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Hormonal acne
Acne is not just a teenage problem.
Many women are surprised and distressed to still be affected by acne in their 20s, 30s, occasionally their 40s and/or at the time of menopause.
This type of acne usually begins in the early 20s and can affect individuals who were blemish free during their teenage years.
Unfortunately, because acne is such a visible condition, hormonal acne can still have a detrimental affect on a person's self-confidence, mood and well-being. Even mild acne can have a big impact on older women.
Adult acne is not the same as teenage acne which is usually more severe in the oilier facial areas including the forehead and central face. Hormonal acne more prominently involves the jaw line and chin area / lower face and neck. These skin areas are more sensitive and easily irritated.
Hormonal acne ranges in severity.
It may be confined to a few small red papules and pustules on the chin which appear during the premenstrual phase of your menstrual cycle, especially if you are stressed. Others have more severe acne with deeper, tender nodules that can appear at any stage of the menstrual cycle and can result in permanent scars. It can be on your face and neck as well as your trunk and shoulders.
Adult females with persistent oily skin will usually have normal hormone levels and skin that will age well. Testing is worthwhile in females with persistent 'seborrhoea' (the medical term for overly oily skin) as some will have hormonal changes warranting treatment.
Hormones (and stress) are also responsible for acne that flares up during the first half of pregnancy or the peri-menopausal period.
Causes
Hormonal acne is thought to result from the interplay of:
- sex hormones, such as progesterones, oestrogens and testosterone
- hormones such as insulin
- chemical substances produced by the body during stressful periods and/or illness
Female hormones, produced mainly in the ovaries, include oestrogen and progesterone as well as low levels of testosterone and androstenedione. They cause male-like effects and are known as androgenic hormones.
The upside of these hormones is they maintain muscle and stimulate your libido. The downside is that they also stimulate oil production in the skin which can result in dilated pores, oily skin, acne and excessive body or facial hair
Skin and sun care
Pore clogging or pore irritating skin care products can cause adult acne. If you're acne prone, products labelled 'non-comodegenic' or 'oil free' are your best bet.
These should feel light and spread easily on the skin as opposed to more heavy products that give the skin a greasy or coated feeling. Definitely avoid using vitamin E cream or sorbolene containing products on your face (these are both oils).
In summer:
- go for a face cream with an SPF of 12 to 15 (or 20 in those with a very fair complexion) rather than 30 for your everyday skin care.
- when spending prolonged time in the sun use an SPF 25-30 either in a gel or spray formulation and/or a light gel/cream or lotion (labelled oil free and 'non-comedogenic')
- face creams and sunscreens containing the ingredients Mexoryl SX and Mexoryl XL (ecamsule) provide excellent broad spectrum UV protection without clogging or irritating pores. Similarly, skincare products and sunscreens using 'Helioplex technology' are also suitable for hormonal acne sufferers
Stress
Studies have shown that women who work in competitive environments under stress can overproduce male hormones. High levels of these male hormones can trigger acne outbreaks in adult females.
Many women juggle jobs, friends, family, financial commitments and many other life stresses which make adrenal glands produce more cortisol hormones, which can set off acne. Also, acne itself can cause stress!
Polycystic ovarian syndrome
Acne can also be a symptom of polycystic ovarian syndrome (PCOS) a common, treatable condition affecting up to one in ten women. See your doctor to rule out this as a cause of acne.
You should consider being tested for insulin resistance and diabetes if you have any of the symptoms mentioned above or if you:
- Have polycystic ovaries
- Family history of diabetes
- Irregular period; and/or
- Despite diet and exercise, you are having trouble loosing excess body fat
Excess weight
Adult women who have excess body weight can be more prone to acne.
Surplus fat can convert the female hormone (oestrogen) into hormones that behave like male hormones (androgens) and promotes acne through various ways including increasing the production and composition of sebum (natural oil that prevents skin from drying out)
Extra sebum mixed with dead skin cells clogs pores. Inflamed or irritated pores contribute to formation of whiteheads or blackheads that turn into pimples.
Obesity also makes female acne more resistant or difficult to treat.
Insulin resistance
Metabolic abnormalities, such as high insulin levels, can also play a role in female adult acne.
Insulin is important for tightly regulating the body's levels of sugar and storage of fat. People with abnormally high levels of insulin are prone to developing diabetes.
The harmful effects of high insulin levels include over-stimulation of the ovaries, which can lead to ovarian cyst formation (e.g. polycystic ovaries), menstrual cycles of variable duration, infertility and higher levels of hormones with testosterone-like effects.
The pill
Some contraceptive pills including high dose progesterone pills, the 'mini' (progestogen only) pill and contraceptive implants can also cause acne by boosting sebum production, while all other pills usually help improve acne (some more effectively than others).
Fertility and acne
For females with acne and polycystic ovarian syndrome, metformin can be beneficial not only for acne but also for increasing fertility and therefore the chance of falling pregnant.
Unfortunately, most other treatments used to assist fertility in females trying to conceive either traditionally or by in vitro fertilisation may temporarily worsen acne.
Treatment
For mild hormonal acne, treatment is similar to that of mild teenage acne however more gentle products are usually preferable.
Over the counter products containing salicylic acid microgel complex, benzoyl peroxide (2.5 - 4.5 per cent to minimise irritation) or an acne wash containing Montaline C40 may be enough to treat mild cases of acne.
If that doesn't work, a doctor can prescribe either a topical retinoid that keeps pores open and prevents inflammation, or a gel that combines benzoyl peroxide with an antibiotic.
If you're still not seeing a response or if the acne is more severe, an oral antibiotic works well. However as this type of acne can be very persistent, hormonal agents can be very effective and a safer option.
Severe acne of all types usually improves with the prescription drug isotretinoin (eg, Roaccutane).
To read a personal story from a person affected by hormonal acne, please click here
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