HORMONAL ACNE- Overview, Statistics and Facts, Risk Factors, Causes, Indications & Manifestations, Diagnosis, Treatment & Management, Complications, Prevention Methods, Outlook & Skin-care

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Overview

What is hormonal acne?

Hormonal acne is also referred to as adult acne. This term is used to refer to acne that forms primarily duet to hormonal changes. Acne can be defined as pimples which result when  the hair follicles are clogged with sebum, proteins and dead skin cells. Clogging attracts bacteria and this leads to inflammation, alongside pimple formation.

 

Sebum, an oily/ greasy substance produced from the sebaceous glands of the skin plays a protective role in the skin. When it is produced in excessive amounts, the pores become clogged and dead skin cells are enmeshed. Skin bacteria are then attracted and his leads to inflammation and formation of acne. Breakouts are formed in adulthood and they could range from blackheads and whiteheads to painful cysts.

 

Hormonal acne is a difficult condition to treat, but not impossible. Sometimes, it might not respond to acne creams such as antibiotics and topical retinoids.

Most common complications include redness, scarring, pigmentation and development of comedones on the face.

Hormonal can is different from fungal acne in terms of the kind of spots formed and where they are located. In fungal acne, the spots are smaller but with even sizes and itchy.

 

High humidity, stress, poor diet (refined carbohydrates) and pollution can worsen hormonal acne. Apart from these, squeezing at blemishes, too, can lead to worsening of the condition.

 

 Statistics and Facts

  • Hormonal acne is a very common condition in women (majorly expectant and post-menopausal women) and people assigned female at birth (AFAB) especially in adulthood.
  • It affects adult individuals, both men and women,  between 20 and 50 years of age.
  • It is the most common dermatological condition in the United States, affecting almost 8 out of 10 people at some point in their lifetime.
  • Acne occurs  most common among teenage groups.
  • It can develop anywhere on the body. For example, the face (chin, jawline), on the chest, shoulders, back and neck.

 

Risk Factors

 

Several factors can lead to formation of acne, and these are:

  1.  Having an oily  or greasy skin.
  2. Wearing comedogenic products (products which block pores).
  3. Excessive exposure t sunlight.
  4. Genetics.
  5. Hormones.

 

Situations that are associated with acne include:

 

  1.  The period of time during pregnancy and just after delivery.
  2.  During perimenopause or menopause.
  3.  Around the time of a woman’s period.
  4.  When taking testosterone-based hormonal medications.
  5.  Hormonal imbalance such as polycystic ovarian syndrome (PCOS).
  6.  Intake of medications which are associated with development of acne such as steroids  and some birth control pills that contain progestin.

 

 

 Causes

What are the causes of hormonal acne?

  • Causes of hormonal acne can be categorized into controllable and uncontrollable causes.
  • Controllable causes are:
  1. Lack of adequate quality sleep.
  2. Stress.
  3. Use of non-comedogenic or non-acnegenic skin-care products.

 

  • Uncontrollable causes are:
  1. Men who are on testosterone therapy.
  2. Genetic predispostion and family history of acne.
  3. Pre-existing medical conditions such as  poly-cystic ovarian syndrome (PCOS).
  4. Alterations in hormone levels in women. For example, during pregnancy and menopause.
  5. Adverse effects of steroid medications.

 

 

  •  Many factors contribute to the formation of acne, including;
  1. Sex hormones such as androgens (male sex hormones). Androgens cause alterations in the skin and also directly influence inflammation.
  2. Sebaceous glands are androgen receptor-rich. Interaction between androgen and their respective receptors leads to increased sebum production.The skin becomes greasy and sebum builds up.
  3. Note that it is in the sebaceous gland where hormone precursors are chemically converted to testosterone and dihydrotestosterone (DHT).

 

  Indications & Manifestations

Individuals who suffer from hormonal acne have can present with various types of acne spots and pimples such as:

  1. White heads.
  2. Blackheads.
  3. Comedones. These refer to pores which are clogged  such as the whitehead and blackhead.
  4. Papules. Papules are infected or inflamed clogged pores and they appear like pimples which are red, brown or violet. The skin tissue is raised and less than 5mm in diameter.
  5. Pustules. These are pus-containing skin bumps or pus-filled papules.
  6. Nodules which are larger, harder and painful pimples.
  7. Cysts which are pus-filled nodules.

 

The above mentioned types of lesions can appear on the following areas of the body:

  1. Face
  2. Cheeks
  3. Neck
  4. Shoulder
  5. Chest
  6. Back

 

Hormonal acne can cause cysts and nodules which are not only deep but also painful. These cysts and nodules can then leave scars or discoloration of the skin as they heal, and tbis is referred to as post-inflammatory hyperpigmentation.

 

 Diagnosis

How is hormonal acne diagnosed?

  •  Hormonal acne is diagnosed by a skin specialist (dermatologist) during a clinical exam of the skin.
  • A dermatologist assesses and evaluates the acne and factors which are likely to contribute.
  • These factors are:
  1.  Poor stress management and unhealthy sleep habits.
  2. Medications currently in use,
  3. Hormonal alterations.
  4. Regular use of skin care products.

 

Treatment & Management

How is hormonal acne treated?

  • Various treatment options can be employed based on how severe the acne is.
  • Treatment is aimed at:
  1.  Reducing pimple formation.
  2.  Lowering production of sebum.
  3.  Reducing inflammation.

 

  • Treatment options depend on:
  1.  Severity of the symptoms.
  2.  Symptoms which bother the patient.
  3.  Any prior treatments.

 

  • Usually, combination regimens work best.

 

  • Treatment options are:
  1. Application of topical creams for blackheads and whiteheads. .Also, topical antibiotics such as dapsone and clindamycin can aid by killing bacteria and reducing inflammation.
  2. Benzoyl peroxide and/or topical antibiotic for inflammatory acne.
  3. Antibiotic for moderate to severe acne.
  4. Steroid injection for cystic acne.
  5. Winlevi, a new cream which treats hormonal acne by reducing rate of production of oil in the skin.
  6. Topical retinoids such as tretinoin.
  • Generally, over-the-counter medications, topical antibiotics and retinoids (mentioned above) are used against mild symptoms.

 

  • For more severe symptoms:
  1. Antibiotic pills such as doxycycline taken for shorter periods (3 months) can kill bacteria and reduce inflammation.
  2. Estrogen and progestin-containing birth control pills can lower acne-causing hormones such as testosterone.
  3. Spironolactone, which is used for management and treatment of high blood pressure, can be used off-label for hormonal acne as it lowers testosterone levels. It blocks androgen receptors.
  4. Isotretinoin, a retinoid pill, is used to treat severe cystic acne although it has many side effects.

 

  • Other treatment modalities are;
  1.  Dietary changes.
  2.  Laser therapy.
  3.  Regular cleansing of the skin. For example, daily.

 

  • Diet for hormonal acne:
  1. Low GI (glycemic index) foods such as nuts and seeds, whole grains and cereals and non-starchy vegetables.
  2. Omega-3 fatty acids that lower inflammation. These can be found in oily fish such as wild salmon and seeds such as flaxseeds.
  3. Anti-oxidants. Blueberries and green tea are examples of foods that are high in anti-oxidants.
  4. Milk alternatives. Reduce intake of milk and other dairy products. Try various alternatives and check whether there will be a positive outcome on the skin.

 

Complications

Scarring of the skin or skin discoloration (post-inflammatory hyperpigmentation).

 

 Prevention Methods

How do we reduce chances of developing hormonal acne?

  • Visit the dermatologist at least twice per year for skin check-ups.
  • Use skincare products that do not clog skin pores.
  1. Lifestyle modification:
  2.  Better quality sleep.
  3.  Consume a healthy diet.

 

 Outlook & Skin-care

  • Hormonal acne affects the skin by causing breakouts, which look like lesions or bumps on the skin. These can become red, painful and sore if not properly managed and treated.
  • Untreated acne can lead to scarring on the parts where lesions had formed.
  • Good skin-care routine:
  1. Wash the face two times per day with clean water and a gentle cleanser.
  2. Wash the face after perspiration.
  3. Avoid squeezing the acne pimples.
  4. Do not use harsh soaps or rough washcloths.

 

  • Other basic tips:
  1. Consume whole-foods that are low in sugar. Also, include healthy fats in your diet. For example, omega-3 fatty acids.
  2. Lower intake of milk and other dairy products.
  3. Regularly perform physical exercises and work outs.

 

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