The Truth About Hormonal Acne
Hormonal acne often feels like you got the short end of the genetic stick. If you often experience acne breakouts, it might indeed feel like you are at the mercy of misbehaving hormones and chemicals within your body.
But here’s a piece of comforting news: hormonal acne as we know it is not some genetic curse. In fact, there is very little scientific basis that “hormonal acne” exists as a diagnosable skin problem. To doctors, hormonal acne is simply acne. Magazines and beauty media have sold us this idea that hormonal acne is incurable and affects an unlucky population of people, but the truth is that hormonal acne can affect anyone. Anyone with hormones has the possibility of developing hormonal acne. Hormonal acne has gotten a bad rep over the years, but it is very simply the result of the way skin reacts to changes in hormones.
Hormonal acne is sometimes also known as acne vulgaris. One of the main hormonal culprits in causing acne are androgens. A familiar androgen is testosterone, which is known for causing a variety of processes such as an increase in sebum production, different cell activity, inflammation, and the entry of Propionibacterium acnes (a bacteria) into skin follicles. These processes are probably familiar as they are how acne forms.
What Are the Types of Acne?
Now that we have established that hormonal acne is pretty much just acne, let’s dive a little deeper into what are the different types of acne you might experience. In general, acne occurs when the sebaceous glands (oil glands) produce excess oil and clogs up pores with dirt and dead skin cells. These are also known as lesions.
There are a few different types of lesions namely:
- Papules (least severe)
- Cysts (most severe)
The above lesions occur when there are bacteria in the clog. The bacteria cause inflammation, which is why acne tends to be sensitive to the touch, red, and raised. Acne can occur anywhere on the body, not just the face. The back, shoulders, arms, chest, and neck are all also potential spots for acne to develop. However, the face is the most likely area that acne will develop simply because the face has the highest concentration of oil-producing glands.
Acne is not limited to the above. Lesions are one type of acne that involves bacterial inflammation. There are other types of much milder acne such as blackheads and whiteheads. This might surprise you because we are used to associating acne with the large, painful, beneath-the-skin cystic kind. However, remember that acne is an umbrella term that encompasses any kind of pore-clogging due to excess oil production. What differentiates the acne types is severity.
How Acne is Caused by Hormones
Hormones are definitely one big cause of acne, specifically lesions, but there are many other causes as well! For this article we will focus on how lesions are formed and the role hormones play in it. First, let’s go through the process of lesion formation.
- A rise in testosterone occurs — this can be due to a range of factors such as puberty, the second half of a menstrual cycle, or getting off birth control pills. Testosterone causes an increase in the activity of the sebaceous glands, the oil-producing glands. The skin becomes oilier and greasier due to this increase in sebum production. A fall in oestrogen levels can also result in an increase in oil production, which is why women might experience acne during menopause and the second half of the menstrual cycle.
- The excess oil on the skin results in the blockage and clogging of hair follicles. Dead skin cells that would typically be pushed up to the surface to clear are unable to do so with this clog of oil. The dead skin cells, therefore, add to the buildup in the clog. This forms a comedone. A comedone that does not get infected by bacteria will be a mild form of acne and can result in blackheads or whiteheads. Blackheads are open comedones that appear dark due to the oxidization of the clog. Whiteheads are closed comedones due to a layer of skin that grows over the comedone.
- If bacteria get introduced to the comedone, this is when a lesion forms. The immune system reacts to the bacteria, causing inflammation to occur. The level of inflammation will determine whether the lesion is a papule, pustule, nodule, or cyst.
How to Deal with Acne Caused by Hormones
If you are lucky to experience infrequent bouts of acne that are not cystic, you can incorporate the following methods to keep acne at bay:
- Wash your face at least once a day
Keep your skin clean and free of excess oil by washing your face twice a day. But also don’t overwash your face though, as the skin does need a little bit of natural oil. Overwashing might actually backfire as the sebaceous glands produce even more oil to compensate for the drying out effect that overwashing might have.
- Try AHAs (Alpha-hydroxy acids) or BHAs (Beta-hydroxy acids)
Alpha-hydroxy acids (AHAs) like glycolic acids and lactic acids are very efficient chemical exfoliants that have the added benefit of helping to fade scars by removing the top layer of dead skin cells. There are also beta hydroxy acids (BHAs) like salicylic acid which causes a chemical disintegration of the skin’s top layer of cells which unblock the pores.
- Incorporate a retinoid into your routine
Retinoids have recently become quite popular in the skincare world, and rightfully so as they are one of the best methods for tackling skin imperfections. A retinoid is a vitamin A-based formula that induces an accelerated exfoliation. You’ll have to be patient with retinoids though, as they take anywhere between 8-12 weeks to show effect. Retinoids can be very strong, and you should only use them at night as the sun causes it to be inactive. Retinoids should be used in gradual increments. Start off using it once or twice a week and pay attention to whether your skin gets red and itchy. Once you have gotten used to the strength, you can use it more frequently or move up the retinoid strength.
- See a dermatologist
The most effective action you can take is to schedule a visit to a dermatologist. Your dermatologist will be able to diagnose your skin problems and give medicine and products specifically targeted to combat those issues. This will save you lots of time and money testing out skincare products without guarantee that they will work.
However, should you experience widespread severe cystic acne, it might be time to get prescription medication to deal with it. You can go to a dermatologist or a specialized skin clinic to get advice on what to do if you have severe cystic acne. There are many different kinds of medication a doctor may prescribe, depending on the severity of your acne.
Moderate acne: Oral antibiotics such as tetracycline, minocycline, erythromycin, and doxycycline are typically prescribed. You will undergo a three-month prescription and must complete it in order for results to show, You may also be given additional topical creams and products to complement the antibiotics. Doctors may also suggest birth control pills for females, since these pills prevent the circulation of androgens which are a culprit for oil production.
Severe acne: Isotretinoin is a well-known drug to treat severe cases of acne. You may know it as Accutane and is often seen as a last resort for acne due to the many side effects. Doctors only prescribe isotretinoin in very severe cases. It is taken for 16-20 weeks and has a very high rate of effectiveness, but the side effects are also quite severe. Women cannot become pregnant while on this drug because it can cause serious birth defects. Doctors will also emphasize the use of contraception for sexually active women of childbearing age before, during, and after a course of isotretinoin to ensure there is no risk to pregnancy.
Another treatment for severe acne is a corticosteroid injection known as triamcinolone. The lesion is injected with triamcinolone and reduces the chances of permanent scars that the inflammation might cause. Hormone therapy is another method for older women that doctors might use. This involves the use of contraceptive pills.
Acne is a normal and common occurrence in all people, but some experience much more severe and frequent acne breakouts that can often decrease self-esteem. The best advice is to see a skin doctor who can effectively diagnose the cause of your acne. It is always best to seek clinical advice rather than test out different products that may irritate the skin.