oral conceptive pills include, but are not limited to:

*Personal history of breast cancer.

*Heart attack, stroke or blood clots.

*Uncontrolled high blood pressure.

*Abnormal vaginal bleeding.

*Patients also need to be monitored regularly while using hormonal therapies.

TIPS FOR ACNE PATIENTS:

*Dr. Schlosser advises patients to use non-comedogenic or sensitive skin products in order to reduce the formation of new acne lesions and to minimize skin irritation.

*Mild cleansers should be used twice a day.

*Avoid cleansers or other skin care products with scrubbing particles or a gritty texture, as they can irritate the skin.

*Use a non-comedogenic moisturizer daily.

*Apply the appropriate amount of topical acne medications (enough for a very thin layer, generally a pea-sized amount for the face) to the skin. Using more medication than is recommended will not produce better results, but may cause more irritation or dryness.

*When starting treatment with topical retinoids, Dr. Schlosser advises that the therapy should only be applied three times a week for the skin to get accustomed to it. Over time, the frequency of the medication should be gradually increased with the goal of using a topical retinoid every night.

*Avoid picking, squeezing, popping or otherwise manipulating acne lesions to minimize trauma to the skin to help reduce the risk of scarring and secondary bacterial infections.

ACADEMY EXPERT ADVICE:
“With acne, it’s important for patients to understand that there are no quick fixes, and none of the therapies used to treat acne work overnight,” said Dr. Schlosser. “Patients need to be consistent when using their acne medications and realize that they may not see the full effects of their treatment regimen for eight to 10 weeks — and in many case, some type of maintenance therapy is required for long-term clearance of acne. ”

FACTS:

*A study examining the prevalence of acne in adults over age 20 found that acne affects more than 50 percent of women between the ages of 20-29 and more than 25 percent of women between the ages of 40-49.

*The study found a disproportionate number of adult women were affected by acne compared to similar-aged men.

*A 2011 clinical study examining photos of women from age 10-70 for visible signs of acne found that 45 percent of women aged 21-30 had clinical acne, 26 percent of women aged 31-40 had clinical acne, and 12 percent of women aged 41-50 had clinical acne

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FEMALE ACNE AND HORMONES

Acne is Extremely Common
hormonal acneAlmost everyone has at least a little of it at one point or another in their life. Though acne is supposed to go away after the teens, it can persist for many years. A few whiteheads or blackheads or an occasional small red pimple can usually be tolerated. However persistent or severe acne is much more troubling.

If someone has acne which is enough to bother her, it is best not to just wait to “grow out of it.” One her first visit, one of my patients said to me recently, “I’m 63 and I’ve been waiting for my acne to go away since I was 18. Though acne, fortunately, rarely lasts this long, it is still common in the thirties and forties. If you are bothered by acne, it is reasonable to seek medical help for it.

Acne is one of those conditions about which insensitive jokes are still made. Yet research has shown that acne lowers self-esteem and is extremely stressful. One study has shown that unemployment rates are higher in both women and men with acne, showing that people with acne are discriminated against. Though our society has been learning not to discriminate against people who are physically challenged, no one speaks up for the miseries of acne.

Acne and Polycystic Ovary Syndrome (PCOS)
PCOS is a very common female hormonal disorder, one in which great advances in treatment have been made. [PCOSupport: The Polycystic Ovarian Syndrome Association Web Site] One of the four main features of PCOS is testosterone-induced skin and hair changes. These are acne, increased facial and body hair and scalp hair thinning. Other features are irregular periods, difficulty controlling weight and metabolic changes. Female acne can be a sign of PCOS. If you have some of the other features, getting worked up for PCOS is a good idea. On the other hand, many women with hormonal acne have just acne, nothing else.

Acne, the Teenage Years and Beyond
Studies show that the earlier acne appears the more likely it is to be severe, so the popular idea that acne is only a teenage problem is erroneous. Teenagers are often more bothered by acne than they let on. I work a lot with adolescents and find that though they may not admit to their parents that their acne is distressing, it is a great relief to them when treatment clears their skin.

When acne is more severe it should be regarded as a pressing medical problem, because permanent scarring may result. A few acne scars may not show, but an accumulation of scars over time can cause considerable damage to the complexion. If acne is enough to cause distress, it is best to get it treated promptly to minimize scarring.

Hormonal Testing for Acne
For more than very mild acne, hormonal testing is useful. This is the same as carried out for extra hair growth or alopecia, and consists in measuring androgens to see if elevated levels are involved in causing the acne. However, even if androgen levels are normal, they are still involved in starting the acne process. Some, but not most, women with acne, have a hormonal disorder. Evaluation by a physician experienced with these conditions is a good idea for severe acne that is not controlled by dermatological medications, or when there are also irregular periods, increased hair, or a weight problem.

Treating the Hormonal Cause of Acne
If have acne and are reading this article, it is likely that the standard measures have not cleared your skin. Fortunately, treatments directed at the hormonal cause usually work when standard ones have not.

Here’s why:
Hormonal treatments block the stimulating effect of androgens on the oil glands. Because this form of treatment stops acne before it begins, it often gives the best result. Only a few specialists are familiar with hormonal treatment and it requires blood tests, and oral medication. However, these may be well worth it if your acne cannot be controlled by standard measures. Even quite severe cystic acne which has resisted treatment for years often clears completely with properly planned hormonal treatment.

I’ll return to hormonal acne treatment shortly but want to review the standard measures first.

Skin Care for Acne
Good skin care is particularly important for women with acne. However, good hygiene, though it will help to control acne, is unlikely to take it away. For that, medication is needed as will be discussed later.
Despite what your mother and your friends may tell you, diet is not an important factor in acne. Chocolate and high fat foods do not cause acne, and eating less of these foods — though it may be good for health overall — will not solve an acne problem. Nor is acne due to poor hygiene. Basically, if you have acne it is not anything you are doing.

Anyone with a tendency to acne should only apply non-comedogenic preparations to their skin. “Comedone” is the medical term for whiteheads and blackheads so “non-comedogenic” simply means not causing breakouts. Non-comedogenic products will not feel greasy if rubbed between the fingers.

hormonal acne skin careA soap-free skin cleanser, such as Purpose®, or a soap that is only slightly drying such as Clinique® for dry skin, is best. Soaps with perfume or high moisturizer content may cause problems. Astringents contain alcohol which dries the skin. Although use of an astringent may make the skin feel less oily immediately after use, it will not stop the increased oil production involved in acne and may irritate the skin. Abrasive preparations also are best avoided.

Some women with acne notice that it gets better after sun exposure. This is not a good way to control acne for two reasons. Firstly, long term sun exposure greatly increases the risk of skin cancer (including melanoma). Secondly, though the skin dries up initially after sun exposure there may be a rebound later, when oiliness actually increases. Sunbathing may therefore exacerbate acne in the long run. Use of a non-comedogenic sun screen lotion that has a Sun Protection Factor (SPF) of at least 15 is recommended. If you are in the water, it will need to be reapplied frequently, whatever it says on the package.

Another important aspect of skin care for people with acne is the use of moisturizers. Dry skin is particularly common in people who live in a northern climate. While women with acne usually have oily skin, when acne is treated, the skin often gets dryer. Some women have oiliness in some facial areas and dryness in others. Many will benefit from the use of a moisturizer, but of course it should be non-comedogenic. There are hundreds of moisturizers on the market, many of which are not really effective. Two good ones are Vaseline Intensive Care Extra Strength (not made from Vaseline which should not be put on the skin), and Mi Fine Skin. The latter was developed by a Cleveland dermatologist, Beno Michel, MD and is the best in my experience. It can be ordered by telephone (1-800-SKIN-066 or on-line www.mifineskin.com). I have no commercial interest in this product but my wife and I use it and have ceased to have dry skin problems.

While acne is not caused by poor hygiene, a good routine can help it. For mild acne, regular use of a skin cleanser at least twice a day, and a daily application of over the counter preparation with benzoyl peroxide, will produce some improvement. But if a regular skin care routine does not help enough, a visit to a physician experienced with acne is the next step.

Non-Prescription Acne Treatments
If acne is mild, there are simple, home treatments for acne that don’t require a prescription.
The best over-the-counter (OTC) acne medicine is benzoyl peroxide (BP). It is sold under several brand names, of which the best known are Oxy 5 and Oxy 10. These have 5% and 10% benzoyl peroxide respectively. BP is an antibacterial, and seems to dry the oiliness of the skin also Like other topicals, BP does need to be applied daily. If redness or irritation of the skin develops, BP often still works if it is put on for 30 to 45 minutes and then washed off. This works better than skipping days.

There are many other OTC acne remedies, not all of which are effective. Some contain ingredients that can irritate the skin or even make things worse. I suggest using a product which contains benzoyl peroxide without a lot of additional ingredients.

Standard Prescription Acne Treatments
Here are the most common medical treatments which most with acne have probably tried already:
Topicals such as tretinoin (Retin-A) and adapalene (Differin) which make the surface protein of the skin less sticky. Topical antibiotics such as erythromycin and clindamycin sold under a variety of brand names.
Oral antibiotics such as tetracycline, minocycline, and erythromycin. Of the oral antibiotics, I think erythromycin is most suitable for women as it does not cause the photosensitivity or yeast infections sometimes induced by tetracycline or minocycline.

Two oral contraceptives (OCs ) have been approved at this time (11/01) for treatment of acne in women who want to be on the pill. These are OrthoTriCyclen® and Estrostep®. (I was involved in the research for both and have lectured and consulted for both companies.) The number of pimples are reduced by about 50%, on average. This is a significant improvement.

However, the pill does not give adequate clearing for all women with acne. For a woman whose skin is still broken out despite use of one of these OCs, or who does not want to take an OC, there are other ways to prevent hormones from triggering it. OCs can be combined with the other acne treatments described above or with other hormonal treatments as described below.

Hormonal Treatment of Acne
Many women with marked acne do not get enough clearing with these standard acne treatments. In this situation, treatment directed at the hormonal cause may produce much clearer skin. These approaches are not often used by dermatologists, who treat most acne. If you have persistent acne and want to consider this form of treatment, you may need to see a physician with special expertise in female hormone problems who might be a endocrinologist or a gynecologist. Be sure to check first because not all doctors who deal with female hormones work with acne.
At the Hormone Center of New York, when I see a woman who has had acne which won’t go away, the first step is to measure hormone levels in order to determine the specific hormonal factors which are causing her acne. Treatment varies depending on the individual but usually involves lowering free testosterone and protecting the oil glands from this hormone. Counteracting the hormonal cause of acne often clears up the skin when the conventional measures have failed.

Oral contraceptives can be part of the treatment because they lower free testosterone. The addition of medications which block testosterone can dramatically clear the skin. Spironolactone (Aldactone®) is usually quite effective. Though often used with an OC, spironolactone can also be used by itself. Spironolactone was originally developed as a blood pressure medication. It blocks aldosterone, a blood pressure-raising hormone. Because testosterone is chemically similar to this hormone, it is also blocked by spironolactone.

Finasteride, sometimes useful for other testosterone problems in women, probably will not help acne and there is serious worry about its safety in pregnancy. This is discussed in detail in the section on treatment of unwanted hair. [Hormones and Unwanted Hair] Although birth defects have not been reported with use of spironolactone to my knowledge, they are theoretically possible since it blocks testosterone, so it is important not to get pregnant while taking this medication also.

A new OC, Yasmin® contains drospirenone, a close cousin of spironolactone, as its form of progesterone. It is not labeled for acne in the United States at this time and is equivalent to a rather low dose of spironolactone. Dose is definitely important with spironolactone; low doses are less effective.
Any acne treatment takes at least a few weeks to work. Once a breakout has occurred, healing is gradual. The best thing is to prevent the breakouts from happening in the first place. This is why acne treatments should be used all the time, not just when lesions appear.

Accutane
The last resort is isotretinoin (Accutane®), a potent form of vitamin A. This drug has made a great difference for some people with bad acne but it can have serious side effects and so must be used very carefully with close monitoring. Absolute avoidance of pregnancy is essentially since fetal isotretinoin exposure can produce serious birth defects. Fortunately, once it is out of the body, isotretinoin will not affect pregnancy outcome. While isotretinoin has a place, in my experience, hormonal treatment is much easier to tolerate and often gives a better result. This is because androgen blockers not only cut down on breakouts but often give a brighter, feminine appearance to complexions which have been damaged by acne.

Acne and Extra Hair
Increases in hair growth and female acne do, unfortunately, go together because the hormonal cause of the two conditions is the same. In both cases, androgens (testosterone and related hormones) act to trigger the condition.
The initial event in acne is increased oil production. The oil is produced in the sebaceous glands which are part of the same skin structure as the hair follicles. The two are part of the same skin structure, called the pilosebaceous unit. While the sebaceous gland responds to testosterone by making more oil, the hair root responds by growing hair that is longer, thicker and darker.

The sebaceous glands respond immediately to testosterone and so acne usually appears fairly soon after levels go up. The hair follicle however may take months or years to respond so increases in hair growth generally appear at a somewhat later age than acne. Not everyone follows this pattern however.

What Causes Acne?
Acne is an androgenic disorder, like hirsutism [Hormones and Unwanted Hair], which means that it is set off by the effects of the family of hormones called androgens. These include testosterone, DHEA-S and others. Testosterone is the most important of these. While androgens are often thought of as male hormones, this is misleading because adult women have active levels in their blood. Women’s levels are only about a tenth of those found in men

The first event leading to acne is stimulation of the sebaceous (oil making) glands by testosterone. Next, the pores plug up and trap the oil inside. Bacteria grow in the trapped oil, causing the production of irritating chemicals. Finally the body’s immune system comes into play. There is both good and bad news about this immune response. While it fights the bacteria, it also causes the redness, swelling, pus-like fluid and later scarring which make acne so unsightly.

Many women notice that their acne is worse in the week before their period. The exact reason for this common pattern is not known, but obviously it is related to hormonal changes during the cycle, perhaps a rise in testosterone at midcycle.

Other Oily Face Conditions
In addition to pimples, increased oil can cause flat areas of inflammation on the skin. In the midline this is called seborrheic dermatitis; in the butterfly area of the nose and the skin next to it, the inflammation is called acne rosacea. The latter can be very embarrassing because it sometimes makes the nose red, which can be confused with the signs of excessive alcohol use.

A Final Note
For me as an endocrinologist, acne is one of the most satisfying conditions to treat. It often gets much better with the hormonal treatments described above, everyone can see for themselves how great the change has been and the person’s life can be greatly changed for the better.

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Hope these articles bring you good informations about hormonal acne and help you.

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