Should I see a dermatologist for hormonal acne?

hormonal acne

The term hormonal acne refers to a very persistent form of acne that is often misunderstood by most acne sufferers.  Many women self-diagnose hormonal acne based on a variety of misconceptions.

For example, female acne sufferers commonly attribute their stubborn acne breakouts to hormonal acne because they tend to break out during their menstrual periods or because they just feel that they have abnormal hormone levels even when they have no evidence of such.

That’s not to say that acne cannot result from abnormal hormone production.  Some women do indeed have conditions in which abnormal hormone levels can be associated with acne breakouts.  Polycystic Ovary Syndrome (PCOS), for example, is a fairly common disorder in which certain acne-causing hormones are overproduced and can be associated with persistent acne.

A variety of other less common conditions can also occur which cause hormone abnormalities that can lead to the development of acne. These conditions can usually be diagnosed by a thorough physical examination and blood tests to examine levels of acne-causing hormones.

Nevertheless, aside from actual medical conditions that are associated with known hormone abnormalities as a cause for acne, most acne sufferers typically refer to hormonal acne as a general label to describe their persistent, frustrating acne breakouts even without a definitive medical diagnosis of a hormonal abnormality.

How some dermatologists misunderstand hormonal acne

This tendency to label one’s acne as hormonal without any evidence for such is not just confined to acne sufferers.  Even for dermatologists, hormonal acne can be an arbitrary diagnosis of a pattern of acne breakouts without any corroborating medical or scientific test results.

Rather, hormonal acne is a clinical diagnosis based on a practitioner’s assessment of certain observed features.  It does not, however, necessarily mean that there is an actual underlying hormone abnormality.

In general, the term hormonal acne is often used by dermatologists to describe a particular clinical pattern of acne breakouts that occurs primarily in young women.  For example, a female acne sufferer with stubborn acne that tends to break out mostly along the lower face and jaw lines is a prime candidate to be diagnosed with hormonal pattern acne.

In addition, this type of acne tends to be very resistant to many standard acne treatments such as topical prescription medications and oral antibiotic pills that are often used to treat other forms of acne.  This acne pattern typically occurs in females in their 20s and 30s but can be seen in other ages less commonly.

All acne starts with the activity of hormones

It is also important to understand that hormonal pattern acne is not the only type of acne that suggests a hormonal source.   In actuality, all acne starts with the activity of hormones.  This is true for males and females alike.

The activity of acne-causing hormones called androgens is at the root of nearly all acne breakouts.    Androgens are testosterone-derived hormones that activate the oil glands within the acne-prone pores causing the pores to become overactive and over-worked.

The pores then begin to malfunction and fill with excess amounts of oil and other material.  Bacteria also begin to grow within the malfunctioning pores causing even greater disruption. As a result of these steps, the pores can become inflamed, leading to a breakout.

As a consequence, the acne-pores become raised, forming an uneven skin texture.  When the inflammation becomes intense, red pimples begin to form on the skin surface which can become very large and painful.

While it is not well understood why some women develop hormonal pattern acne, the basic steps in its formation are essentially the same as for all acne breakouts in general.  The contribution of other undefined factors is likely at work that leads to the development of this particular form of acne breakouts.

Hormonal acne can be difficult to treat

In general, hormonal pattern acne tends to be more difficult to treat with conventional acne treatments.  It is often necessary to rely on more effective methods to gain control over this acne type.  Indeed, acne sufferers often become very frustrated with the failure of standard treatments to provide relief.

Prescription creams and gels and lotions are usually ineffective in combating a hormonal pattern acne breakout.  Likewise, antibiotic pills do not usually provide significant improvement.

Certain birth control pills, which help to regulate acne-causing hormones, can sometimes be effective.  However, birth control pills are not always helpful and can sometimes make this form of acne worse.

Even though hormonal pattern acne is not directly associated with a proven hormone abnormality, it is nevertheless often very helpful to treat this acne type with hormone-based treatments.

One such treatment is a medication that works by blocking the acne-causing hormones from the start.  Spironolactone is a pill that can prevent these hormones from activating the acne-prone pores.  This treatment option can be very effective and is often used in controlling hormonal pattern acne.  In many women suffering with this acne type, spironolactone can be life-changing.

When hormonal acne is very resistant to treatment and for those who are seeking a more definitive solution, isotretinoin (also known by its original brand name Accutane) can be a very effective option.   This oral medication is the most effective acne treatment available and works on the acne-prone pore to prevent the development of acne breakouts even in hormonal pattern acne.

Why you should see a dermatologist for hormonal acne treatment

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.  While this can provide reassurance that hormone levels are within normal range, this detour can often delay effective treatment and lead to further frustration.

A dermatologist that specializes in acne treatment can immediately recognize hormonal pattern acne from the start and begin effective treatment right away.  For acne sufferers who may be concerned that they actually have an underlying hormone abnormality, the dermatologist can also identify this possibility and recommend referral to the appropriate specialist as part of overall management.

The Advanced Acne Institute is a unique dermatology practice located in Miami, Florida specializing only in the treatment of acne.   We focus solely on providing the most effective treatments to help our patients achieve clear skin.  We are pleased to share our insights and perspectives in acne treatment as an educational service, however this information is provided strictly for educational purposes only and should not be considered medical advice and is not a substitute for seeking the advice and treatment by an appropriate medical professional.