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Hormonal acne causes and treatments

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In this article

What causes hormonal acne?
When does hormonal acne usually occur?
Where is hormonal acne usually found?
The stages of hormonal acne 
Caring for hormonal acne 
How to treat hormonal acne 
Natural treatment of hormonal acne

Acne has a reputation of being a young man’s or a woman’s problem. In fact, acne may develop at any time after puberty up to middle age. Acne can be caused by many things, one of which is due to hormonal imbalance. And treating face acne can be a consideration for all age groups. 

What causes hormonal acne?

Hormones play an important role in acne development of all types. Several factors make it likely that a person’s acne is specifically sensitive to changes in hormonal levels. These are covered below.

Growth hormones

Having high levels of growth hormone and insulin-like growth factor can lead to severe acne formation are high levels of growth hormone and insulin-like growth factor 1. In this case, the external hormones may come from food such as red meat and milk.

Artificial changes in hormone balance

Artificial changes in hormone balance also lead to acne. Over-the-counter bodybuilding and dietary supplements may contain added anabolic steroids - synthetic androgens. They can cause or increase the extent of hormonal acne, especially in males.

Polycystic ovary syndrome

Medical condition polycystic ovary syndrome that affects one in five women in the UK can also cause acne.

When does hormonal acne usually occur?

Hormonal acne during puberty

During puberty an increase in androgens causes the skin follicle glands to grow larger and make more oily sebum and cause a hormonal acne flare up. Both female and male sex hormones surge during puberty which can cause hormonal acne. Ultimately, they increase skin oil production followed by acne formation.

Menstrual cycle can trigger acne breakouts

While most people of both sexes start experiencing acne outbreaks during puberty, up to 85 percent of adult women report a worsening of their acne in the days before menstruation.

Pregnancy acne

During pregnancy androgen production also increases which again causes the skin follicle glands to grow larger and make more oily sebum. Half of the pregnant women develop acne, mostly in the first trimester.

Treating pregnancy acne

Many prescription and over the counter acne medications and preparations have a possibility of harming the baby. That is why doctors strongly advise avoiding medicated and chemical remedies during pregnancy and use of natural remedies for hormonal acne.

Where is hormonal acne usually found?

Hormonal acne is usually found in the lower third part of the face around the mouth, chin and jawline. While acne in older women tends to be mild, many adult femal acne patients have acne lesions around the mouth and chin while younger patients do not necessarily have this pattern. When hormonal acne breaks out in these areas common treatments include local therapies which we will cover below.

The stages of hormonal acne

Comedonal acne

Acne – including hormonal acne – progresses through several stages. The earliest stage is the formation of a plug made from dead skin cells stuck together with sebum in the pore of a hair follicle. The plug is called microcomedone. Propionibacteria colonise the microcomedone.

Skin pigment melanin that accumulates in the plug is oxidised by oxygen in the air, and that causes the microcomedone to become black. This stage is known as open comedo or blackhead. On the other hand, when microcomedoes forms deep within the hair follicle, and there is no oxygen access, it remains white. White or open comedones are called whiteheads.

Cystic acne

If left untreated and the hormonal imbalance remains, hormonal comedonal acne will proceed to the next, most serious stage of hormonal cystic acne. Mentioned above colonisation of open and closed comedones by propionibacteria causes inflammation in and around blocked hair follicles. Chemical signals such as IL-1 produced by skin cells attract immune system cells that deal with a bacterial infection. However, they also have a side effect of increasing skin cells reproduction. Rapid skin cell accumulation speeds up comedones formation.

The inflammation process around hair follicles leads to the formation of progressively worsening inflammatory acne lesions. These lesions are called papules, nodules, and pustules. They are characteristic symptoms of cystic acne. If the inflammation is severe, the content of comedones breaches skin layer underneath the hair follicle and causes the formation of deep nodules and pustules filled with pus.

Deep nodules often result in skin scarring in the form of

  • Shallow depressions in the skin
  • Small but deep skin pits called 'ice-pick scars
  • Red-raised scars

The cure of hormonal cystic acne lies in managing acne development. Tackling earlier stages of acne e.g. blackhead and whitehead treatment will significantly alleviate or even prevent cystic acne formation.

Caring for hormonal acne

  • Tips on how to look after hormonal acne include:
  • Correct skin care becomes especially important during pregnancy
  • Try not to irritate skin by touching your face
  • Use mobile hands-free to prevent skin rubbing and irritation
  • Change pillowcases frequently to avoid discarded skin cells and bacteria accumulation
  • Wash face only twice a day and after heavy sweating
  • Avoid over cleansing because it can stimulate skin oil production
  • Use a gentle, oil-free, alcohol-free, non-abrasive cleanser
  • Use a washcloth made from natural materials such as cotton and change it daily
  • Frequently wash your hair as the scalp oil production links with face oil production
  • Booking a professional facial can be considered as a part of pregnancy care similar to dental checkups
The above skincare regime advice applies to all other categories of hormonal acne.

How to treat hormonal acne

Many different treatments exist for acne. They work in several ways, including hormonal manipulation, reducing inflammation, killing propionibacteria. The other groups of medication also normalise skin cell shedding and sebum production in the pore to prevent blockage. We will look at some of the commonly used treatments below.

Natural treatment of hormonal acne

Before you go to your doctor and start taking medication, it’s better to try natural remedies for your hormonal acne treatment. Concealing the outbreaks and applying topical products to control the most severe effects is not enough and will not prevent further flares.

It’s important to understand that as any long-term condition acne requires an initial treatment with the long-term maintenance regime.

The only cause of acne you can do nothing about is your genes. The other causes of acne including stress, diet and especially skin care regime during acne are manageable.

Reduce levels of stress

Persistent stress leads to the release of the stress hormone cortisol and sex hormones. The high hormones level leads to acne outbreaks or makes the condition worse. In a recent study in France, stress was listed as a precipitating factor for acne in half of the surveyed women.

Reducing stress is the best place to start your acne treatment. Find if your work, commuting or your home life stresses you out and try to reduce the associated amount of stress. Practice mindfulness. Getting enough sleep is shown to reduce stress significantly.

Hormonal acne diet

How diet affects the skin is important to think about. Your diet is the most essential and preventable cause of excessive skin oil production. The best foods for hormonal acne are oily fish and eggs, vegetables, replace cow milk with non-dairy alternatives such as almond or oat milk. Avoiding sugar, excessive animal fat, unregulated dietary supplements will help balance hormones and manage acne.

Does exercise help hormonal acne?

The amount of exercise you get can correlate with the extent of your acne. Hormonal acne depends not only on the level of your sex hormones but also on the presence of stress hormone, cortisol. The higher is the level of cortisol, the more severe are acne outbreaks.

Moderate physical exercise such as hiking, running or yoga reduces the amount of stress hormones.

Besides physical activity, the other type of exercise that helps to reduce the severity of hormonal acne is mental exercise such as mindfulness or meditation.

Just don't forget that any excise should be followed by a shower and proper skin care routine.

Homeopathy for hormonal acne?

Some people may find that homeopathic remedies for acne help them. Homeopathy is supposed to work by introducing the irritant that causes acne in minimal quantities. Mainstream science thinks that the effects of homeopathic remedies are psychological. While the result of homeopathic preparations is very variable and not guaranteed, there are no known side effects of homeopathic treatments.

Supplements for hormonal acne

While it is important to maintain a healthy diet to reduce the hormonal acne occurrence and severity, it is possible to increase chances for acne eradication by taking vitamins and supplements for hormonal acne. The useful supplements include vitamins and microelements that you may have insufficient amount in your diet, especially during cold months.

Zinc supplements for hormonal acne

There are some data that metal zinc fights all three main components of acne formation. Zinc reduces sebum production that is the first step in acne formation. It also alleviates inflammation that leads to severe acne. Finally, it works as an antibacterial agent that inhibits propionibacteria growth. The side effects of a high concentration of zinc as a result of combining pills and topical remedies is a copper deficiency, so it is essential not to exceed the prescribed amount of zinc in all preparations combined.

Selenium supplements for hormonal acne

Selenium is another metal, rarer than zinc that reduces skin inflammation. Selenium is often sold as a complex with zinc-containing compounds and vitamin E. Because the amount of selenium required to fulfill daily requirement is small, selenium supplements shouldn't have any side effects.

Vitamins for hormonal acne

Several vitamins, mostly involved in the normal functioning of immune systems used to reduce hormonal acne:

Vitamin A  is involved in the maintenance of a healthy immune system as well as skin cells regeneration;

Vitamin B3 has anti-inflammatory properties, suppresses sebum production, and promotes wound healing;

Vitamin C reduces skin damage by free radicals and improves collagen renewal;

Vitamin E is also antioxidant and has anti-inflammatory properties;

While omega-3 fatty acids found in oily fish such as mackerel and krill are not ‘classical’ vitamins, they are shown to strengthen skin and nails. Omega-3 fatty acids also help to maintain healthy hormonal levels that are especially important in hormonal acne treatment.

Except for vitamin A, the overdose of which increases skin sensitivity to UV light, there no side effects of the other vitamins.

If you do decide to supplement your diet with vitamins, multivitamins rather than individuals vitamins are better. Multivitamins contain a combination of a daily dose of most vitamins. Some formulations also contain zinc and selenium.

Herbal supplements for hormonal acne

Herbal or plant supplements can be a part of the holistic factors and lifestyle that aims to reduce and eliminate acne. Supplements contain compounds found in medicines but in less concentrated form. Variation in the concentration of active ingredients between different preparations makes them less effective than medications. However, decreased herbal supplements efficiency is more than compensated by the rarity and mildness of side effects.

Vitex for hormonal acne

One of the best herbs for hormonal acne, Vitex agnus castus is a shrub common to Mediterranean region. It contains essential oils rich in flavonoids and steroids. Preparations derived from leaves and fruits are recommended in Germany for normalisation of male and female hormone production. As such, vitex preparation may help with acne. Possible side effects include nausea, headache, gastrointestinal disturbances. However, even if you have side effects, they are mild and reversible.

Tea tree oil for hormonal acne

Traditional skin clearing remedy, tea tree oil is thought to be as effective as benzoyl peroxide or salicylic acid. Proposed mechanisms for tea tree oil's anti-acne effects include antibacterial action against propionibacteria and anti-inflammatory properties. However, tea tree oil is associated with allergic contact dermatitis in some individuals.

Other plant derived therapies for acne

Other plant-derived therapies have positive effects on acne. They include but not limited to basil oil and oligosaccharides from seaweed. Flax and chia seeds that contain omega-3 are effective against skin inflammation and recommended for consumption by acne-prone individuals.

Best topical treatments for hormonal acne

Topical treatments for hormonal acne work by targeting the early stages of comedo formation and are generally ineffective for visible skin lesions. They are applied to the sites of acne as creams, gels, lotions and have a local effect. Topical medicines usually contain antibacterial agents like salicylic acid or antibiotics. Vitamins are also frequently used in topical applications.

Benzoyl peroxide for hormonal acne

Benzoyl peroxide serves as an active anti-acne agent that is applied topically in the form of a gel, cream or liquid — prescribed on its own in cases of mild to moderate acne. For more severe cases it is recommended in combination with antibiotics or synthetic retinoids.

Benzoyl peroxide works as an antimicrobial agent. Benzoyl peroxide often causes initial dryness and sometimes skin irritation, although the skin develops tolerance after a week or so. Less frequent are cases of a burning sensation as well as swelling. An even smaller number of people develop an allergy to it.

Does proactiv work for hormonal acne

Proactiv is a brand of skin-care products best known for its three-step anti-acne kit that includes a cleanser, toner, and lotion. Proactive products contain benzoyl peroxide that is effective against acne. However, other less expensive products also contain this compound. A Consumer Reports study compared Proactiv with two less expensive AcneFree and OXY Maximum. It found all three equally effective.

Medication for hormonal acne

Hormonal acne medication divided into treatments that kill propionibacteria, reduce inflammation, and normalising the skin cell renewal cycle. Different groups of medicines are often prescribed together to strengthen the effect. For example, for longer courses of antibiotics benzoyl peroxide or a retinoid can be used at the same time.

Antibiotics for hormonal acne

Antibiotics are prescribed for mild to moderate acne. They kill propionibacteria and help to reduce inflammation.

Topical antibiotics applied to the skin in sites of acne concentration in a form of cream. The second group of antibiotics, general antibiotics taken in form of pills is more effective because the blood distributes them to all acne sites.

Antibiotics from different groups should not be taken together. Also, it is essential not to interrupt the prescribed course and not to take the antibiotics longer than necessary. Incomplete course or prolonged antibiotic treatment may lead to appearance of antibiotic-resistant bacteria that are difficult to treat. A general side effect of antibiotics prescribed for acne treatment is the development of an allergy. Specific side effects depend on the particular antibiotic prescribed and can be checked in the accompanying information.

Does accutane work for hormonal acne

Accutane or Roaccutane is the brand name of drugs containing isotretinoin or 13-cis-retinoic acid. The patent for the drug has run out, and it is sold under different names.

Isotretinoin is a very strong, effective retinoid, e.g. vitamin A precursor prescribed for severe acne. After a single course, about 80% of people report an improvement in hormonal acne, with more than 50% have a complete remission.

The confirmed side effect is skin, nasal and eye dryness. Other effects may include mood changes.

Due to the potential adverse effect on baby development, women of childbearing age are required to use two forms of contraception before, during and after the course of isotretinoin and have negative pregnancy tests.

In conclusion, Accutane and its generic variants can cure hormonal acne, but you need to be aware of side effects.

Oral retinoids for hormonal acne

Oral retinoids are the first-line treatment for acne. They are precursors of vitamin A that is responsible for active skin cells regeneration. The retinoids influence the cell life cycle in the follicle lining, reducing inflammation and decreasing sebum production. Downregulation of inflammation and oil accumulation prevents the accumulation of skin cells within the hair follicle that creates an acne-inducing blockage.

Side effects of retinoids include skin sensitivity to UV light, that is why retinoids usually are taken in the evening. Generally, the stronger is the effect of a retinoid, the stronger are the side effects.

Using hormonal agents to manage hormonal acne

Because sex hormones are the underlying cause of the increased sebum production, they are often prescribed to alleviate the hormone imbalance.

In women, acne improves in most of the cases with the use of any combined birth control pill that contains female hormones estrogen and a progestin. The pills lower the amount of internally produced male hormones decreasing the acne formation. Birth control pills can be as effective as antibiotics in acne reduction with an additional benefit in normalising the menstrual cycle. Side effects of hormonal contraception pills include mood swings or weight change. Hormones are not prescribed to normalise male acne.

Skincare for hormonal acne

Skin care regime is very important in fighting hormonal acne. Products that exclude oil-based and deploy water-based formulas will help you to keep your skin clear.

The use of proper cosmetic that doesn’t cause comedones formation and acne is very important for avoiding acne flares. In addition to makeup itself, skin care products, such as moisturisers are commonly used along with acne medications. One study has shown that the application of a moisturiser before topical acne medications did not interfere with efficiency and enhanced tolerability of the drug.

Sond has several products that are formulated to treat facial acne including a universal serum and a range of specially formulated products.

Best facial cleanser or face wash for hormonal acne

Facial cleansers for hormonal acne are important for regular removing of excess sebum. Facial cleansers should not contain oil as micellar water. They should also not contain irritants. The best cleansers also contain anti-acne compounds such as tea tree oil or salicylic acid. Sond has an effective cleanser formulated to fight acne.

Best moisturizer for hormonal acne

While cleansing is a foundation of your skincare routine, it should be followed by a moisturiser that supports the acne healing process. It is crucial to hydrate skin and lock in moisture to prevent skin irritation that will result in inflammation and excessive oil production. Sond has the solution for this problem with its Product Sidekick Day Cream. It is important to use the best night cream that provides long term nourishment for your skin helping it to fight acne. Sönd has developed the perfect night cream to be used for acne prone skin.

Hannah de Gruchy BSc(Hons)

About Author

Hannah de Gruchy is a freelancer writer who specialises in health and wellness. She has a keen interest in the biology of skin and loves using her words to help separate the real science of skincare from the pseudoscience of some skincare brands. Hannah has a degree in Human Biology and many years’ experience working in laboratories around London. Using this experience, Hannah enjoys turning complex science into interesting, engaging and easy to digest pieces to read. In her spare time, Hannah runs, practices yoga and loves cooking plant based foods.

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