Acne skin is a common skin condition, affecting more than 85% of people by adolescence , with women affected more frequently than men. It is observed in almost 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. Although it does not affect overall health, its impact on well-being be emotional and functionality can be a source of frustration.
However, with a thorough understanding of this condition and a proper 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 care strategies to counter 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 commonly by nodules , deep pustules, or pseudocysts, and , in some cases, it is accompanied by scars .
Follicular hyperkeratinization, excessive sebum production, hypercolonization of the duct by Propionibacterium acnes, direct or indirect inflammation, and recently, matrix metalloproteinases (MMPs) have been included as having a role in the pathogenesis of acne vulgaris.
Hormonal acne differs from juvenile acne in that it usually appears during puberty and is closely linked to hormonal fluctuations, particularly female hormones.
The underlying causes of hormonal acne: deciphering the hormonal factors
- Impact of sex hormones on the skin
The skin locally synthesizes significant amounts of sex hormones with intracrine or paracrine actions (intracrinia is characterized by the production and action of hormones within a target cell itself, while regulation paracrine involves the secretion of hormones acting locally on neighboring cells in the surrounding tissue).
The local level of each sex steroid depends on the expression of each androgen- and estrogen-synthesizing enzyme in each cell type, with sebaceous glands and sweat glands being the major contributors.
- Role of androgens
Androgens are a group of male sex hormones, including testosterone, that are responsible for the development of male sexual characteristics and play a crucial role in various physiological processes in adult men and women around the age of 40 .
They affect several functions of human skin, such as 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 may have important implications in the development of hyperandrogenism and associated skin diseases such as acne, seborrhea, hirsutism, and androgenetic alopecia.
This is because these hormones stimulate the sebaceous glands in the skin to produce sebum, which can then clog hair follicles , creating an environment conducive to the growth of bacteria , particularly Propionibacterium acnes. This bacterial overgrowth and associated inflammation can lead to the formation of comedones, papules and pustules characteristic of acne.
- Role of estrogen
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 the regulation of sebum.
However, during the menstrual cycle , hormonal fluctuations can cause overproduction of sebum and excess sebum , clogging pores and leading to the appearance of blemishes , painful red spots 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 the regulation of the menstrual cycle, pregnancy management, and are used in medical contexts such as hormonal contraception and therapy. hormone replacement.
Clinical studies show that they play no role in the pathogenesis of skin disorders.
They do, however, 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 therapy can reduce the need to shave in half and stop the progression of hirsutism of various etiologies, but does not necessarily reverse it. However, they reliably reduce acne.
Care strategies: from anti-acne routine to invasive solutions
- Cosmetics and active ingredients: salicylic acid , essential oils and clay
Using anti- inflammatory ingredients, such as salicylic acid in cleansers , lotion , serums or moisturizer can help control hormonal acne. These products target inflammation, unclog pores, and regulate sebum production. In addition, certain essential oils, such as tea tree essential oil , are recognized for their antibacterial and anti-inflammatory properties, making them valuable allies in the fight against hormonal acne .
Clay can also be helpful in purifying pores and absorbing excess oil.- Hormonal treatments: contraceptive pills
For some women, taking birth control pills can help regulate the hormonal fluctuations that cause acne. The hormones in these contraceptives can balance androgen levels, reducing the severity of acne breakouts .
- Oral care: zinc and retinoids
Zinc, known for its anti-inflammatory properties, can be taken as a dietary supplement to help control hormonal acne . Additionally, retinoids, derived from vitamin A, are often prescribed for their effectiveness in treating severe acne and reducing acne scarring .
- Dermatological care: laser treatments and peels
For cases of severe acne or scarring , 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-rounded skincare routine , it is possible to minimize breakouts, improve healing, and restore confidence in the skin.
Whether through topical treatments, hormonal options, or dermatological care, there are strategies for all skin types and severity of acne. The key lies in persistence and consultation with dermatologists to develop a personalized treatment plan.
Sources
Arora MK, Yadav A, Saini V. Role of hormones in acne vulgaris. Clin Biochem. 2011 Sep;44(13):1035-1040. doi: 10.1016/j.clinbiochem.2011.06.984. Epub 2011 Jul 6. PMID: 21763298.
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.