Hormonal Acne: Why It Happens and How to Treat It

Most people develop acne while they are teenagers. Puberty causes the body to go through a number of changes, including a significant rise in hormone production. Acne is a result of the action of these hormones on the skin's oil glands. But occasionally acne can last far into adulthood. Any hormonal changes, including those brought on by pregnancy, stress, hormone abnormalities, and the use of birth control pills, could be to blame for this.

Although hormonal acne is frequently linked to hormone changes during adolescence, it can afflict adults of any age. Women are particularly prone to it. Menstruation and menopause are two potential contributors to this. Women between the ages of 20 and 29 are thought to experience acne in 50% of cases. It affects roughly 25% of women between the ages of 40 and 49.

During a physical examination, a healthcare professional will examine the acne and consider any contributing variables to make the diagnosis of hormonal acne. Talk about the skin care items you use frequently, sleep patterns and stress, you currently take drugs, alterations to your health (hormonal changes).

Other factors aggravate hormonal acne-

• stress
• heavy humidity
• pollution
• rubbing or plucking at flaws.
• a poor diet (specifically refined carbohydrates and sugars).

Does Hormonal Acne Include Menopausal Acne?

In their 40s and 50s, many women start to go through the menopause. Your reproductive hormones naturally decrease as a result, ending your menstrual cycle.

Menopause can cause acne in some women. This is probably brought on by a decrease in oestrogen levels or a rise in androgen hormones, such as testosterone.

Even if you're utilising hormone replacement treatments (HRTs) to lessen your menopause symptoms, you can still get menopausal acne. This is so that the oestrogen and progesterone your body loses may be replaced by some HRTs, which use an inflow of the hormone progestin. Your skin may get inflamed after taking this hormone for the first time.

Prescription drugs can typically get rid of menopausal acne. Natural treatment options might be effective for some ladies. The options that might be best for you can be discussed with your doctor.

What Are The Causes That People Get Hormonal Acne?

Because of changes in hormone levels, the body develops hormonal acne. The production of sebum by the oil glands rises as a result of an imbalance in hormone levels. This might result in blocked pores, mild bacterial infections, and ultimately acne.

The skin's hair follicles at the base are affected by the four acne-causing factors:

• As a teenager, you start producing more testosterone. Sebum, the lubricating and protective oil released at the base of hairs, is produced more as a result, which results in greasy skin.
• Comedones, often known as "clogged pores," or blocked hair follicles, develop. Additionally contributing to this process is the overproduction of skin cells that would otherwise be pushed up and shed from the surface.
• A bacterial infection may worsen the comedones.
• As a result of the immune system's response to the bacteria, inflammation develops.

Acne can be brought on or made worse by a number of circumstances, such as:

• Pregnancy anxiety or stress
• Medicines for contraception
• Such as polycystic ovary syndrome, are hormonal diseases (PCOS)
• an inheritance of acne
• Elevated amounts of androgen in the body
• Menstruation
• Testosterone boosters
• Hyperinsulinemia

Pore clogging is the root cause of acne. When your skin generates more oil as a result of hormonal fluctuations, hormonal acne occurs. Acne is the result of the interaction between this oil and the microorganisms on your skin's pores, or hair follicles. Some common reasons behind the occurrence of clogged pores are-

• Sebum in excess (the oily substance created from the sebaceous glands in the middle layer of your skin)
• dead skin cells
• bacteria
• hormone-related acne causes you can manage
• anxiety
• sleep deprivation
• using hair and skin care items that don't have oil-free or ingredient-free formulas that won't clog pores (non-comedogenic or non-acnegenic)

Changes in hormone levels in women, such as those that occur during menstruation, irregular periods, pregnancy, menopause, or after stopping birth control, can lead to hormonal acne for which there is little you can do about it. Other reasons of hormonal acne for which one cannot do anything are-

• males getting testosterone therapy.
• acne prevalence in the family (genetic predisposition).
• a medication's unintended effects (steroids).
• illnesses that were present before (polycystic ovary syndrome, other ovarian conditions and metabolic conditions).

What Signs And Symptoms Of Hormonal Acne Are There?

Lesions (damaged skin tissue) brought on by acne may swell up, turn red, uncomfortable, or sore. Your cheeks are where lesions are most prone to form, although they can also develop elsewhere.

• Face.
• Neck.
• Back.
• Shoulders.
• Chest.

The following types of lesions can develop as a result of hormonal acne:

On your nose, chin, and forehead (also known as the T-zone), hormonal acne frequently manifests during adolescence. Adults with hormonal acne may first experience symptoms on their lower face, which includes their jawline and lower cheeks.

• Open comedones, also known as blackheads, develop at the skin's surface and turn black when sebum reacts with the air.
• Whiteheads (closed comedones) have a white appearance on top but are closed beneath the skin's surface.
• Papules (raised skin tissue, 2-5 mm in diameter) (raised skin tissue, 2-5 mm in diameter).
• Pustules (skin lumps that contain pus, 2-5 mm in diameter) (skin bumps that contain pus, 2-5 mm in diameter).
• Cysts (pockets under the skin that contain fluid) (pockets under the skin that contain fluid).

Because there is more sebum in this area than in other areas of the face, such the cheeks, they are more likely to develop on the forehead. Because of the effects on self-esteem, depression can be a side effect of acne. According to estimates, 80 percent of persons between the ages of 11 and 30—and particularly those between the ages of 14 and 19—have acne. After turning 30 years old, some people still have acne. Hormonal shifts can once more cause acne to plague women during pregnancy and around menopause.

The degree or severity of acne

When there is inflammation and a large number of lesions, acne is severe. It is possible to prescribe medication. Acne can range from mild to severe.

Current classifications imply that:

• Blackheads and whiteheads make up the majority of mild acne, which is rarely treated by doctors. There are 30 lesions in all, less than 20 comedones, 15 inflammatory lesions, and 15 other lesions.
• Both inflamed and non-inflamed lesions, some of which may leave scars, are present in moderate acne. There are between 20 and 100 comedones and between 15 and 50 inflammatory lesions, for a total of between 30 and 125 lesions.
• Widespread, inflammatory lesions are a sign of severe acne. It can leave scars and have an effect on one's appearance and self-esteem.

Acne in any form can be upsetting. A person's self-confidence can be impacted by even minor acne. This is not just because of the way it looks, but also because it frequently has an impact on young people when they start to form connections.

Treatment of Acne

For acne, there are numerous medicinal remedies. Choices for both standard and complementary therapies:

Usually, the first-line treatment for acne consists of topical and oral drugs-

Topical Agents

The initial acne medication administered is typically a topical antibiotic. Examples include nadoxin, dapsone, and clindamycin. Common topical retinoids for the treatment of comedonal acne include adapalene gel (0.1%), tretinoin gel/cream (0.025%), and others.

Different Topical Agents

For inflammatory acne, benzoyl peroxide is frequently utilised since it has anti-inflammatory effects. To lessen the hyperpigmentation brought on by acne, azelaic acid is utilised in topical formulations. In face cleansers, gels, and serums, salicylic acid is employed.

Oral Medicines

Acne treatment options include oral antibiotics. Azithromycin, minocycline, and doxycycline are a few of these.

 Hormones and Anti-Androgen Medications

Anti-androgen therapy describes the use of drugs by women to combat the skin-damaging effects of male sex hormones like testosterone. Men's skin issues are not appropriate candidates for anti-androgens. Acne in women is frequently caused by elevated androgen levels. In these circumstances, anti-androgen medications are administered to reduce the body's production of testosterone. Anti-androgen medication reduces insulin resistance in the body, androgen production in the ovaries and pituitary glands, as well as prolactin production.

By inhibiting the enzyme 5-alpha reductase, which helps to raise levels of dihydroxy testosterone, androgen receptors in the body are blocked, androgen production in the adrenal glands is decreased, androgen levels are increased.

Some medicines of anti-androgen that are very commonly prescribed and used-

• Spironolactone is one anti-androgen medication that is frequently administered.
• Spironolactone is a diuretic that aids in eliminating extra fluid from the body and reduces the synthesis of testosterone.
• It is made from the hormone aldosterone and is useful for treating hormonal acne brought on by excessive levels of testosterone.
• Within 3-6 months of treatment, spirolactone has been shown to drastically reduce the amount of acne in the body.

Due to its diuretic properties, spirolactone should be used with caution.

• Men should not use spirolactone since it lowers the body's testosterone levels.
• This medication should not be used by pregnant women as it may harm the foetus.
• Consuming too much potassium while taking spironolactone should be avoided.
• Spironolactone's side effects include soreness or breast enlargement as well as irregular menstruation.

Tablets of Oral Isotretinoin

• When alternative therapies are ineffective for severe cases of acne, oral retinoids are given. Usually, doctors will prescribe these in smaller amounts to be taken with food.
• Pregnancy should not be attempted while using oral retinoids because they can cause birth abnormalities. At least three months before trying to get pregnant, stop taking these medications.

Oral contraceptives used in combination to treat hormonal acne

• Birth control pills known as combined oral contraceptives (COCs) are made up of synthetic progesterone and oestrogen (progestin). COCs have oestrogen, which aids in lowering the body's androgen levels and, consequently, acne.
• Progestins may not be as effective as oestrogen at lowering testosterone levels, according to research. Consequently, birth control pills that exclusively contain progestins could not be effective in treating acne.
• There are numerous COCs on the market right now. Only three of them have been given the go-ahead by the US FDA for sale here. But numerous research have revealed that all COCs work well to treat acne.

Side effects that this may cause-

• Blood clots or obstructions in the blood vessels known as "thromboembolisms," which can be lethal, can occasionally result from COCs. Therefore, they shouldn't be used by women who have coagulation issues, such as those with heart conditions, clotting disorders, hypertension, obesity, cancer, diabetes, and those who are pregnant or nursing.
• Flutamide - Prostate cancer is treated with the anti-androgen medication flutamide. To reduce the body's level of testosterone, it inhibits androgen receptors. Hormonal acne can occasionally be treated with flutamide.
• GnRH antagonists - In order to reduce androgen levels in the body and treat acne, drugs referred to as GnRH agonists (such as buserelin, leuprolide, and nafarelin) block GnRH production. Women who don't respond to COC therapies are the only ones for whom they are prescribed.

Adverse Consequences of GnRH Antagonists

• GnRH agonists are rarely prescribed to female patients because they reduce oestrogen levels, which might have unfavourable side effects include osteoporosis and irregular bleeding. When pregnant or nursing, GnRH agonists should not be taken.

If you don't respond to any of the aforementioned therapies for hormonal acne, there are surgical therapy alternatives available.

Clinic Treatments

• To treat hormonal acne, use chemical peels first.
• For the purpose of promoting the formation of new skin cells, chemical peels are used to delicately remove the top layers of your skin. Acne scars, clogged pores, and persistent acne are all things they aid in removing.
• Chemical peels come in a variety of forms, from superficial to more aggressive.

The Use of Lasers

• Single wavelengths of intense light with a high power are used in LASERs (light amplification by stimulated emission of radiation) to cure wrinkles, scars, and other skin disorders.
• Lasers that use fluids containing organic dyes are known as pulsed-dye lasers (PDL). In order to treat acne and redness, a powerful laser is employed to pump this solution. Uses the idea of selective photothermolysis (i.e., concentrating heat on a specific diseased tissue without damaging the surrounding healthy tissues).
• Potassium titanyl phosphate lasers (KTP): Potassium titanyl phosphate lasers emit a green light with a 532 nm wavelength using potassium titanyl phosphate as the source material. It can help treat acne and redness and is a very efficient therapy with few adverse effects.
• In photodynamic treatment (PDT), the skin is first treated with a photosensitive solution before being exposed to a laser. Thus, the skin may be more effectively penetrated by the laser. Acne, cysts, and acne scars can all be eliminated with PDT therapy.
• Utilizing a vacuum and an intense pulsed light (IPL) laser, photopneumatic therapy uses these two elements. Your pores are cleaned of excess oil and grime, and it helps to open up your skin's pores. It is a medical procedure that has received FDA approval and aids in treating nodules as well as reducing blackheads and whiteheads.

For the treatment of hormonal acne, there are LED therapies available.

• Using specialised equipment that emits red and blue light, light therapy is used to treat acne. It is applied to the skin to calm it, decrease oil production, and treat inflammation and acne.
• These gadgets are known as visible light devices because the colour of the light they emit can be seen in blue, red, and blue+red light devices. Blackheads, whiteheads, cystic acne, and nodules cannot be treated by visible light, which only helps to clear up pimples.
• Devices used at home: Using LED at-home devices is a successful alternative to visiting a dermatologist for acne treatment. Blue, red, and red-blue light gadgets, among other varieties of visible light equipment, are now widely accessible. The clinical LED gadgets are more efficient, but they are still not as good. In order to see effects from the majority of at-home LED gadgets, users must use them every day for at least one or two months while putting in half an hour of effort.
• Far-infrared light Blackheads, whiteheads, cysts, etc. cannot be treated with infrared light, but infrared light can be used to treat acne.
• Injections of corticosteroids into the skin's surface are used to treat nodular acne and cysts. Injections of cortisone are given directly into the lesion to instantly relieve inflammation. Be aware that these injections may result in sunken skin or whitening of the skin in the area where they were given.

How To Naturally Cure Hormonal Acne?

Plant-based remedies can sometimes be utilised to get rid of minor hormonal acne.

Natural remedies typically don't have the adverse effects that prescription drugs can occasionally have. However, they might not be as successful. Natural remedies haven't been thoroughly studied, and none has yet been shown to be effective. To make sure the treatment won't interact with any of the medications you're taking or discuss potential concerns, speak with your doctor.

Tea Tree Oil

• Inflammation, which can worsen acne, is reduced by tea tree oil. According to one study, participants with mild to moderate acne saw symptom relief after applying topical tea tree oil at a 5 percent concentration.
• There are numerous skin care products, including cleansers and toners, that include tea tree oil. Tea tree oil has other uses than being applied topically.
• Tea tree essential oil should always be diluted with a carrier oil before usage. Jojoba, coconut, and olive carrier oils are all widely used. The usual rule is to add one to two drops of essential oil for every 12 drops of carrier oil.
• Before utilising tea tree essential oil that has been diluted, it's crucial to perform a skin patch test. Apply the diluted oil on your forearm's interior to do this. It should be okay to use elsewhere if, after 24 hours, you don't suffer any itchiness or inflammation.

An Alpha-Hydroxy Acid

• Alpha hydroxy acids (AHAs) come primarily from citrus fruits and are plant acids. Excess dead skin cells blocking pores can be removed with the use of AHAs. Plus, AHAs can aid in reducing acne scarring's visual impact.
• Many OTC masks and lotions contain AHA. AHAs can make your skin more sensitive to the sun, same to how retinoids do. When using products containing AHA, you should always wear sunscreen.

Green Tea

• The anti-inflammatory properties of green tea are well established. Consider adding a few cups to your daily routine in addition to your topical skin care routine for a more all-encompassing approach. A wide variety of green teas are available here. It might be advantageous to use lotions and gels with at least 2% green tea extract.

Diet Guidelines for Hormonal Acne

It is unclear exactly how diet and hormonal acne relate to one another. Certain meals, especially those that reduce inflammation, may help prevent acne. Antioxidant-rich plant-based diets may aid in reducing inflammation and promoting brighter skin. Omega-3 fatty acids might lessen skin irritation as well. Contrary to what many people think, eating junk food alone doesn't cause acne. But consuming too much of a given food can result in more inflammation.

You may want to restrict the following:

• dairy goods 
• sugar
• refined carbohydrates, including spaghetti and white bread
• red meats

It might be challenging to deal with hormonal acne. Consult a dermatologist if you have this issue to receive a treatment plan based on the severity of your acne and the type of skin you have. Despite the fact that everyone's hormonal acne progresses at a different rate, being proactive can help avoid associated breakouts. The full impact of a new acne treatment regimen usually takes eight to ten weeks.

Birth control may occasionally be recommended as a treatment. If your doctor thinks using birth control is the best course of action for you, you can talk to them about the advantages and disadvantages of doing so. Discuss a long-term treatment strategy with your physician or dermatologist if your acne continues. To enhance your results, they can modify your existing regimen and add new treatments.

Everybody's acne treatment may be different, but persistence is essential. After starting therapy, it typically takes four to six weeks before you start noticing improvements in your skin. It is advised that you continue therapy even if you don't see any improvement in your skin because doing so will stop fresh acne from developing.