The Truth About Hormonal Acne

Hormonal acne. We have all heard of it and probably experienced it. Whether hormonal acne plagues you on a daily and monthly basis or you are one of the lucky ones - learning about what hormonal acne is and how you can combat it can only serve your skin health for the better. 

What Is Hormonal Acne?

Hormonal acne, also known asadult acne, is caused by excess sebum (or oil) in the sebaceous glands [1]. 

Hormonal acne can be [1-4]:

• White heads: oil and dead skin block the sebaceous gland or hair follicle. Usually caused by excess oil on the skin or hair irritation (ingrown hair). 
• Black heads: black heads arealso caused by dead skin and oil blocking a sebaceous gland or hair follicle but instead, there is no skin covering the pore which oxidizes the dirt and makes it appear dark. 
• Pimples: The overarching umbrella of facial irregularity is the pimple - under which everything else is categorized.In addition to oil and dead skin, pimples can also be the result ofpimple-promotingbacteria living on the problem area.  
• Cysts: pimples filled with a thick, yellow or white fluid, white blood cells, and fragments of tissue with bacteria (known as pus). Cysts are more likely to cause scarring and hyperpigmentation on the problem area. 

Adult hormonal acne can happen in both men and women, but the statistics are disproportionatelyskewed to females - especially those who are pregnant or experiencing menopause. This is due to the fact that sebum production and hormonal fluctuations are linked. For example, progesterone interacts to exacerbate sebum production by blocking a reductase that converts testosterone to DHT. Androgens are the most important hormone in the regulation of acne because it is associated in the pathway or sebum production [5]. It is also the case that those with hyperandrogenism and hormonal discrepancies experience a quite resistant and severe form of acne, particularly on the face [5]. 

How To Treat Hormonal Acne?

Although hormonal imbalances can wreak havoc on our skin and cause acne, in certain cases, hormonal intervention is the needed treatment for those with persistent acne. 

Indications of acne that can be treated with hormonal therapy [5]:

• Severe flare-ups before menstruation
• Oral contraceptives is wanted
• Acne is unresponsive to conventional treatment
• PCOS is present
• Late onset acne (in the patient’s 30s)
• Ovarian or adrenalhyperandrogenism

For treatment, the mainobjectives are [5]:

• Suppress androgen production by ovaries, adrenals and pituitary glands
• Inhibit androgen receptors on sebaceous glands 

The most common form of hormonal therapy is hormonal birth control - which regulates the hormones in the body to both stop ovulation and clear up acne. A more severe therapy is spironolactone or accutane, which has been known to be associated with unfavorable side effects and is usually only used for a short period of time. Hormonal therapies are often mixed with another therapy as opposed to being a stand alone option. Hormonal therapies can be synergistically combined with antibiotics, benzoyl peroxide, acids and retinoids to keep acne at bay [5].  

1. https://my.clevelandclinic.org/health/diseases/21792-hormonal-acne
2. https://my.clevelandclinic.org/health/diseases/22039-whiteheads
3. https://my.clevelandclinic.org/health/diseases/22038-blackheads
4. https://my.clevelandclinic.org/health/diseases/22468-pimples
5. Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016 Sep 2;9:241-8. doi: 10.2147/CCID.S114830. PMID: 27621661; PMCID: PMC5015761.