Amy Murphy, PA-C, DSDPA
I see many patients with acne in any given day at the office. Acne is caused by oil production of the skin, bacteria, clogged pores (from overproduction of keratin in the follicles), and inflammation. Sometimes when hormones are off, the skin is more oily and this leads to a break-out. Androgens, a type of hormone, play an important role in causing acne. Often, we will see female patients of child-bearing age with this condition. When checking for further causes of hard to treat zits, we may check for thyroid issues. Stress can additionally affect hormone levels, which can cause more oil production.
So what is an androgen? Androgens are a group of hormones including testosterone and DHEA-S. These hormones cause oil to be produced by the glands in the skin. As the oil increases, the pores become clogged. This process can cause black heads or comedones, the bumps common in acne. The extra oil allows bacteria to grow, creating the redness, swelling and pus-like fluid involved in acne. As oil increases in puberty, so do hormonal levels.
Hormonal acne is often found in those who notice break-outs worsening after their teenage years. Sometimes when common acne treatments fail to work, we consider hormones as playing a part in skin problems.
Another strong sign of hormonal involvement is when acne becomes worse the week before your period. Sometimes hormone levels including free testosterone and DHEA-S will be at the high, but total testosterone and DHEA-S will remain normal.
We might think of acne as hormonal in women if they notice facial hair, irregular periods, changes in voice, increased sex drive, insulin resistance, or hair loss. Inflammatory acne on the lower face and neck is another clue of hormonal factors. A specific type of hormone condition that can involve acne is PCOS (polycystic ovarian syndrome). This disorder can involve acne, cystic ovaries, irregular periods and being overweight.
Usual forms of treating persistent inflammatory acne include antibiotics and isotretinoin. If these types of acne treatments do not improve skin, other medicines such as spironolactone can be helpful in treating hormonal acne. This is an antiandrogen medication. It works by stopping androgens from working in the body before they cause clogged pores. Spironolactone can also stop testosterone from becoming active, which can help decrease break-outs. In the end, this medicine can decrease oil production by about 30 to 50 percent. It is not for women who are pregnant or trying to become pregnant. It takes three to six months to tell if it is working well.
Oral birth control pills are also commonly prescribed to treat hormonal acne. Oral contraceptives that have estrogen and progestin may reduce androgens. If someone is already taking oral birth control pills, hormonal issues can be masked. This is in part because estrogens can decrease acne.
Men can also experience hormonal imbalances. Symptoms for men may include patterned baldness and acne, among other signs.
We offer several products that target hormonal acne specifically. Epionce, a botanical skin care line, offers Lytic Plus Tx. This product works to help clear pores and improve skin texture. Lytic Plus Tx is a treatment product that helps reduce symptoms and inflammatory factors of acne, among other skin issues. Patients enjoy implementing this into their daily regimen morning and night after washing their face. It also helps reduce redness, irritation, and oil production. Some of the key ingredients include salicylic acid 2.95%, azelaic acid and willow bark extract, among others.
DIM (diindolylmethane) supplement is a natural, organic compound that promotes healthy estrogen metabolism in men and women. It is a phytonutrient and antioxidant found naturally in small amounts in cruciferous vegetables such as broccoli, cauliflower, cabbage and Brussels sprouts. This supplement helps the body break down estrogen into helpful substances and encourage healthy levels of hormones.
Lastly, when considering diet, it is important to eat dairy in moderation when you are trying to improve your complexion. Also, studies have shown that sugars such as those in high glycemic foods including bananas, melons, and other simple carbohydrates, can worsen acne. Therefore, watching your sugar intake can be worthwhile if combating break-outs.