Acne is a skin condition that affects nearly 17 million Americans of which over 50% sufferers are women aged 25 and older, and the majority of the patients are suffering from hormonal acne.
Another term for the skin condition is acne vulgaris, and it is sometimes called hormonal acne because of the way the skin problem develops in response to hormonal changes.
People with acne, which is very common and treatable, have pimples or spots of varying severity that typically affect the face.
Causes of Acne
There are four main factors behind the formation of acne lesions, and hormones are one major factor. This may be why some people call it hormonal acne.
Production of the hormone testosterone rises during puberty, which causes greasy skin because it increases production of sebum. Sebum is the oily substance secreted at the base of hairs to protect and lubricate the skin. Then, the hair follicles become blocked, forming comedones or “clogged pores.”
The production and overproduction of skin cells that would usually be pushed up and lost from the surface also add to this process, and the comedones can be made worse by a bacterial infection. The immune system reacts to the bacteria, resulting in inflammation (not all acne is inflammatory).
What Does It Mean To Have Hormonal Acne?
Hormonal acne is acne tied to fluctuations in your hormones and is typically associated with hormone fluctuations during puberty. However, hormonal acne can affect adults of any age, and it’s especially common in women. A number of factors may contribute to hormonal acne in women, including menstruation and menopause.
It’s estimated that 50 percent of women ages 20 to 29 have acne, and about 25 percent of women ages 40 to 49 are affected too.
Expert opinions are mixed when it comes to hormonal acne, but it is believed that hormonal imbalances may contribute to acne in adults with underlying medical conditions.
In other cases, adults with acne may not show measurable hormone issues, which can make diagnosis and treatment challenging.
The Role Of Hormones In Acne Formation
Hormones are known to play an important role in the development of acne, which may lead to over-secretion of sebum in the sebaceous glands leading to clogged pores. Whiteheads and blackheads are hence seen in the T-zone region of the face.
In girls, at the onset of puberty, ovaries produce estrogen as well as androgens. This further increases sebum production resulting in inflammatory hormonal acne during this period. This is characterized by papules and pustules, mainly on the chin, forehead, and cheeks where there is a high concentration of sebaceous glands.
Characteristics Of Hormonal Acne
During puberty, hormonal acne often appears in areas like your forehead, nose, and chin, which is often referred to as the T-zone.
Hormonal adult acne typically forms on the lower part of your face, that includes the bottom of your cheeks and around your jawline.
For some people, hormonal acne takes the form of blackheads, whiteheads, and small pimples or cysts, which form deep under the skin. These bumps are often tender to the touch.
Hormonal acne may be caused by influxes of hormones from menstruation, polycystic ovarian syndrome, menopause and increased androgen levels.
These hormone fluctuations may aggravate acne issues by increasing overall skin inflammation, oil (sebum) production in the pores, clogged skin cells in hair follicles, and production of acne-causing bacteria called Propionibacterium acnes.
Is Menopausal Acne a Form Of Hormonal Acne?
In adult women, hormonal acne tends to be concentrated on the lower region of the face such as lower jawline, chin, cheeks or neck, and these lesions are also more painful and inflammatory in nature, which is due to hormonal stimulation which results in increased sensitivity of the sebaceous glands.
Moreover, hormonal acne flare-ups are closely related to the menstrual cycle, and most adult women suffering from hormonal acne, reports that the flare-ups are greater around the pre-menstrual phase. Though some women also experience acne mid-cycle or during ovulation.
Stress, birth control pills, and other factors also stimulate the adrenal glands to release more androgens, which all can contribute to acne breakouts.
Diagnosing Hormonal Acne
Not all kinds of acne are related to hormones, and that is the reason why dermatologists must take the complete menstrual history when acne is present, especially, in adult women. One must be certain whether one’s periods are regular and whether the acne is indeed related to the menstrual cycle.
Obesity, infertility, irregular periods and scalp alopecia are also indications of complete hormonal workup as all these are signs of excess androgen production.
Traditional Treatments For Hormonal Acne
Unless your hormonal acne is mild, over-the-counter acne products usually aren’t successful, because hormonal acne typically takes the form of cystic bumps, which form deep under the skin, out of reach of most topical medications.
Oral medications like oral contraceptives and anti-androgen drugs can work from the inside out to balance your hormones and clear up the skin. Oral contraceptives specifically used for acne treatment contain ethinylestradiol plus one of drospirenone, norgestimate, or norethindrone.
Together, these ingredients target the hormones that can contribute to acne, and can be especially helpful during peaks in hormones, such as during ovulation.
Oral contraceptives may not be an option for you if you have a history of blood clots, high blood pressure, or breast cancer, and you should not take these if you smoke.
If you are suffering from hormonal acne, it is important that you visit a dermatologist to seek the right treatment for it, as many modern medicines including contraceptive pills with estrogen can help decrease the free circulating testosterone, helping to reduce hormonal output causing the acne.
Also, apart from such systemic medicines, topical retinoids and antimicrobials, as well as antibiotics, may be prescribed to treat hormonal acne breakouts.