How to tell if your acne is hormonal | causes and treatment
Acne-prone skin is a common skin condition, affecting over 85% of people during adolescence, with women more frequently affected than men. It is observed in nearly 100% of individuals at some point in their lives. For some, it is temporary and resolves on its own by their mid-twenties; however, more severe cases often take longer to resolve, and it can persist into adulthood in up to 50% of individuals. While it doesn't affect overall health, its impact on emotional well-being and daily function can be a source of frustration.
However, with a thorough understanding of this condition and an appropriate skincare routine, it is possible to minimize acne breakouts and acne spots and promote clear, healthy skin. In this article, we will explore methods for recognizing hormonal acne, its causes, and the most effective skincare strategies to combat this persistent dermatological problem.
What is hormonal acne?
Acne is a chronic inflammatory disease of the pilosebaceous unit, characterized by seborrhea, the formation of comedones, oily skin, erythematous papules and pustules, less frequently by nodules, deep pustules, or pseudocysts, and, in some cases, it is accompanied by scars.
Follicular hyperkeratinization, excessive sebum production, overcolonization of the duct by Propionibacterium acnes, direct or indirect inflammation, and more recently, matrix metalloproteinases (MMPs) have been included as playing a role in the pathogenesis of acne vulgaris.
Hormonal acne differs from teenage acne because it usually appears during puberty and is closely linked to hormonal fluctuations, especially female hormones.
The underlying causes of hormonal acne: understanding hormonal factors
- Impact of sex hormones on the skin
The skin locally produces significant amounts of sex hormones that have intracrine or paracrine effects (intracrine action means hormones are produced and act within the same target cell, while paracrine regulation involves the secretion of hormones that act locally on nearby cells in the surrounding tissue).
The local level of each sex steroid depends on the expression of each enzyme that synthesizes androgens and estrogens in each cell type, with sebaceous glands and sweat glands being the main contributors.
- Role of androgens
Androgens are a group of male sex hormones, including testosterone, which are responsible for the development of male sexual characteristics and play a crucial role in various physiological processes in men and adult women, around the age of 40.
They affect several functions of human skin, such as the growth and differentiation of sebaceous glands, hair growth, epidermal homeostasis, and wound healing.
Their effects are mediated by binding to the nuclear androgen receptor. Changes in androgen receptor levels can have significant implications in the development of hyperandrogenism and associated skin conditions such as acne, seborrhea, hirsutism, and androgenetic alopecia.
Indeed, these hormones stimulate the skin's sebaceous glands to produce sebum, which can then clog hair follicles, creating an environment favorable for the growth of bacteria, particularly Propionibacterium acnes. This bacterial proliferation and associated inflammation can lead to the formation of comedones, papules, and pustules characteristic of acne.
- Role of estrogens
Estrogens are a group of sex hormones, primarily secreted by the ovaries in women, that play an essential role in the development of female sexual characteristics and regulate various aspects of the reproductive system and other physiological functions.
The production of female hormones, such as estrogen, plays a key role in regulating sebum.
However, during the menstrual cycle, hormonal fluctuations can lead to sebum overproduction and excess sebum, clogging pores and leading to the appearance of blemishes, painful red pimples, and blackheads. The sebaceous glands then become more active, increasing the risk of hormonal acne.
Estrogens are involved in skin aging, pigmentation, hair growth, sebum production, and skin cancer.
- Progestins
Progestins are substances, often hormones, that mimic the effects of progesterone, playing a key role in regulating the menstrual cycle, managing pregnancy, and are used in medical contexts such as hormonal contraception and hormone replacement therapy.
Clinical studies show that they play no role in the pathogenesis of skin disorders.
However, they play a major role in the treatment of hirsutism and acne vulgaris, where they are prescribed as components of combined estrogen-progestin pills and as anti-androgens.
Estrogen-progestin treatment can halve the need for shaving and stop the progression of hirsutism of various etiologies, but does not necessarily reverse it. However, they reliably reduce acne.
Skincare strategies: from anti-acne routines to invasive solutions
- Cosmetics and active ingredients: salicylic acid, essential oils, and clay
Using anti-inflammatory ingredients, such as salicylic acid in cleansers, lotions, serums, or moisturizers, can help control hormonal acne. These products target inflammation, unclog pores, and regulate sebum production. Additionally, certain essential oils, like tea tree essential oil, are known for their antibacterial and anti-inflammatory properties, making them valuable allies in the fight against hormonal acne.
Theclay can also be useful for purifying pores and absorbing excess sebum.- Hormonal treatments: birth control pills
For some women, taking birth control pills can help regulate the hormonal fluctuations responsible for acne. The hormones in these contraceptives can balance androgen levels, thereby reducing the severity of acne breakouts.
- Oral Treatments: Zinc and Retinoids
Zinc, known for its anti-inflammatory properties, can be taken as a dietary supplement to help control hormonal acne. Additionally, retinoids, which are derived from vitamin A, are often prescribed for their effectiveness in treating severe acne and reducing acne scars.
- Dermatological Treatments: Laser Treatments and Peels
For cases of severe acne or scars, dermatological treatments such as lasers and peels may be considered. These procedures aim to stimulate cell regeneration, reduce inflammation, and improve skin texture.
Hormonal acne can present challenges, but with a holistic approach and a well-balanced skincare routine, it is possible to minimize breakouts, improve healing, and restore skin confidence.
Whether through topical treatments, hormonal options, or dermatological care, strategies exist for all skin types and acne severities. The key lies in perseverance and consulting with dermatologists to develop a personalized treatment plan.
Sources
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Thiboutot D. Hormones and acne: pathophysiology, clinical evaluation, and therapies. Semin Cutan Med Surg. 2001 Sep;20(3):144-53. doi: 10.1053/sder.2001.28208. PMID: 11594669.
Zouboulis CC, Chen WC, Thornton MJ, Qin K, Rosenfield R. Sexual hormones in human skin. Horm Metab Res. 2007 Feb;39(2):85-95. doi: 10.1055/s-2007-961807. PMID: 17326004.