Dr Tariq Jagnarine
Fam Medicine, Endocrinology/ Diabetes
Hormonal acne is exactly what it sounds like — acne tied to fluctuations in hormone levels. Although it’s typically associated with hormone fluctuations during puberty, hormonal acne can affect adults of any age. It’s especially common in women. A number of factors may contribute to this, including menstruation and menopause.
It’s estimated that 50 percent of women aged 20 to 29 have acne. It affects about 25 percent of women aged 40 to 49.
Expert opinions are mixed when it comes to hormonal acne. Although the Mayo Clinic says hormones generally aren’t a factor in adult acne, hormonal imbalances may contribute to acne in adults with underlying medical conditions. In other cases, adults with acne may not have any “measurable” hormone issues. This can make diagnosis and treatment challenging.
During puberty, hormonal acne often appears in the T-zone. This includes a person’s forehead, nose, and chin. Hormonal adult acne typically forms on the lower part of the face. This includes the bottom of the cheeks and around the jawline.
For some people, hormonal acne takes the form of blackheads, whiteheads, and small pimples that come to a head, or cysts. Cysts form deep under the skin, and don’t come to a head on the surface. These bumps are often tender to the touch.
Hormonal acne may be caused by influxes of hormones from:
* Menstruation
* Polycystic ovarian syndrome (PCOS)
* Menopause
* Increased androgen levels
Specifically, these hormone fluctuations may aggravate acne issues by increasing:
* Overall skin inflammation
* Oil (sebum) production in the pores
* Clogged skin cells in hair follicles
* Production of acne-causing bacteria called Propionibacterium acnes
Menopausal acne
Many women begin to experience menopause in their 40s and 50s. This causes a natural decline in their reproductive hormones, resulting in an end to menstruation. Some women experience acne during menopause. This is likely due to a drop in estrogen levels, or an increase in androgen hormones, like testosterone.
Women may still experience menopausal acne even if they are using hormone replacement therapies (HRTs) to ease their menopause symptoms. This is because some HRTs use an influx of the hormone progestin to replace the estrogen and progesterone the body loses. Introducing this hormone to the body can cause the skin to break out. In most cases, prescription medication can clear up menopausal acne. Some women may find success using natural treatment methods.
Treatments for hormonal acne
Unless one’s hormonal acne is mild, over-the-counter (OTC) products usually aren’t successful in treating it. This is because hormonal acne typically takes the form of cystic bumps. These bumps form deep under the skin, out of reach of most topical medications.
Oral medications can work from the inside out to balance hormones and clear up the skin. Common options include oral contraceptives and anti-androgen drugs.
* Oral contraceptives
Oral contraceptives specifically used for acne treatment contain ethinyl estradiol plus one of the following:
* Drospirenone
* Norgestimate
* Norethindrone
Together, these ingredients target the hormones that can contribute to acne. This can be especially helpful during peaks in hormones, such as during ovulation. Oral contraceptives may not be an option for everyone if the person has a history of blood clots, high blood pressure, or breast cancer or smoking.
* Anti-androgen drugs
Anti-androgen drugs work by decreasing the male hormone androgen. Both men and women have natural levels of this hormone. Too much androgen, though, can contribute to acne issues by interfering with hair follicles that regulate skin cells, and by increasing oil production.
Although spironolactone (Aldactone) is primarily used to treat high blood pressure, it has anti-androgen effects. In other words, it can prevent the body from producing more androgen, and allow the hormone levels to stabilise.
* Retinoids
If the hormonal acne is mild, persons may be able to use topical retinoids. Retinoids are derived from vitamin A.
Many retinoid creams, gels, and lotions are available over the counter. Applying a topical retinoid to one’s regimen, it’s important to apply sunscreen daily. Retinoids can increase the risk of sunburn.
Natural treatment
In some cases, plant-based treatment options may be used to clear up mild hormonal acne.
Natural treatments are usually free of the side effects sometimes caused by prescription options, but they may not be as effective. Research on natural options is lacking, and, at this time, nothing has been proven to produce results.
* Tea tree oil
Tea tree oil works by decreasing inflammation that can contribute to acne. One study found that 5 percent topical tea tree oil relieved symptoms in participants with mild to moderate acne. Tea tree oil is available in many skin care products, such as cleansers and toners.
Dilute tea tree essential oil with a carrier oil before use. Popular carrier oils include coconut, jojoba, and olive. The general rule is to add about 12 drops of carrier oil to every one to two drops of essential oil.
It’s also important to do a skin patch test before using diluted tea tree essential oil. To do this, apply the diluted oil to the inside of the forearm. If no irritation or inflammation is experienced within 24 hours, it should be safe to apply elsewhere.
* Alpha hydroxy acid
Alpha hydroxy acids (AHAs) are plant acids derived mostly from citrus fruits. AHAs can help remove excess dead skin cells clogging pores. As a bonus, AHAs can help minimise the appearance of acne scars. AHA can be found in many OTC masks and creams. As with retinoids, AHAs can increase the skin’s sun sensitivity. Wear sunscreen when using products with AHA.
* Green tea
Green tea is known for decreasing inflammation in the body. For a more holistic approach, consider drinking a few cups per day besides practising topical skin care regimen. Lotions and gels containing at least 2 percent green tea extract may be beneficial.
