Is It My Hormones? Hormonal Acne

Hormonal acne is actually a very hot topic at the Advanced Acne Institute. Many female patients at the Institute ask if their hormones could be a cause for their breakouts. When they bring up this concern, it’s usually obvious that they’re not quite sure what they’re asking other than the fact they “just have a feeling” that their hormones are “out of whack.” The first thing I tell them is that all acne is related to hormones. So there’s really no such thing as true “hormonal acne.” However, acne dermatologists refer to a certain type of acne as “hormonal acne” because it has a unique pattern that’s different from the more common type of breakout.

What is Hormonal Acne

severe acne
Hormonal Acne

“Hormonal acne” typically refers to acne breakouts that mostly affect the lower face and jaw lines of women who are often in their 20s and 30s. Hormonal acne tends to be more difficult to treat and is often resistant to many of the standard acne remedies. Patients with hormonal acne often become very frustrated with their large, persistent breakouts and they usually experience a flare-up just before they have their menstrual period each month. Sometimes with hormonal acne the breakouts are large or even appear as acne cysts along the lower jaw. They are often painful and can last a long time. Sometimes hormonal acne breakouts extend down along the upper neck areas and they are difficult to cover with concealers or makeup.

What causes it?

So what do we do for hormonal acne? Well, the first thing we do is to make sure there is no underlying hormone abnormality that needs to be addressed. Most women with hormonal acne have a normal hormone pattern. In these women, the reasons for their “hormonal acne” are due to other factors, such as an increased sensitivity to acne-causing hormones even though they are at normal levels. In other women with hormonal acne, there may in fact be increased levels of some of the acne-causing hormones in their system. It’s especially important to recognize this possibility in women who may develop acne suddenly or who may have other signs of hormone imbalances such as irregular menstrual periods, excessive facial hair growth or thinning of the hair on their scalp. In a future blog post, I’ll discuss the types of blood tests performed by acne dermatologists to evaluate women with hormonal acne.

Treatment for Hormonal Acne

Hormonal acne can be more difficult to treat than other forms of acne breakouts. It tends to be resistant to many of the standard treatments for other forms of acne. Topical treatments are usually ineffective for this type of acne. Oral antibiotics are also not very effective for long term control of hormonal acne. Other types of treatments such as facials, chemical peels and light therapies are also of variable help.

Spironolactone
Spironolactone

The most effective forms of treatment for this condition include birth control pills, spironolactone and isotretinoin. Birth control pills help to regulate hormonal activity to control hormonal acne. Although they can sometimes be very effective, birth control pills are not always that helpful, especially for the more severe forms of hormonal acne. Spironolactone is another treatment that can be very effective for most forms of acne breakouts. Spironolactone works by blocking the acne-causing hormones from excessively stimulating the acne-prone oil glands. At the right dose, spironolactone can lead to completely clear skin and also works very well for acne involving the back.

In cases where spironolactone doesn’t help or is contraindicated for a given patient, then a different or stronger treatment is needed. Isotretinoin is usually the next treatment that is considered. Isotretinoin is the strongest treatment of all for hormonal acne. It is almost always very effective, even for the most severe forms of hormonal acne. Because of the potential for side effects, isotretinoin is often reserved for acne that has not responded to any other form of treatment or for acne that is causing significant scarring.