Hormonal acne treatments At A Glance
- Best Results2-3 months
- Treatment Recovery0-1 day
- Procedure Time10-15 minutes
- Skin SpecialistNurse, Medical Dermatologist
- Duration of ResultsVariable
- Back to WorkImmediately
Hormonal treatments for acne
Hormonal acne is a very common condition affecting over 20% of Australian adult women. This form of acne usually varies with the period cycle, and presents as deep lumps, cysts & blind ending pimples. Hormonal acne can be very distressing, & often resistant to over the counter washes & creams. Early & effective management prevents acne scarring.
FactsFacts on acne and hormones
- Adult onset acne is common, particularly in women in their 20’s to 40’s
- Hormonal acne is often tender with inflammatory lumps & deep cysts
- Acne can significantly impact on self-esteem, mood & confidence. Scarring is common, acne picking can compound the situation
- Hormone acne favors the chin, jawline and neck
- Hormones can be affected by the menstrual cycle, pregnancy and menopause
- This form of acne is usually resistant to topical & home remedies
- Early control by a medical dermatologist mitigates acne scarring
How do I know if I have hormonal acne?
Hormonal acne often begins in the 20s and may continue into the 30s & beyond. The location of pimples can be a clue to whether you have hormonal acne. Unlike teenager acne, the skin at the jaw line & chin area are more often affected. This may extend to the lower face and neck.
Affected skin areas are sensitive and easily irritated by topical agents. Many patients did not have acne as a teenager.
What causes hormonal acne?
Hormonal acne is thought to result from the interplay of a number of factors. One or several of these factors may cause hormonal acne in any particular patient. It is important that your dermatologist takes a thorough history from you to establish likely contributing factors. Factors that may contribute to hormonal acne include:
- Hormones, such as progesterones, oestrogens & testosterone – in most cases, levels of these hormones are normal but your doctor may test for them if you have other symptoms
- Other hormones such as insulin
- Stress or illness
- Comedogenic & oily skin care products, make-ups & some sunscreens
- Hormonal & metabolic disorders such as polycystic ovarian syndrome (PCOS) and diabetes and rarely, some types of cancers
- Oral contraceptives – many contraceptive pills help acne but progestogen only pills can worsen it, the same goes for Implenon.
- Dietary factors play a significant role in some.
What treatment options are there to control hormonal acne?
If your dermatologist suspects a hormonal problem, a number of simple blood tests may be performed to test hormone levels. A pelvic ultrasound may also be requested if an ovarian disorder is suspected.
Often a combined approach to managing hormonal acne is most effective. It is essential for any underlying medical problems that may be contributing to hormonal acne to be corrected. Other contributing factors such as inappropriate cosmetics or medical creams and ointments may need to be stopped. Treatment may be prolonged and it is essential that patients follow their treatment plan to offer the best chance of a cure.
Hormonal acne can often respond to the same treatments used to treat teenage acne. This includes various topical cream & gel treatments for very mild cases, however in most patients other treatment modalities are indicated -see below.
A range of topical creams and gels often containing multiple ingredients including antibiotics, “retinoids” (vitamin A compounds) & benzoyl peroxide are usually a good start to treatment. Sometimes, your doctor may also prescribe an oral antibiotic as well. These treatments usually require a tailored approach to each patient.
More persistent or severe cases often benefit from an “anti-androgen” medication such as spironolactone, which is often effective either alone, or in combination with the oral contraceptive pill.
The most severe cases sometimes require treatment with special vitamin A type systemic (tablet) drugs such as Isotretinoin (Roaccutane, Oratane). These medications are available only from your Dermatologist and are particularly useful where the acne is causing scarring or is not responding to other treatments.
How long will it take for my acne to clear up on hormone control?
It may take up to 3-6 months or more to achieve and maintain improvement in your skin.
The “anti-androgen” spironolactone, may offer quicker results with reduction in skin oiliness occurring within 2 months and acne improving after this time frame.
It is essential that any underlying medical disorder be identified and treated or else the acne may persist.
The use of supportive acne treatments such as topical creams & gels or oral antibiotics may speed up the clearance of your acne.
Do not underestimate the importance of diet. Acne support vitamins such a zinc can help, as can skin care formulations of niacinamide, azelaic acid & ascorbic acid.
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What skin care ingredients can I use at home?
Hormonal acne treatment can be supported with at home skin care. A sensible combination goes like this-
Niacinamide: This is vitamin B3, it can reduce inflammation from acne & rosacea. Great for pimples, spots & early red marks from inflammatory acne. It has a low irritant potential. Use in am or pm.
Hydrocolloid patches or acne patches. Great for picking acne or drying out pimples & zits. They usually contain salicylic acid, some contain BPO (benzoyl peroxide)
Ascorbic acid is vitamin C. This can reduce inflammation (anti-oxidant), and help repair scars as it stimulates collagen. It can also decrease PIH or pigmentation from inflammatory acne. Best used in the am.
Retinol can help mild cases of acne. Your dermatologist may have prescribed you retinoic acid (more power). You can use this under guidance in the evening.
Salicylic acid washes can be effective for oily skin & blackheads. Use in the am, titrating your retinol & ascorbic acids. For ‘how to’ goto 101. skin
SPF & sunscreens are vitally important, as this reduces red & brown marks from acne. Use twice a day, choose an SPF 50+
Are anti-hormone treatments safe in pregnancy?
Patients taking the “anti-androgen” medication spironolactone should stop this treatment if they become pregnant. There does not appear to be any established risk of birth defects if a patient was to take this medication while in the early stages of pregnancy.
If a pregnant woman did take this medicine in the later stages of pregnancy with a male child, it could affect the normal development of that baby. It is important that your doctor ensures you are not pregnant before starting treatment with this medication. If you suspect you may have become pregnant while on this medication you should discuss it with your doctor.
What are the side effects of hormone control for acne?
There are various different oral contraceptive pills. They have different benefits and different side effects.
The pill, containing the drug cyproterone, is often very effective for hormonal acne. However, used alone, it has a higher risk of venous thrombosis and emboli.
Combined oral contraceptive pills containing estrogen and levonorgestrol, often have a safer side effect profile. They can still cause nausea, weight gain, menstrual irregularity or spotting & breast tenderness.
Spironolactone, an anti-androgen drug, can also cause period irregularity and tender breasts. If you suffer from low blood pressure, this tablet may also cause dizziness. By combining this medication with a combined oral contraceptive pill, side effects can be reduced. Most often we start on a low dose of Spironolactone, such as 50mg in the morning, with the option to double the dose after 2-3 months. Be guided by your medical dermatologist.
Can other forms of contraception such as Implanon worsen acne?
Some oral contraceptive pills can make hormonal acne worse. The “mini-pill” (progestogen only) and implant devices such as Implanon and Mirena may make hormonal acne worse rather than improve it.
An option is to remove these devices. Discuss this with your OBG.
What if anti-hormone treatments don't work?
There may be a number of reasons for your anti-hormone treatments to be ineffective for your acne. The medication may have not been taken for long enough. Other factors contributing to your acne may still be affecting it. Sometimes switching to a different oral contraceptive or combining the “pill” with another anti-androgen medication may be required.
In some cases your dermatologist may elect to prescribe you a vitamin A drug, known as Isotretinoin (Roaccutane/Oratane/ Accutane).
Can hormonal acne be associated with any other skin conditions?
Yes. In some cases hormonal acne maybe associated with other skin conditions related to acne, including blackheads, and oily skin. Hormonal acne may also produce unwanted hair, as part of PCOS, or Polycystic Ovarian Syndrome.
Cutis Clinic so provides treatment for skin related issues associated with PCOS, including hair removal.
What can be done for acne scarring?
Acne scarring can have significant psychological impact on patients. It can directly affect self-confidence and many aspects of professional & social life.
There are different types of acne scars. Different scars and skin types will require different treatments and often, scar treatment requires a number of different treatment methods in combination to achieve the best results. Acne scar management is a specialised area of dermatology. Treatments include:
- Fraxel & Fractional laser resurfacing
- TCA techniques
- Subcision & dermal grafting for acne scars
- Vascular lasers for red scars
- Pico lasers
- Fat Transfer
- Dermal fillers
- RadioFrequency or RF treatment of acne scars
- Corticosteroid injections for raised or keloid scars
l can l assess your acne scarring and tailor scar treatments to give you the best results. Please, please control your acne before seeing me. If you have background inflammation, no matter how insignificant, this will have a negative impact on your outcome. It is best to see one of my medical colleagues for acne treatment, place your acne in remission before seeing me & my clinical team for procedures. Please note, I DO NOT treat acne as this is medical.
Davin’s Perspective on hormone control of acne
Many patients find adult onset or hormonal acne very distressing. Like all acne, the appearance on the face can be devastating to patients and patients often cannot understand why they are getting “pimples” at this older age in life.
While hormonal acne can be difficult to treat often requiring longer courses of treatment, improvement are achievable with the right combination of treatments and thoroughly investigating and treating any underlying medical problems that may be causing the acne.
It is important to manage hormonal acne properly because it can have significant psychological impacts on patients, particularly if it results in scarring. Often, a longer-term maintenance plan may be required to provide ongoing results. Once the acne is controlled, improvement to any scars may be needed. Acne scar management is something we specialise in at Cutis Clinic.
Disclaimer: I DO NOT treat acne, my work is procedural. If you have active acne, please see my colleagues @cliniccutis for management.
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