Hormonal therapy is an option for many women with stubborn acne, but it's not always the only option. A dermatologist can tell you what can help clear your stubborn acne.
Management and Treatment
Blackheads and whiteheads: Topical cream (tretinoin). Inflammatory acne: Topical retinoid and/or topical antibiotic and/or benzoyl peroxide. Moderate to severe acne: Antibiotic and/or isotretinoin (retinoid). Cystic acne: Steroid injection (intralesional triamcinolone).
Visit a doctor when the acne is severe, reoccurring, itchy or painful. It is also wise to see a dermatologist before you try any DIY products or over-the-counter items. A doctor can evaluate your acne and tell you what treatments are best for you and your skin.
Hormonal acne treatments
There are several ways to treat hormonal acne. One option is to take birth control pills that contain estrogen and progesterone. Pills FDA-approved to treat acne include Ortho Tri-Cyclen, Yaz, Beyaz and Estrostep Fe. They treat hormonal acne by decreasing the circulation of androgens.
The severity of the symptoms of hormonal acne are different for everyone. If you develop acne during puberty, it tends to peak at age 17-19 and for most people will go away by their mid-20s. However, some people continue to suffer from acne into their 40s.
Your acne appears around your chin and jawline. One of the telltale signs of a hormonal breakout is its location on the face. If you're noticing inflamed cystic acne on your chin or jawline area—anywhere around your lower face, really—you can bet your bottom dollar that it's probably hormonal acne.
Androgens, blood sugar and insulin are reliable tests we can do to examine the root cause of acne. Using blood tests for estrogen and progesterone are unfortunately less useful.
Screening tests include serum DHEAS, total and free testosterone, and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio. These tests should be obtained during the two weeks prior to the onset of menses to avoid the LH surge associated with ovulation.
Androgens represent the most important of all hormones regulating sebum production. As of puberty, androgens stimulate sebum production and acne formation in both sexes.
The most common cause of hormonal acne is an excess amount of androgens and increased systemic inflammation . Both can lead to an increase in sebum production, and this is where the major problem starts. Sebum is oil produced by your skin via the sebaceous glands, also known as the oil glands.
Acne is considered a condition related to lower levels of estrogen relative to testosterone and progesterone.
Isotretinoin (Accutane)
The most effective treatment for hormonal pattern acne is isotretinoin, often known by its original brand name of Accutane. Accutane works by “shrinking” or deactivating the oil gland in acne-prone pores thereby preventing the overactivity of the oil glands that is necessary for acne to develop.
According to a study published in the Archives of Dermatology, 63% of acne-prone women experience these premenstrual flares. They usually strike about seven to 10 days before the onset of a woman's period and then subside as soon as bleeding begins.
“The OB/GYN is competent and capable of taking care of most issues associated with acne or breakouts,” Dr. Lara-Torre says. Of course, you should also consider visiting your dermatologist to talk about any skin-related concerns you may have — but it's always good to know you have options.
For women suffering with possible hormonal acne, evaluation by a dermatologist is appropriate. However, it is fairly common for some patients to first see their gynecologist or even an endocrinologist in an attempt to seek help for their perceived abnormal hormones as a cause for their hormonal acne.
“In general, if there's a hormonal cause of a dermatologic problem, getting things back in balance is the way to go,” says Hollmig. “As dermatologists, we are able to use medications that help normalize hormone levels to improve skin health,” he adds.
There are many ways in which your gynecologist can help get your hormones back on track. There are medications, lifestyle adjustments and alternative therapies that can all aid in improving your imbalance. The most common medication prescribed for treating a hormonal imbalance is a synthetic or bioidentical hormone.
Acne is considered a condition related to lower levels of estrogen relative to testosterone and progesterone.
Screening tests include serum DHEAS, total and free testosterone, and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio. These tests should be obtained during the two weeks prior to the onset of menses to avoid the LH surge associated with ovulation.
The most effective treatment for hormonal pattern acne is isotretinoin, often known by its original brand name of Accutane. Accutane works by “shrinking” or deactivating the oil gland in acne-prone pores thereby preventing the overactivity of the oil glands that is necessary for acne to develop.
Androgens, blood sugar and insulin are reliable tests we can do to examine the root cause of acne. Using blood tests for estrogen and progesterone are unfortunately less useful.
If acne appears on a younger child's skin, a dermatologist may recommend a blood test to determine if there is a hormonal imbalance responsible. This test can be conducted in a doctor's office.
Acne is considered as a symptom of female infertility, in cases where it has been triggered by hormonal fluctuations. In many cases, women suffering from acne also suffer from polycystic ovarian syndrome – PCOS, which is very commonly associated with infertility.
An endocrinologist is a healthcare provider who's an expert in endocrinology — the study of your body's hormones. Endocrinologists diagnose, treat and manage several different conditions that affect your endocrine system.