Hormonal acne is a very common condition affecting over 20% of Australian adult women. This form of acne usually varies with the period cycle, and presents as deep seeded lumps, bumps and blind ending pimples around the jawline, chin, and cheek areas.
Hormonal acne can be very distressing, and is often resistant to over the counter washes and creams. Specialists manage this type of acne with a combination of tablets, including anti-hormonal medication and Vitamin A.
A simplified skin care program, coupled with a scar management program can help repair and restore the skin barrier. Effective solutions are possible at the Acne Specialist Clinic at Westside Laser Dermatology.
Specialist Perspective on hormone control of acne
Many patients find adult onset or hormonal acne very distressing. Like all acne, the appearance on the face can be devastating to patients and patients often cannot understand why they are getting “pimples” at this older age in life. While hormonal acne can be difficult to treat and require longer courses of treatment, improvement should be achievable with the right combination of treatments and thoroughly investigating and treating any underlying medical problems that may be causing the acne. It is important to manage hormonal acne properly because it can have significant psychological impacts on patients, particularly if it results in scarring. Often, a longer-term maintenance plan may be required to provide ongoing results. Once the acne is controlled, improvement to any scars may be needed. Acne scar management is something we specialise in at the Westside Laser Dermatology.
Hormonal acne often begins in the 20s and may continue into the 30s and 40s. The location of pimples can be a clue to whether you have hormonal acne. Unlike teenager acne, the skin at the jaw line and chin area are more often affected. This may extend to the lower face and neck.
Affected skin areas are sensitive and easily irritated by topical agents. Many patients did not have acne as a teenager.
Hormonal acne is thought to result from the interplay of a number of factors. One or several of these factors may cause hormonal acne in any particular patient. It is important that your doctor takes a thorough history from you to establish likely contributing factors. Factors that may contribute to hormonal acne include:
- sex hormones, such as progesterones, oestrogens and testosterone – in most cases, levels of these hormones are normal but your doctor may test for them if you have other symptoms
- other hormones such as insulin
- stress or illness
- comedogenic and oily skin care products, make-ups and some sunscreens
- underlying hormonal and metabolic disorders such as polycystic ovarian syndrome (PCOS) and diabetes and rarely, some types of cancers
- some oral contraceptives – many contraceptive pills help acne but progestogen only pills can worsen it
- dietary factors
If your dermatologist suspects a hormonal problem, a number of simple blood tests may be performed to test hormone levels. A pelvic ultrasound may also be requested if an ovarian disorder is suspected.
Often a combined approach to managing hormonal acne is most effective. It is essential for any underlying medical problems that may be contributing to hormonal acne to be corrected. Other contributing factors such as inappropriate cosmetics or medical creams and ointments may need to be stopped. Treatment may be prolonged and it is essential that patients follow their treatment plan to offer the best chance of a cure.
Hormonal acne will often respond to the same treatments used to treat teenage acne. This includes various topical cream and gel treatments, oral antibiotics and gentle cleansers and moisturisers.
A range of topical creams and gels often containing multiple ingredients including antibiotics, “retinoids” (vitamin A compounds) and benzoyl peroxide are usually a good start to treatment. Sometimes, your doctor may also prescribe an oral antibiotic as well. These treatments usually require a tailored approach to each patient.
More persistent or severe cases often benefit from an “anti-androgen” medication such as spironolactone, which is often effective either alone, or in combination with the oral contraceptive pill.
The most severe cases sometimes require treatment with special vitamin A type systemic (tablet) drugs such as Isotretinoin (Roaccutane, Oratane). These medications are available only from your Dermatologist and are particularly useful where the acne is causing scarring or is not responding to other treatments.
Often, if you are using the oral contraceptive pill to treat hormonal acne, it may take up to 3-6 months or more to achieve and maintain improvement in your skin.
The “anti-androgen” spironolactone, may offer quicker results with reduction in skin oiliness occurring within 2 months and acne improving after this time frame.
It is essential that any underlying medical disorder be identified and treated or else the acne may persist.
The use of supportive acne treatments such as topical creams and gels or oral antibiotics may speed up the clearance of your acne.
Patients taking the “anti-androgen” medication spironolactone should stop this treatment if they become pregnant. There does not appear to be any established risk of birth defects if a patient was to take this medication while in the early stages of pregnancy.
If a pregnant woman did take this medicine in the later stages of pregnancy with a male child, it could affect the normal development of that baby. It is important that your doctor ensures you are not pregnant before starting treatment with this medication. If you suspect you may have become pregnant while on this medication you should discuss it with your doctor.
There are various different oral contraceptive pills. They have different benefits and different side effects.
The pill, containing the drug cyproterone, is often very effective for hormonal acne. However, used alone, it has a higher risk of venous thrombosis and emboli.
Combined oral contraceptive pills containing estrogen and levonorgestrol, often have a safer side effect profile and are often very useful for hormonal acne. They may still cause nausea, weight gain, menstrual irregularity or spotting and breast tenderness.
Spironolactone, an anti-androgen drug, can also cause period irregularity and tender breasts. If you suffer from low blood pressure, this tablet may also cause dizziness. By combining this medication with a combined oral contraceptive pill, side effects can be reduced. Most often we start on a low dose of Spironolactone, such as 50mg in the morning, with the option to double the dose after 2-3 months.
Some oral contraceptive pills can make hormonal acne worse. The “mini-pill” (progestogen only) and implant devices such as Implanon and Mirena may make hormonal acne worse rather than improve it.
There may be a number of reasons for your anti-hormone treatments to be ineffective for your acne. The medication may have not been taken for long enough. Other factors contributing to your acne may still be affecting it. Sometimes switching to a different oral contraceptive or combining the “pill” with another anti-androgen medication may be required.
Even in the most severe cases, improvement can be achieved with use of the vitamin A drug, Isotretinoin (Roaccutane/Oratane).
Yes. In some cases hormonal acne maybe associated with other skin conditions related to acne, including blackheads, and oily skin. Hormonal acne may also produce unwanted hair, as part of PCOS, or Polycystic Ovarian Syndrome.
Westside Laser Dermatology also provides treatment for skin related issues associated with PCOS, including hair removal.
Acne scarring can have significant psychological impacts on patients. It can directly affect self-confidence and many aspects of professional and social life.
There are different types of acne scars. Different scars and skin types will require different treatments and often, scar treatment requires a number of different treatment methods in combination to achieve the best results. Acne scar management is a specialised area of dermatology. Treatments include:
- Fraxel and Fractional laser resurfacing
- TCA cross technique
- Subcision and dermal grafting for acne scars
- Vascular lasers for red scars
- Dermal fillers
- RadioFrequency or RF treatment of acne scars
- Corticosteroid injections for raised or keloid scars
Specialists at the Acne Specialist Clinic at Westside Laser Dermatology will assess your acne scarring and tailor scar treatments to give you the best results.