Ep22: Hormonal Acne – Causes and Treatments
Dermatology Weekly Flash Briefing – What causes hormonal acne? Hormonal acne is often treated with birth control, which is effective but has certain effects with long term use. In this flash briefing, Dr. Teo Wan Lin shares why you get hormonal acne, how oral contraceptives work to treat hormonal acne, and other alternative treatments.
What is the difference between male and female skin?
The differences between men and women is in the circulating amounts of sex hormones. The reason why male skin is coarser in texture and oilier than female skin, is because it is influenced by testosterone. When a female undergoes menstruation, there is a drop in estrogen and progesterone levels just before one’s period starts. This can trigger off the oil glands to produce more sebum – which is an oil that lubricates the skin. Excess oil production results in increased comedone formation, or in layperson’s terms, clogged pores and acne breakouts.
What causes hormonal acne?
The fluctuation of hormones can also predispose to skin inflammation, a key pathway in the development of acne. It can also make the environment much more conducive to acne-causing bacteria. These same hormonal fluctuations before the onset of the period is also responsible for PMS. Which is itself, associated with increased stress. This is a psychological reaction that can also worsen acne.
How do birth control pills treat hormonal acne?
The way birth control pills work in the treatment of adult hormonal acne is via manipulation of the levels of circulating sex hormones. Most oral contraceptive pills used for the treatment of acne specifically, contain two ingredients. These are a derivate of estrogen, as well as Cyproterone acetate, itself a progestin medication that is also an anti-androgen. This means that it counteracts the effects of testosterone. This means if you have higher levels of circulating estrogen, which is physiologically the case for women vs men, you’re going to expect softer, smoother skin.
When you are suffering from hormonal acne and you take a birth control pill, you are essentially increasing the levels of circulating estrogen. At the same time, if you are taking a medication for the treatment for acne, such as one that contains the anti-androgen Cyproterone acetate, it’s going to block the effects of testosterone – which is responsible for acne flareups just before your period starts.
What are the effects of birth control pills?
Sometimes you observe this phenomenon amongst women who have been on birth control pills for several years, or even decades. When they are thinking of starting a family, there is an abrupt withdrawal of this supply of estrogen that the body is used to, and they develop hormonal acne. That can be a physiological reaction, which can settle by itself within a month or 2 months. However, it can also be a symptom of underlying polycystic ovarian syndrome, or PCOS.
Polycystic ovarian syndrome (PCOS)
PCOS manifests in women with the following symptoms. Increased hair growth – what we term hirsutism, adult-onset acne that is also recalcitrant to treatment, weight gain, and irregular periods. The treatment for PCOS also involves taking contraceptive pills to regulate the circulating amounts of estrogen. When you are on a contraceptive for decades, it is possible that it disguises the fact that you actually polycystic ovaries. So when you stop it, and you develop these symptoms, it could be a sign that you do need to have a gynecological follow-up to evaluate your condition.
Are the effects of birth control pills temporary?
The important thing to understand is that if you do have a strong family history of inflammatory acne, cystic acne, and especially so if an individual that you are related to has been treated with a medication known as isotretinoin, you are very likely genetically predisposed to severe forms of acne – cystic acne. Oral contraceptive pills can help to treat such types of acne. But, it is very likely that when you stop the contraceptive pill, the underlying acne condition will act up again. In that sense, it is a temporary measure.
More than oral medication
However, we should not merely treat acne with oral medications. If you are using an oral contraceptive it shouldn’t be the only therapy you’re on. It’s a combination of physical therapies in the form of blue light treatment, chemical peels, microdermabrasion, certain types of lasers, combined with topical therapy – this can include anti-inflammatory botanical actives.
Botanical anti-inflammatory ingredients
Chlorella Vulgaris is an algae-derived extract that can regulate sebum production. The traditional acne medication in the category of retinoids, would be medications such as tretinoin, adapalene. These reduce the occurrence of comedone formation, but can also have medium to long term side effects such as increased dryness of the skin – what we call retinoid dermatitis.
A promising ingredient in the treatment of acne is a TCM derived herb known as berberine. Berberine acts on hormonal acne via the following pathways. First of all, it reduces and regulates sebum production via intervention in the hormonal pathways. Secondly, it also directly reduces inflammation and reduces the chance of post-inflammation erythema, and hyperpigmentation.
Hormonal acne treatment: takeaway
The key to understand is that for successful treatment of hormonal acne, you actually need a multi-pronged approach. When you stop oral treatment, say with a contraceptive pill, you have to maintain at least topical therapy, because it does not change the fact that any individual suffering from acne, is genetically predisposed to this condition. As you know, one cannot change your genetics.