How to treat Hormonal Acne

What is Hormonal Acne?

Hormonal acne often affects women in their 20s, 30s and 40s. It can also develop around the time of menopause. It’s incredibly common and can start in the teenage years or later on (even if you haven’t had acne as a teenager!). It tends to be triggered by menstruation – spots can appear just before or during a period. The typical locations for hormonal acne are the sides of the face, jawline and chin. Some people find it is associated with a lot of whiteheads and cysts which can take a while to go away.

What causes it?

Often, there is no identifiable trigger other than it being associated with the time of the month. External triggers can include the mini pill (progesterone only pill) and some women find that other types of contraception can trigger hormonal acne, such as the Mirena coil. Hormonal acne can also occur in conditions associated with raised levels of androgens such as polycystic ovarian syndrome.

So why does it happen?

We asked Dr Emma Horton, dermatology doctor, why some people suffer with hormonal acne. ‘Hormonal acne occurs because of the effects of hormones called androgens. Testosterone is an example of an androgen – often people think of androgens as ‘male hormones’. There are lots of androgen receptors in your sebaceous glands and when these are triggered they produce sebum which causes oily skin and clogs up your pores. This results in comedone formation (whitehead sand blackheads). Certain androgens are also implicated in causing inflammation in the skin and this leads to spots’.

So do women with hormonal acne have higher levels of androgens? ‘The evidence is a bit conflicting in this matter. The bottom line is not all women with hormonal acne have increased levels of androgens – it is likely that their skin is just be more sensitive to the effects of androgens. If you have other signs of elevated androgen levels such as increased facial and body hair and/ or irregular periods, then it’s advisable to check in with your GP as they may recommend some hormonal blood tests. Polycystic ovarian syndrome is an example of a common condition that affects a lot of women and is associated with raised levels of androgens.’

Dr Emma says ‘It’s important to remember that androgens are not all bad though. They have a lot of important effects like regulating the menstrual cycle and and strengthening bones.’

So how do I treat my hormonal acne?

One of the most common treatments for hormonal acne is the combined oral contraceptive pill which contains both progesterone and oestrogen. Certain progesterones have anti-androgenic effects and your GP can tell you which pills are recommended. Topical anti-acne treatments such as salicylic acid, antibiotics, azelaic acid and topical retinoids can be very effective for hormonal acne. Spironolactone is a specific anti-androgen medication (there are both topical and oral forms). Oral spironolactone is actually a tablet used to treat high blood pressure but it is also frequently prescribed by dermatologists to treat hormonal acne – it works by blocking androgen receptors. More information on spironolactone can be found here: https://www.bad.org.uk/pils/spironolactone/

So in summary hormonal acne is incredibly common. Most women in fact suffer with spots around the time of their periods. And if it is affecting your quality of life, then there are many treatments available!

References

Seirafi H et al. Assessment of androgens in women with adult-onset acne. Int J Dermatol. 2007 Nov;46(11):1188-91.

Layton AM et al. Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review. Am J Clin Dermatol. 2017 Apr;18(2):169-191.

da Cunha MG, Fonseca FL, Machado CD. Androgenic hormone profile of adult women with acne. Dermatology. 2013;226(2):167-71.