Did you know that women produce more testosterone than estrogen over their lifetime? We tend to think of estrogen as a “female hormone” and testosterone as a “male hormone,” but everybody produces both of these hormones in balance.
On average, puberty runs its course from 10 years to 14 years of age for girls and from 12 years to 16 years of age for boys. And once it’s over, it’s not really over. Hormonal changes continue beyond these ages for both men and women and one of those changes is hormonal acne, which can continue into adulthood. This type of acne causes breakouts that typically occur on the lower face, jawline or chin. The breakouts are usually cyclic in relation to the menstrual cycle. Statistics show hormonal acne is experienced by fifty percent of women in their 20s, and twenty-five percent of women in their 40s still suffer from it. It usually lasts a few days, but sometimes is continuous throughout the month.
Some factors that increase the likelihood of developing hormonal acne include your family’s genetic history, what medications you take and any pre-existing medical conditions you might have, such as polycystic ovarian syndrome. Men who undergo testosterone treatment or those who are transitioning also can experience this type of acne. But there are also some factors we can control to lessen the chance of getting acne overall, such as reducing our stress, getting better sleep and reducing hair and skincare products that contain oil. For example, poor sleep can result in a spike in cortisol, a steroid and the body’s main stress hormone. Studies have shown that cortisol may contribute to an increase in immune system receptors which, together with the presence of Cutibacterium acnes, may bring on an acne breakout.
…dermatologists have identified which treatments have the highest likelihood of working for hormonal acne.
Although everyone’s skin is unique and treatments work differently for different people, dermatologists have identified which treatments have the highest likelihood of working for hormonal acne. Here’s a list of prescriptions your doctor might consider for you.
1. Topical antibiotic and/or benzoyl peroxide: these are great at reducing red bumps or pustules (pus-filled bumps) quickly, before they leave scars.
2. Topical anti-androgens: A new, first-in-class medication was released in late 2021 by the name of clascoterone (brand name: Winlevi). This is the only topical medication designed to treat acne from a hormonal angle.
3. Retinoid creams (such as tretinoin): once thought to be useful only for blackheads and whiteheads, now understood to also be useful for inflamed bumps and reducing post-inflammatory hyperpigmentation (leftover dark spots from acne).
4. Spironolactone: a potent anti-androgen, and extremely helpful at reducing hormonal acne with few side effects. Unfortunately, not suitable for use in men.
5. Oral antibiotics and/or isotretinoin: these may be necessary if one experiences moderate to severe acne. These, like others in this list, require a prescription from your doctor.
6. Steroid Injections (intralesional triamcinolone): an in-office injection performed to quickly reduce cystic or nodular acne.
If you aren’t ready to visit the dermatologist yet you might try these other options beforehand.
First, consider combination oral contraceptive pills (OCPs) instead of implantable uterine devices (IUDs) or progestin implants. OCPs have a balance of estrogen and progesterone that typically helps treat and prevent hormonal acne. For people who don’t like taking pills, the NuvaRing is a good combination option, too. Secondly, make sure you are washing your face daily and consider ketoconazole as a face wash. A randomized, controlled study published in the Journal of Dermatology in 2019 found that two percent ketoconazole cream significantly improved adult female acne when compared with a placebo. And finally, consider a low androgen diet. Drinking spearmint tea, for example, may help improve PCOS symptoms, including hormonal acne and hirsutism. Marjoram herb is also known for its ability to restore hormonal balance and to regulate the menstrual cycle.
There’s a lot to learn about hormones and their effects on our skin. If you’re struggling with acne at home, consult with a dermatologist to prevent further breakouts and irritation from home therapy.