How to deal with hormonal acne

According to research, up to 20% of women aged 25-40 years suffer from acne, and 87% of them have a condition called hyperandrogenism - a high level of production or activity of male sex hormones. Everything that happens on the skin is a consequence of the synthesis of sex steroid hormones, which exert their influence through specific receptors. Hormonal acne in women most often begins to appear due to estrogen deficiency and excessive androgen production. Therefore, both the diagnosis and treatment of acne in women and men differ, as well as the reasons for their appearance.

Why do acne appear due to hormone imbalance?

The skin is a target organ for steroids, so acne and hormones are closely related. Androgens can influence the size of the sebaceous glands and lead to disruption of their functioning, more precisely to hypersecretion. An increase in sebum production causes a change in its composition and a significant reduction in the amount of linoleic acid. Because of this process, follicular hyperkeratosis appears, in which skin cells begin to rapidly divide. Dead scales of the epidermis clog the ducts of the sebaceous glands that exit into the hair follicles. In this area, an environment is created that meets all the requirements for the active growth and reproduction of conditionally pathogenic microflora, including acne bacteria. As a result of their vital activity, acne appears.

What hormones cause acne

The ovaries, adrenal cortex, and subcutaneous fatty tissue (to a lesser extent) are responsible for the production of androgens in a woman’s body. Androgens are necessary for full development during puberty, but their excess in adulthood leads to global changes that affect appearance, reproductive health, metabolic processes and menstrual background.

The list of hormones that influence acne is as follows:

1. testosterone;
2. progesterone;
3. dihydrotestosterone;
4. prolactin.

Increased testosterone is a background factor contributing to the occurrence of female acne, while progesterone is responsible for how severe hormonal acne will be. Dihydrotestosterone is a more active testosterone that increases the number of receptors in the skin and the sensitivity of the sebaceous glands to them. It also stimulates the secretion of sebum and changes its properties. Prolactin is not a steroid hormone, however, it helps reduce estrogen production, which affects hormonal levels. Acne due to hormones has received various names: “postmenopausal”, “premenstrual”, “endocrine”, “late”, “hyperandrogenic”.

Hormonal acne on the face can appear due to dysfunction of the ovaries or adrenal cortex, and can be acquired or hereditary. The reasons that influence the appearance of acne can be both an increase in the level of androgens, and their normal amount, but capable of turning into more active forms or penetrating into target organs, one of which is the skin.

Polycystic ovary syndrome

Excessive androgen production and hormonal acne are more often a consequence of the disease polycystic ovary syndrome. Healthy ovaries produce two main hormones, estrogen and progesterone, and small amounts of androgens. The latter are necessary during pregnancy for the formation of a male fetus. The syndrome develops for many reasons, in particular during complicated pregnancy, head injuries, and endocrine disorders. In 70% of women, the disease is closely related to the pancreatic hormone insulin, which is responsible for regulating blood sugar levels. When there is too much insulin in the blood, the ovaries begin to actively produce androgens. Male hormones disrupt the functioning of the ovaries, which results in the formation of cysts. One of the external signs of polycystic disease is acne on the face.

How does prolactin affect acne?

Hormonal acne in women can be a consequence of increased levels of the hormone prolactin, which is responsible for the formation of mammary glands and milk production during breastfeeding. In addition, high levels of prolactin suppress the growth of follicle-stimulating hormone, without which estrogen cannot be produced. Prolactin is also a stimulator of androgen production. Insufficient concentration of estrogen and high growth of male hormones directly affect the appearance of acne.

Prolactin increases for the following reasons:

1. frequent stress;
2. strict diets;
3. taking antidepressants and steroid drugs;
4. kidney and liver disease;
5. pathology of the pituitary gland, etc.

Even a slight imbalance between hormones associated with taking medications, steroids, or the menstrual cycle can cause the occurrence or recurrence of acne.

Signs of hormonal acne

Hormonal acne in women is localized mainly in the face and less often in the upper torso. They are comedones and inflammatory elements (papulopustular rash). Acne in women can be single, which is typical for a mild stage of the disease, or multiple in the form of red bumps and pustules.

The most severe form is conglobate acne in the form of nodules and cysts, after resolution of which deep scars remain.

Acne due to hormonal imbalance is often accompanied by other symptoms of hyperandrogenemia: seborrhea, menstrual irregularities, excess male-pattern hair growth on the face, abdomen, around the nipples and arms.

Diagnostics

Before treating hormonal acne, a dermatologist, together with a gynecologist, examines the patient in order to identify the causes of the disease:

conducts a survey about the presence of gynecological diseases and the use of oral contraceptives; excludes diseases such as demodicosis, rosacea, perioral dermatitis; prescribes a biochemical blood test to identify the condition of the liver and kidneys; prescribes a laboratory study of the hormonal profile; reveals the nature of hyperandrogenemia (ovarian or adrenal).

It is possible that before treating acne due to hormonal imbalance, an ultrasound of the pelvic organs and an MRI of the adrenal glands will be necessary. In most cases, if hormonal acne is suspected, treatment will require consultation with a gynecologist and endocrinologist and appropriate examinations.

Acne therapy

When hormonal acne is diagnosed in women, treatment requires an individual approach. Both systemic and local medications are prescribed. Compliance with acne-toilet is a must, as this allows you to reduce treatment time, drug dosage and improve skin condition.

The general principle of how to deal with acne is aimed at reducing the level of male hormones, or stimulating estrogen and treating the disease that provoked hormonal imbalance.

Drugs are used that slow down the production of androgens in the adrenal glands and ovaries, block steroid receptors in the dermis, and suppress the process of converting testosterone into the more active form of dihydrotestosterone. For this purpose, combined oral contraceptives are prescribed.

Use of oral contraceptives

From a large list of drugs that are considered effective for treating hormonal acne in women, contraceptives based on ethinyl estradiol (estrogen), which reduces the level of androgen concentration in the blood, are isolated. As a result of taking medications, the secretion of the sebaceous glands is reduced and thus it is possible to cure hormonal acne.

However, in case of hormonal imbalance, therapy is mainly carried out with drugs based on drospirenone, dienogest, cyproterone acetate, desogestrel, the properties of which are similar to the female hormone progesterone. These are female gestagen hormones, which are produced in the body by the ovaries and slightly by the adrenal glands. They reduce the activity of androgens, prevent testosterone from being converted into active dihydrotestosterone, and reduce the sensitivity of androgen receptors in the skin.

Drospirenone

The 4th generation of combined contraceptives include drugs containing both ethinyl estradiol and drospirenone: Jess, Yarina, Midiana, Dimia. They not only eliminate acne, but also promote weight loss, so they are most suitable for women suffering from acne and prone to excess weight.

Midiana and Yarina are drugs with a low dosage of ethinyl estradiol. They are used according to the established scheme, 1 tablet for 21 days. The next course is after a week's break. The total duration of therapy is 6 months. During the treatment process, not only a significant reduction in acne is noted, but also that the skin becomes smoother, matte, its structure improves and the secretion of the sebaceous glands decreases.

Preparations Jess and Dimia microdosed with ethinyl estradiol are used for 24 days, then a 4-day break.

Cyproterone acetate

Until now, the most effective drug used to combat hormonal acne, especially severe acne, is Diane-35, which combines ethinyl estradiol and cyproterone acetate. Analogues of Diana-35 are contraceptives Chloe and Belluna 35. All drugs belong to the 3rd generation of oral contraceptives. Cyproterone acetate is a substance with the most powerful antiandrogenic effect, but its use is limited and cannot last more than 6 months due to the high risk of side effects. After starting treatment, seborrhea and oily hair are noticeably reduced, and acne can be cured in 3-6 months. The drugs are used 1 tablet per day from the beginning of the menstrual cycle. The effectiveness of treatment can be judged after the first 3 months of use with mandatory monitoring based on test results.

Dienogest and desogestrel

Birth control pills based on dienogest (Janine, Siluet, Qlaira) are officially indicated for the treatment of acne. Siluet and Janine also contain ethinyl estradiol and are taken according to the standard regimen. Qlaira is several types of multi-colored tablets with different hormone contents, so the use of this contraceptive is multiphasic.

Using desogestrel-based contraceptives is another way to get rid of hormonal acne. These are drugs such as Regulon and Novinet. The reception scheme is classic.

Conclusion

Combined contraceptives only lead to a decrease in sebum production, so it is recommended to combine them with external agents based on azelaic acid, benzoyl peroxide, and antibiotics. These are drugs such as Baziron AS, Skinoren, Differin. Don't fight acne on your own. Only by comprehensively influencing all parts of the process of acne vulgaris can acne be treated effectively. Therefore, treatment is carried out by two doctors - a gynecologist and a dermatologist. The gynecologist prescribes drugs to normalize the ratio of hormone levels, the dermatologist prescribes local agents that affect hyperkeratosis and destroy bacteria. Only combination therapy allows for long-term remission and such good results in the treatment of acne that are difficult to achieve using any one method or remedy.

When adolescence is over, but there are no rashes on your face, there is reason to worry. Everyone who has encountered this has thought: “What if there is simply no gap between pimples and the first deep wrinkles?”

piedradealumbre.org

If, in the fight for healthy skin, you have already tried all the mass market products that promise to solve the problem in 15 minutes, poured heavy artillery on yourself in the form of expensive pharmaceutical cosmetics, and even went to the dermatologist, who still did not help you - this text is for you .

We asked the gynecologist five main questions about how hormones affect the condition of our skin.

Obstetrician-gynecologist of the first qualification category at the Eva Women's Health Clinic, clinical resident at the Department of Obstetrics and Gynecology of BelMAPO

How do the phases of the menstrual cycle affect our body and, in particular, the skin?

A woman’s body is subject to hormonal fluctuations depending on the phase of the menstrual cycle, and even our temperament determines the ratio of certain sex hormones.

In previous articles, I already talked about the fact that a woman’s body produces not only female sex hormones, but also male ones, which are called androgens. Androgens include testosterone - in the female body it is produced not only by the ovaries, but also by the adrenal glands.

Now let's figure out why testosterone affects the condition of our skin. The thing is that skin cells have special receptors for hormones - including testosterone. These receptors are responsible for the actions of androgens.

Androgens (in our case, testosterone), in turn, regulate all processes that occur in the cells of the epidermis, dermis, subcutaneous fat, and hair follicles. These are the processes of division, keratinization and - the main thing in our topic - the secretion of sebum.

instagram.com/myfacestory / Kali Kushner's story proves that getting rid of acne is real

What causes acne?

If the body produces a large amount of testosterone, this leads to hyperstimulation of the sebaceous and sweat glands - they have the highest sensitivity to this hormone.

This means that too much sebum begins to be produced - sebum, which mixes with keratinized skin scales. Because of this, the water-lipid balance changes and pores become clogged.

The process of sebum removal slows down, and it, entering into oxidative processes with oxygen, darkens - this is how blackheads or blackheads appear on the skin. This sebaceous plug becomes an excellent breeding ground for bacteria and microorganisms that can live on the skin. They begin to actively multiply, and this leads to inflammatory processes - that’s why acne appears on our face.

We often encounter all this during adolescence. But similar processes occur in our body in adulthood - in the second phase of the menstrual cycle. Before menstruation, the level of steroid hormones - testosterone precursors - increases in the body. They trigger processes that inevitably lead to a rash on the face.

instagram.com/asprinkleofhealthandbeauty / Blogger Rachel Crowley also demonstrates on her Instagram that even severe acne can be dealt with

Will the situation change with age?

In old age, there is a significant decrease in the level of sex hormones. But at the same time, all processes that restore and renew our skin slow down.

Again, the water-lipid balance changes, but in the direction of thinning and dryness. The skin loses its tone due to the fact that the body greatly reduces the production of collagen and elastane it needs.

While wrinkles have not yet appeared... What to do with acne?

Firstly, do not self-medicate! If you have acne-prone skin, consult a dermatologist first. Inflammatory processes on the skin can be associated not only with hormones, but also with infection - for example, streptococcal or staphylococcal. In this case, the doctor will take a special analysis and select a treatment regimen for you.

Secondly, never try to squeeze out pimples yourself. This will only intensify the inflammatory process and help the infection penetrate into the deeper layers of the skin.

Thirdly, if a dermatologist has ruled out the presence of an infectious acne pathogen, be sure to contact a gynecologist, who will first refer you to a test for sex hormones.

If the analysis shows elevated testosterone levels, hormonal treatment is most likely impossible. Today there are a sufficient number of drugs that have an antiandrogenic effect, but each of them has its own spectrum of action. And only a doctor can determine which one is right for you!

When will the result be visible (and on the face)?

Elevated testosterone levels, or hyperandrogenism, are not so difficult to treat, but they take quite a long time. But the results will appear from the first days of treatment!

Many people are worried: what will happen after stopping the drug? If you take the medicine for 1-2 months, of course, after you stop taking it, everything will return to normal. Well, if you have been taking the drug for a year or more, the result will be stable and will persist even after discontinuation.

Don’t put off solving your problem, because beautiful skin is not only a sign of your health, but also a guarantee of a good mood every day!

This type of acne occurs due to hormonal imbalance in the body - a disturbance in the exchange of male sex hormones, or androgens. They are produced in different quantities by both women and men. In individuals with androgen deficiency or reduced sensitivity to them, sebum production is reduced and hormonal acne does not occur. Insulin and insulin-like growth factor also play a certain role in the development of pathology.

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In women, hormonal acne most often occurs between the ages of 30 and 50, and also appears during the premenstrual period. In men, the prevalence of this pathology is slightly lower. Juvenile acne most often has a non-hormonal cause, or it is not the leading one.

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Causes and mechanism of development

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Excess androgens

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The body synthesizes androgen precursors. In the skin they are converted into testosterone and dihydrotestosterone. These substances stimulate the growth of skin cells and the production of sebum.

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Causes of acne due to excess androgens:

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1. an increase in sebum secretion leads to a decrease in the concentration of linoleic acid on the skin surface, which irritates epidermal cells and promotes inflammation;
2. hypersecretion of sebum leads to an increase in its viscosity and blockage of pores, which creates unfavorable conditions in the sebaceous glands;
3. under the influence of sunlight and external pollution, sebum substances oxidize, causing the appearance of comedones and other types of acne;
4. With increased skin greasiness, favorable conditions are created for the proliferation of bacteria that cause inflammation.

The reasons why the synthesis of androgens in the body increases:

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1. polycystic ovary syndrome;
2. tumors of the adrenal glands, ovaries, and in men – testicles;
3. abuse of anabolic steroids during sports;
4. operations to change the female to male sex.

Signs of hyperandrogenism are detected in 20-40% of women with hormonal acne. Therefore, if such a rash appears, it is necessary to contact a gynecologist and endocrinologist and undergo a thorough examination.

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In addition to acne, patients usually have other signs of androgen imbalance:

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1. hirsutism – excessive hair growth on the chest, face, abdomen and thighs;
2. sudden appearance of acne on previously healthy skin;
3. ineffectiveness of conventional treatment for such pathology;
4. absence or irregularity of menstruation;
5. muscle enlargement, decreased voice tone;
6. reduction in the size of the mammary glands;
7. weight gain, initial signs of diabetes.

Insulin and insulin-like growth factor

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Not all people experience hormonal acne with elevated levels of androgens in the blood, since this process is more closely related to the synthesis of testosterone and dihydrotestosterone from their precursors in the skin, which may not be reflected in routine blood tests for hormones. The process is enhanced by the action of insulin and insulin-like growth factor (IGF).

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Insulin and IGF trigger a cascading hormonal response that causes increased sebum production and an increased risk of acne. There are studies showing that eating a diet limited in sugar, other carbohydrates and milk reduces the appearance of hormonal acne.

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Insulin resistance also plays a role in the appearance of this skin pathology. This is tissue resistance to the action of insulin, as a result of which they do not receive enough glucose. To provide cells with energy, the pancreas is forced to produce more and more insulin, which, among other things, leads to the formation of acne. This mechanism is most clearly evident in people with type 2 diabetes.

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Lack of estrogen and hypothyroidism

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Female sex hormones - estrogens - have the opposite effect of androgens and protect the skin from hormonal acne. When there is a lack of these hormones (for example, when the ovaries are removed as a result of surgery), rashes begin to appear.

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Hormone-associated rashes are also observed in patients with hypothyroidism, that is, with reduced thyroid function. This disrupts the functioning of the reproductive organs and the production of estrogen, which has a negative effect on the skin.

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Types of hormonal acne

Acne in babies

Rashes occur in the first months of a newborn's life. They are associated with the reaction of superficially located small sebaceous glands to maternal sex hormones. Often in this case the mother suffers from acne.

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Such pimples are few and far between. They look like small lumps or raised areas with a small reddened rim around them caused by inflammation. The forehead, nose, cheeks, nasolabial folds, and back of the head are mainly affected.

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This is a physiological condition and does not need to be treated. It is only necessary to maintain the baby’s hygiene, bathe on time, change bed linen, and so on. A few days after its appearance, the rash disappears spontaneously.

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Manifestation of the disease in adolescents

The maturing gonads in girls and boys do not always provide a normal balance of hormones in the body. The result is a skin rash, usually located on the forehead, nose and chin. With age, hormonal balance is restored, and with proper care, acne disappears in most young people. In this case, taking medications is often not necessary.

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Premenstrual acne

In the first (follicular) phase of the cycle, estrogens dominate in the blood, and after ovulation their level decreases and progesterone begins to predominate. Testosterone levels remain stable throughout the cycle.

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However, by reducing the “restraining” effect of estrogens before menstruation, testosterone begins to have a negative effect on the skin, and acne of hormonal etiology appears on the face, chest, and back.

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Rash during menopause

At the age of 45-50 years, ovarian function begins to decline, which leads to a reduction in estrogen synthesis. As a result, the amount of androgens, which in women are produced mainly in the adrenal glands, increases relatively.

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A rash may appear despite the use of hormone replacement therapy if it contains a large amount of progestin and a relatively small proportion of estrogen. Therefore, it is recommended to consult a gynecologist to select the optimal treatment option.

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Hormonal acne in men

The condition usually only appears in men who take too many anabolic steroids. However, acne does not always indicate a high level of male sex hormones.

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The main cause of hormonal rashes is insulin resistance and type 2 diabetes. Therefore, a diet with limited carbohydrates is effective for correcting the condition.

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The question of the nature of the pathological condition of the skin in men has not been fully studied, so treating hormonal acne can present significant difficulties.

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Rash after childbirth

After the birth of a child, the level of progesterone in a woman’s body quickly increases, and the amount of estrogen is unstable. As a result, sebum production increases and pores become clogged. Hormonal acne that occurs after childbirth is usually located on the neck and lower face, and persists for several months.

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The most effective treatment option is birth control pills. However, they should be prescribed by a doctor, taking into account possible breastfeeding.

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External manifestations

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The rashes are localized in places where sebaceous glands accumulate, on the face, lower cheeks, chin and neck. These are small red formations located on a large surface of the skin. If inflammation occurs, pain appears and itching is possible.

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In some cases, intense acne occurs with the formation of purulent heads or deep subcutaneous cysts.

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For diagnosis, examinations for hormones (estrogens, testosterone, TSH, T4 and others) are prescribed, if necessary - ultrasound of the thyroid gland, ovaries, adrenal glands, pituitary gland.

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Treatment

Helps get rid of hormonal acne by reducing testosterone levels. Methods aimed at eliminating insulin resistance or increasing estrogen concentrations, as well as antiandrogens, may be useful. Additionally, a diet, taking certain nutritional supplements and proper skin care are required.

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Drug therapy

To cure pathological rashes, it is necessary to eliminate their cause. To do this, you should carry out all diagnostic measures prescribed by your doctor.

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Conservative therapy consists of taking the following medications:

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1. oral contraceptives containing estrogens and progesterone - reduce the production of androgens and the appearance of rash by the end of the 3rd month of use; however, after their cancellation, acne may appear again, and in even greater numbers than before treatment; It is better if in combination with ethinyl estradiol there are substances such as drospirenone, norgestimate or norethindrone;
2. antiandrogens (spironolactone) – reduce the production of testosterone and the formation of dihydrotestosterone in the skin, which helps eliminate acne in 66% of women within 3 months of use; however, the medicine is not recommended for the treatment of rash in men;
3. Metformin – reduces insulin resistance.

Oral contraceptives should not be used by women with high blood viscosity, hypertension, breast cancer, or smokers.

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Diet

How to treat hormonal acne with nutrition has been studied in detail since 2002. The most harmful substances in this pathology are sugar and carbohydrates, as well as dairy products.

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1. exclude sugar and easily digestible (“fast”) carbohydrates from the diet, which lead to a sharp increase in the concentration of insulin in the blood;
2. replace “fast” carbohydrates with foods with a low glycemic index, for example, cereals, whole grain bread;
3. Fats and proteins should not be limited, but the quality composition of fats should be dominated by vegetable ones.
4. Switching to such a diet reduces the appearance of rashes in 25–50% of patients. This food:
5. reduces the level of testosterone and other androgens;
6. reduces the production of insulin and IGF;
7. increases the synthesis of proteins that bind and inactivate sex hormones;
8. activates the secretion of estrogen;
9. reduces the symptoms of premenstrual acne.

Dairy products are also harmful for patients with hormonal-associated acne. The following effects have been proven:

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1. increased levels of insulin and IGF;
2. increased production of androgens in the ovaries, adrenal glands, testicles;
3. increased skin sensitivity to androgens.

People who regularly consume milk are more prone to acne.

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Herbal medicine and nutritional supplements

The most useful are those plants and drugs that reduce insulin levels or restore the balance of sex hormones.

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The following funds can be distinguished from them:

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1. Vitex sacred or Abraham's tree. Products based on it are available in the form of tablets, capsules, tea and tinctures. Reduces the manifestations of premenstrual syndrome and accompanying acne, and is also useful for elevated prolactin levels and irregular menstrual cycles.
2. Cinnamon. Despite evidence of the effectiveness of this herb for insulin resistance, for hormonal acne the data is conflicting. It helps some patients, but not others. In any case, adding cinnamon to dishes will not harm your health, but it can reduce the severity of acne.
3. Apple cider vinegar slows down the digestion process and the absorption of carbohydrates, thereby reducing the peak insulin production. Its benefits have been proven for women with polycystic ovary syndrome. Therefore, it helps some patients get rid of acne when taken orally 2 tablespoons per day.
4. Mint. Drinking 2 cups of peppermint tea per day has been shown to suppress androgen synthesis and increase estrogen production, which is beneficial for women with hormone-dependent rashes. Men should not take this drug, as it reduces potency and libido.

Nutritional supplements that will be useful for hormonal imbalances and related skin problems:

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1. preparations containing magnesium and calcium reduce inflammation, also enhance skin cell renewal and regulate the functioning of the sebaceous glands;
2. omega-3 fatty acids contained in sea fish or, for example, flaxseed oil, make the skin softer, even out its texture, and also rejuvenate the entire body;
3. zinc and copper prevent inflammatory processes and bacterial growth;
4. probiotics, essential for intestinal health, which helps the body utilize excess hormones;
5. vitamins that ensure active metabolism in cells; Vitamin B6 specifically prevents skin inflammation and sebum production.

Skin care

The same remedies are used as for other types of acne. In addition, there is a peculiarity - preference is given to drugs containing dihydrotestosterone blockers. This substance, as mentioned above, is formed in the skin and becomes the main cause of rashes.

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Therefore, for hormonal acne, it is recommended to choose cosmetics containing the following components:

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1. green tea;
2. lotus extract;
3. Argan oil;
4. tea tree oil;
5. sesame seed oil.

Powerful dihydrotestosterone blockers - essential oils of black currant, primrose, rose hips, grape seed or hemp. Products containing olive or coconut oil should be avoided.

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In addition to these medications, it is recommended to use medications to prevent complications of hormone-dependent rashes, such as infection. The drug Zinerit, containing zinc salt and erythromycin, is ideal for this purpose. It not only dries the skin and reduces the activity of the sebaceous glands, but also prevents the proliferation of bacteria on the skin surface that cause inflammation and the formation of pustules.

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For moderate rashes, creams containing retinoids can be used. It is important to treat exposed skin with sunscreen every day, as these substances increase the risk of sunburn.

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The duration of treatment is about 10 weeks. If after this period the rash has not disappeared, a second consultation with a dermatologist, gynecologist, or endocrinologist is necessary.

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Additional tips to combat hormonal acne:

1. do not sunbathe, in summer constantly use products with a UV filter with SPF of at least 15-30;
2. wash with warm water and foam containing, for example, green tea extract, without soap, morning and evening;
3. do not touch your face with dirty hands during the day;
4. do not squeeze out blackheads;
5. Do not cauterize with alcohol, iodine, brilliant green, or potassium permanganate.