Hormonal Acne & Treatment Recommended by Dermatologists 

A word that generates a variety of negative emotions: acne.

The mere existence of acne is enough to make you feel bad. To make matters worse, we have society continually asking us about it. “What is that?” or “Oh my god, what happened?” I mean, come on. It is acne. You know it. I know it. We all know it. We all have it. Now let's address the elephant in the room!

There is a perfect chance that the only reason that the person might even have acne in the first place might be because of existing stress.

Another million-dollar question is, “Why are you breaking out?”

Well, here is an article that you could forward to anybody asking you that question. 

What is acne? 

It is a skin condition that could affect people of all ages, where the hair follicles on the face get clogged with oil and dead skin cells. It causes pimples, blackheads, and whiteheads. Acne is, however, most common in teenagers. 

So, what is hormonal acne?  

Well, hormonal acne is an acute condition. It is also called “acne vulgaris.” Acne affects 80% of adolescents, and hormonal acne affects people aged between 15 to 30 years. There are a million reasons behind why this condition arises. Acne vulgaris might occur either because of hyperandrogenism or hormonal discrepancies, to sum up the reason in short.

Hormonal acne cannot be treated using traditional methods. They are usually the monthly flare-ups or severe, resistant to treat hormonal acne. Such conditions can only be treated through hormonal therapies.  

What is the hallmark of hormonal acne? 

The hallmarks of acne vulgaris are clogging and follicular hyperproliferation, excess secretion, accumulation of sebum, Propionibacterium acnes’ activity, and inflammation.  

What are the signs of hormonal acne? 

1. Your teen years are gone –

A lot of us have been happy through school where our skin was envied as everyone else suffered from acne. Fast forward to college, clear skin has gotten affected by adult acne, and we are suffering worse than we could imagine because all we are used to is clear skin.

Women are exceptionally hormonally active from the 20 years and above the stage. 

S. Manjula Jegasothy, M.D., a board-certified dermatologist and founder of Miami Skin Institute. Says,

Your 20s is often peaked childbearing age, making women more prone to the intense hormonal fluctuations of pregnancy, childbirth, and lactation (breastfeeding)

2. The pop-ups are on the chin and around the jawline –

Location of acne tells us a lot about where it is coming from; if acne pops up on the chin or around the jawline, the solid bet is that it is a cause of hormonal imbalance. “This is because these excess hormones in your body stimulate the oil glands—many of which are around your chin area,” Marina Peredo, M.D., a cosmetic and medical board-certified dermatologist and associate clinical professor of dermatology at Mount Sinai Hospital. Hormonal acne is also found to pop up on the sides of the face and even down the neckline. 

3. Acne pop up once a month -

“Hormonal acne often manifests in a cyclical pattern, much like women’s menstrual cycles,” explains Jegasothy. “This is true even in postmenopausal women, as these women still experience monthly fluctuations in their estrogen and progesterone levels, albeit lower than pre-menopausal women.” 

4. Serious stress issues –

The stress hormone cortisol affects all the other hormones causing a stir in the body that creates acute stress periods. This is common in young adults, always stressed about an exam to crack, a promotion to achieve, the million other things they could stress over. It creates the perfect environment for hormonal acne flare-ups.

5. Painful cysts -

“These painful cysts manifest as deeper bumps that are under the skin’s surface and cannot be extracted with manual extraction either by an individual or an esthetician,” Jegasothy says. “These bumps are usually tender to the touch because they’ve accumulated oil over days or weeks that then causes an inflammatory reaction.” The flare-ups seem to occur on the same spot, becoming chronic or subatomic.  

Reasons for hormonal acne:

1. Fluctuation of hormonal levels –

An imbalance of hormones is the reason behind such acne. I mean, it is called “hormonal acne.” But, let’s look at the periods when such imbalance occurs. 

• Around periods. 
  
• Menopause, pre-menopause, during pregnancy. 
  
• After starting or discontinuing birth control pills. 
  

2. Stress –

Most research work shows how stress and acne flare-ups have a relationship. Our bodies contain more androgens in response to our stress that stimulates oil glands and hair follicles to clog and cause acne. Constant pressure almost immediately causes havoc in our hormonal production, and we find ourselves stuck with acne. 

3. Family history –

Often, we ignore that acne could be a disease passed on from someone in your family to you via genes. It is quite common and is the same as having asthma from your previous generations. 

4. Hair and skincare products –

More often than not, the skincare or hair care products that we use contain ingredients that mess with the body’s normal hormone levels. Many hair growth and skin-glow pills contain hormones that cause imbalance and result in acne formation.  

5. Side effects of medication –

Medications impact the body, and a lot of times, its side effect is an imbalance of hormones. However, it is best if the same is communicated to the doctor who prescribed the medicine in case of such conditions.

6. Undiagnosed medical condition –

Often, underlying medical conditions are the reason behind hormonal acne. Once that medical condition is diagnosed and treated, the acne clears out. 

Hormonal Acne Pathogenesis: 

Acne, a follicular unit disease, involves a pathologically excessive production of abnormal follicular keratinization, the formation of acne colonies and biofilms, sebum, and proinflammatory mediators that are released on the skin. 

Let us look at the hormonal acne pathogenesis – 

1. Androgens –

It represents the most important of all hormones that regulate sebum secretion. Androgens stimulate sebum secretion and acne in both sexes.  

2. Progesterone –

Progesterone is the cause behind sebum exacerbations and menstrual flare-ups. Progesterone converts testosterone to the more potent DHT (dihydrotestosterone, a testosterone-based hormone found in elevated levels in the bodies of acne sufferers). 

3. Estrogen –

A negative feedback is exerted on the gonadal axis due to high-dose estrogen. This reduces the size of sebaceous glands, resulting in sebum secretion reduction, increased production of sex hormones, decreased secretion of free serum testosterone, and therefore, sebocyte formation.

4. Insulin –

Maturation and growth of sebaceous glands are stimulated by insulin. The link between acne and diet can be explained through the fact that consuming food with high glycemic index results in the release of insulin and, in turn, produces excess androgen and sebum. 

5. Corticotrophin-releasing hormone -

CRH attacks the sebaceous glands and stimulates lipogenesis by enhancing androgen bioavailability and inducing DHEA (dehydroepiandrosterone) to testosterone. This causes severe hormonal acne. 

6. Glucocorticoids –

Acne eruptions tend to increase with the consumption of steroids. Such acne is also termed as “steroid acne.” 

7. Pituitary Gland –  

• ACTH – stimulates sebum production 
  
• GH – stimulates testosterone to convert to pimple-causing DHT. 
  
• LH – under the regulation of LH, ovaries secrete androgens that cause acne. 
  
• Prolactin – adrenal androgens secrete to contribute to the rapid production of hormonal acne. 
  

So, the billion-dollar question: how do I treat my hormonal acne? 

Here is a list of treatments: 

1. Over-the-counter treatment –

Antibacterial skin cleansers that are ready to buy without a prescription are suitable for mild conditions of hormonal acne. Benzoyl peroxide is an excellent topical drug that can help overcome favorable conditions. However, it should be kept in mind to avoid sunlight and UV rays while using such products as they make the skin highly sensitive. 

2. Moderate to severe hormonal acne treatment –

This form of acne can be treated with oral consumption of the following: 

• Tetracycline 
  
• Minocycline
  
• Erythromycin 
  
• Doxycycline 
  

Antibiotics are normally prescribed for three months for moderate to severe acne cases.  

3. Istotretinoin –

This oral treatment is usually prescribed for 16-20 weeks. It is effective against severe acne but has side effects that need monitoring.

Women are advised to take a pregnancy test before consuming isotretinoin and not consume the same if they test positive for pregnancy. Sexually active women of childbearing age must use contraception of two forms before, one during, and one after treatment with isotretinoin. 

4. Triamcinolone –

Triamcinolone, a corticosteroid injection, may be used to treat severe forms of acne. This injection helps reduce scarring caused by inflammation.  

5. Lasers and Light therapy 

6. Chemical peels 

7. Drainage and extraction of the cyst. 

Many of us suffer from one of the other reasons that cause hormonal acne, and the best advice to solve the problem is to visit a dermatologist to help cure it. It is also the fastest and the healthiest way to get rid of them.