Hormonal Acne

Hormonal acne is caused by changes in your hormones, which is most common in teenagers and adult women. In teenagers, this is usually caused by hormonal changes during puberty. For adult women, hormonal imbalances can be a common cause. Hormonal acne is normal, and approximately 95% of people between 11 and 30 years old experience some type of acne.

Hormonal acne appears as spots, pimples, or bumps on your skin. The 6 common types are:

• blackheads, which are small black or yellow bumps
• whiteheads, which are firmer than blackheads and nothing comes out if you squeeze them
• pustules, which are tender or sore red bumps with a white tip in the centre
• papules, which are the same as pustules but without the white tip
• nodules, which are painful and large hard lumps underneath the surface of the skin
• cysts, which are large pus filled lumps that look like boils and can cause scarring

Where does hormonal acne affect?

Hormonal acne usually develops on your:

• face, where it is most common
• back, for more than half of people who get acne
• chest, in about 15% of cases

How long does hormonal acne last?

Hormonal acne often lasts for several years with symptoms coming and going, particularly among younger people. However it can last for short periods of time, such as days or weeks too.

Hormonal acne normally improves as you get older. It disappears for most people by their mid 20s. However, some people continue to experience acne as they get older. For example, 3% of adults over 35 get acne.

Hormonal acne is caused by changes in your hormone levels, most commonly testosterone during puberty or progesterone and oestrogen in adult women.

These hormonal changes cause your skin to produce more of an oily substance called sebum, which is created naturally by the body to protect and lubricate your skin. When excess sebum is produced, it can clog up hair follicles on your face, trapping dead skin cells and bacteria. This results in comedones, or clogged pores.

These clogged pores can become infected by trapped bacteria. This bacterial infection causes these clogged pores to become inflamed and filled with pus, leading to acne.

Hormonal acne is commonly caused by:

• Puberty
• Pregnancy
• Menopause
• Menstrual cycles

While hormonal changes during puberty are a common cause for acne, hormonal acne can occur at any age.

You may have heard that poor hygiene and sexual activity can affect acne. However there is currently no evidence to support this. Recent studies have shown there is a possible link between high glycaemic index (GI) diets and acne, and that eating a balanced diet could help prevent acne. It is normal for hormone levels to constantly change in your body, so acne is not necessarily a sign of a hormonal problem.

Hormonal acne occurs most commonly during puberty, when your hormone levels change dramatically. Both boys and girls experience an increase in testosterone levels during puberty, as their bodies grow and develop. This stimulates the production of excess sebum, causing hair follicles to become clogged. The rise in hormone levels also thickens the inner lining of the hair follicle, making it easier for the pores to block. Unfortunately, these cannot be removed by cleaning, and attempts to clean them out can cause acne scars. Acne most commonly occurs on your face, back and chest. Most acne experienced during puberty clears up by your mid-20s.

Hormonal acne is not just a problem for teenagers. Many adults suffer into their thirties and beyond. For women, this is most commonly caused by the natural hormonal fluctuations that occur at different times in their life. Acne associated with these hormonal changes most commonly breaks out on the lower face (jawline, neck, chin, mouth) and hairline.

Acne during your period

Menstrual acne is caused by levels of the female hormones estrogen and progesterone cycling with your monthly period. The ratio of these hormones to the testosterone in your body changes as they cycle, which can cause acne. The severity of your acne may also cycle, with women commonly getting acne flare-ups just before their period is due.

Women going through the menopause may experience late-onset acne due to their changing hormone levels.

Pregnancy

50% of women experience acne when pregnant, usually during the first 3 months of pregnancy. This is due to a surge in hormones, particularly progesterone, which stimulates sebum secretion, which in turn can cause acne.

Oral contraceptive

The combined contraceptive pill, which contains both estrogen and progestin, can be effective against acne. The combination of hormones causes a decrease in androgen levels, which reduces sebum production. If you have been on the contraceptive pill and stop taking it, you may start to suffer from acne because the hormones in your pill have been suppressing the symptoms.

Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome causes your ovaries to be overstimulated, producing more testosterone than normal, which increases production of oil from the sebaceous glands. Many women with PCOS have irregular periods, or do not menstruate at all. This lack of hormone cycling means that patients can suffer constantly from acne. Your acne may be associated with PCOS if it is accompanied by other symptoms, including excess facial hair, irregular periods, and bald spots.

Does hormonal acne go away?

Acne can’t be cured, but with careful treatment you can keep it under control. The severity of the symptoms of hormonal acne are different for everyone. If you develop acne during puberty, it tends to peak at age 17-19 and for most people will go away by their mid-20s. However, some people continue to suffer from acne into their 40s.

Hormonal acne can be diagnosed by a doctor who examines your skin. They will normally look for symptoms on your face, chest, and back. They can then decide how serious your symptoms are and give you the appropriate treatment.

Acne is often categorised as:

• mild, consisting of blackheads,whiteheads, and some pustules and papules
• moderate, consisting of a large number of blackheads and whiteheads, and many pustules and papules
• Severe, consisting of lots of large and painful pustules, papules, nodules, or cysts, and possibly some scarring

If your acne is mild, a pharmacist can give you advice about treatments. Otherwise, speak to a doctor.

Your doctor may talk to you about factors which could contribute to your acne symptoms, such as:

• skincare products you use
• stress levels
• sleeping routines
• any medication you take
• other changes in your health

This information can help your doctor make recommendations about ways to improve your acne.

Some factors can make hormonal acne worse which you cannot control, such as:

• living somewhere with high pollution and/or high humidity
• family history of acne
• existing medical conditions that cause acne such as polycystic ovarian syndrome
• side effects of medication you are taking such as steroids
• female hormonal changes associated with periods, pregnancy, menopause, or contraception
• male hormonal changes associated with testosterone treatments

How to reduce your risk of hormonal acne

Although you cannot control every possible cause for acne, some changes in your lifestyle can help to reduce the risk of acne.

These include:

• not squeezing or picking spots and blemishes
• eating a healthy, balanced diet low in refined carbohydrates and sugars
• using skincare and haircare products that are not oil based (sometimes labelled ‘non comedogenic’ or ‘non acnegenic’)
• talking to your GP or doctor about treatment options if your acne persists

Acne cannot be cured, but it can often be improved by hygiene habits and treatments, both self-administered and prescribed by a doctor.

Things you can do yourself to help improve acne symptoms include:

• daily skin cleansing, no more than twice a day, using a cleanser or mild soap with lukewarm water
• wearing less makeup and cosmetics, and removing these before bed
• not squeezing or cleaning out spots
• showering straight after exercise to remove sweat, which can irritate acne
• washing your hair regularly and keeping it away from your face
• if you have dry skin, using a fragrance free, water-based medical moisturiser (emollient)

Hormonal acne can also be treated by prescription medications, depending on how severe it is. These treatments can reduce sebum production, inflammation, and pimples.

Below are the typical treatments prescribed for different acne symptoms.

• Whiteheads and blackheads: topical creams
• Inflammatory acne: topical retinoid, benzoyl peroxide, an topical antibiotics
• Moderate and severe acne: oral antibiotics and topical treatments or isotretinoin
• Cystic acne: steroid injections