Hormonal acne is generally commonly referred to as acne. Acne vulgaris is another term for the condition of the skin.
Due to the way the skin issue evolves in response to hormonal changes, and especially an increase in androgens, such as testosterone, it is often called hormonal acne.
The increase in androgen levels can cause a higher sebum production process, changes in the activity of skin cells, inflammation and colonization of hair follicles by a bacterium known as Propionibacterium acnes (P. acnes). This can result in acne.
Typically, acne lesions or zits of varying severity influence the face and upper body. Acne is a common and treatable condition.
What is acne?
Acne is a skin condition.
This occurs as the body makes excess sebum, an oil that prevents the skin from drying out, and it clumps in a pore along with dead skin cells. An acne lesion or zit can form where the clogging occurs.
Comedones, which can be open or closed plugs that grow at the base of the hair, are the lesions in the skin formed by acne.
Other lesion types include:
- papules
- pustules
- nodules
- cysts
When bacteria are associated with the plugs, these four types of lesions, of growing size and severity, form. An inflammatory reaction from the immune system is triggered by bacteria.
The most common skin disorder in the U.S. is acne. The American Academy of Dermatology (AAD) reports that as many as 50 million people in the United States may have acne at any one time.
What is hormonal acne?
Hormonal acne is not a term used by physicians or in medical studies, but it can be used on the internet, in glossy magazines, or by individuals who sell natural remedies.
Hormonal acne is clearly assumed to mean acne in this article. One reason people may call it hormonal acne is to correlate it with the fact that it is more common in adolescents who are going through puberty hormone changes.
Symptoms
Acne symptoms can include:
- whiteheads
- blackheads
- papules
- pustules
- cysts
- nodules
Whiteheads and blackheads do not get inflamed and do not cause swelling or discomfort. They can become cysts or pustules if they become inflamed. Inflamed lesions can be painful, sore, and red. The lesion and the area around it may be raised.
Lesions often appear on the:
- face
- neck
- back
- shoulders
- chest
They are much more likely to occur on the forehead than other parts of the face, such as the cheeks, because sebum levels are higher in this area.
Because of the effect on self esteem, depression may be a complication of acne.
Acne is thought to affect 80 percent of individuals between 11 and 30 years of age, and especially between 14 and 19 years of age. After the age of 30 years, some people continue to develop acne.
Hormonal changes can again cause acne to affect females during pregnancy and around menopause.
Causes
The development of acne lesions is influenced by four key factors. One major factor is hormones, which may be why some individuals call it hormonal acne.
The four acne components include the units at the base of the skin’s hair:
- During puberty, development of the hormone testosterone increases. This causes greasy skin because sebum, the oily substance secreted at the base of the hair to protect and lubricate the skin, increases development.
- The hair follicles are blocked, forming comedones or “clogged pores”. This process also contributes to the overproduction of skin cells that would usually be pushed up and lost from the surface.
- Comedones can be made worse by contamination with bacteria.
- The immune system reacts to the bacteria, resulting in inflammation.
Not all acne is inflammatory. Simple comedones — blackheads and whiteheads — may not be inflamed. In order of increasing intensity, pimples called papules, pustules, nodules, and cysts are inflamed.
The role of hormones in acne formation
Since one big causative factor is the hormone testosterone, acne can be known as hormonal acne.
In the teenage years, testosterone levels go up as part of puberty. In boys, this induces male growth and gives muscle and bone strength in girls.
The hormone also has the effect of raising the development of sebum at the hair base. This is because they are responsive to testosterone in the glands that secrete the oil.
Other hormones play a part in acne, too. For women, acne may also be caused by hormonal changes due to pregnancy or the menstrual cycle. The risk of acne around menopause may be increased by dropping levels of estrogen.
Progesterone‘s function remains unclear.
Acne can be caused by conditions which affect hormone levels, such as polycystic ovary syndrome (PCOS).
Acne in menopause
According to the AAD, beyond their teenage years and into their 30s, 40s, and 50s, a rising number of women experience acne. The majority of adult female acne cases are mild to moderate.
Most adult female acne is permanent, but between 20 and 40 percent of cases start after puberty, continuing from puberty after the age of 24 years.
It is not clear why this is so, but a flare-up may be caused by any changes in life.
In pregnancy and around the moment of menopause, hormonal variations can lead to acne.
Researchers note that women who experience acne around menopause typically have levels of androgen within the normal range, but decreasing levels of estrogen.
It may be this imbalance that causes flares of acne. The new hormonal ratios lead to additional stimulation of the sebaceous glands, causing outbreaks as hormones hit a’ tipping point.’
Severity
Acne may be extreme, moderate, or mild.
Existing classfications suggest that:
Mild acne often includes blackheads and whiteheads and typically needs little support from doctors. There are less than 20 lesions, or 15 inflammatory lesions, or a total of 30 lesions.
Moderate acne contains lesions that are both inflamed and non-inflamed, some of which may leave marks. There are between 20 and 100 comedones, or between 15 and 50 inflammatory lesions, or between 30 and 125 total lesions.
Severe acne features widespread inflamed lesions. It can effect both looks and self-esteem, and it can cause scars.
All types of acne can be distressing.
Even mild acne can influence the self confidence of an individual. This is not only due to its appearance, but also the fact that when they start forming relationships, it also affects young people.
Myths about acne cause
There are many myths about the causes of acne.
There is no evidence that any of the following cause acne:
- poor hygiene
- chocolate and other diet factors, including nuts or greasy foods
- masturbation or sex
Some studies have found weak ties between acne and milk products, and skim milk in particular.
There is also research that connects acne with diets containing tons of high glycemic index foods. These involve basic carbohydrates and sugar drinks found in white bread, chips, and white potatoes.
These foods can raise the levels of blood sugar, and this can have an effect on the levels of hormones that then influence the risk of acne.
Natural treatment
Examples of complementary and alternative acne therapies include natural remedies. These are generally harmless, but tea tree oil and clove basil are some examples that have been used.
Practical tips for people with acne
Acne self-care advice can assist with the issue, or prevent making it worse.
Tips include:
- No more than twice a day and after sweating, gentle daily washing
- using mild soaps or cleansers and warm water, not hot water
- Do not use scrubs that are harsh or exfoliating,
- avoiding scrubbing, picking, or scraping pimples, as doing so can make them worse and can cause inflammation
- People should stop make-up or use products that are sparingly labelled as non-comedogenic, based on water.
- Avoiding high humidity conditions that cause excessive sweating, where possible
Over-washing is not good for acne.
Washing and scrubbing too much will remove oil from the skin and further irritate it. By producing more oil and thus worsening the acne, the skin may react.
Treatment
Acne is dealt with according to severity. It is possible to treat mild acne with over-the-counter medications as well as drugs offered by physicians.
For acne, there is no quick-fix remedy. It takes weeks for all treatments to show an effect.
Over-the-counter treatment
Mild acne treatment options without prescription include antibacterial skin cleansers. There is no proof that, however, acne is caused by bad hygiene.
Benzoyl peroxide is an over-the-counter topical medication available that can help. There are other non-prescription medications available, but with less proof of good effect.
People should avoid direct sunlight and tanning beds when using drugs to treat acne, as the skin may be more susceptible to UV light at this time.
Treatment for moderate and severe acne
Doctors can assist individuals whose acne involves more severe pimples, which can lead to scarring.
With oral antibiotics, mild acne can be treated. Examples are:
- tetracycline
- minocycline
- erythromycin
- doxycycline
For complete results, antibiotics for acne usually need to be continued for 3 months. Both topical antibiotics and oral antibiotics can also be prescribed.
Anti-androgen hormonal therapy or birth control medicine can be prescribed to women with mild acne who do not respond to oral antibiotics.
Istotretinoin
Extreme acne can require prescription therapy, such as isotretinoin, a drug.
This is an oral treatment that is needed for a duration of 16 to 20 weeks. It is very effective against extreme acne, but has side effects and needs to be checked for use.
If you are trying to become pregnant or if you are or may be pregnant, it is important not to use isotretinoin, as there is a danger to the unborn child.
Women should have a pregnancy test before starting the medication and use reliable contraceptives before and during its use.
Before, during, and after treatment with isotretinoin, sexually active women of childbearing age must use two forms of contraception.
A dermatologist who is licensed with the U.S. must be directed to people with extreme acne who need to use isotretinoin. Food and Drug Administration (FDA) monitoring program for the drug.
Cystic acne and triamcinolone
Cystic acne, which can be treated with a corticosteroid injection called triamcinolone, is the most serious type of acne. This injection into the lesion aims to reduce inflammation-induced scarring.
Other procedures
One or a combination of the following can be prescribed or used by a dermatologist:
- lasers and light therapy
- chemical peels
- drainage and extraction to remove a cyst
If there is a need to do it quickly, an injection of medicine will minimize the size of a big cyst.
Hormonal therapy for adult women with acne
In adult women, care for acne is the same as for other persons. Hormone treatment provides more options.
These include the contraceptive pill as it can assist to clear acne in females. Those approved by the FDA contain ethinyl estradiol.
It is possible to use an oral contraceptive alone or with an anti-androgen drug.
Those with such health problems should not use oral contraceptive pills.
These include:
- a history of breast cancer
- previous heart attack or stroke
- a history of blood clots
- uncontrolled hypertension
- abnormal vaginal bleeding
As with isotretinoin, hormone therapy patients will need to be monitored periodically to ensure the safety of the treatment.
When to see a doctor
For extreme acne, a specialist who specializes in skin disorders, called a dermatologist, needs to be seen.
It is recommended that people see a physician and even a specialist dermatologist if:
- they have a lot of acne
- there are severe lesions
- there is a risk of scarring
- acne could affect pigmentation
If the existence of acne impacts the daily functioning of an individual, they should also seek assistance.
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