Hormonal Acne
So called because of the way the skin problem develops in response to hormonal changes and especially a rise in androgens such as testosterone.
The rise in androgen levels can trigger a process of higher sebum production, changes in skin cell activity, inflammation, and colonization of the hair follicles by a bacterium, known as Propionibacterium acnes (P. acnes). This can lead to acne lesions or spots of varying severity typically affect the face and upper body.
Acne is a common and treatable condition.
First what exactly is Acne?
A condition of the skin that happens when the body makes excess sebum, an oil that stops the skin from drying out, this clumps together with dead skin cells in a pore. Where the clogging occurs, an acne lesion or spot can form.
The lesions in the skin formed by acne include comedones, which can be open or closed plugs that form at the base of hairs.
Other types of lesion include;
· Papules
· Pustules
· Nodules
· Cysts
These four types of lesions of increasing size and severity, form when bacteria become involved with the plugs. The bacteria cause an inflammatory response from the immune system.
So what is hormonal acne?
Hormonal acne is most common in teenagers going through the hormonal changes of puberty and young females perhaps trying to perfect birth control methods involving the differing hormones.
Acne is thought to affect 80% of people between the ages of 11-30 years old and especially from 14-19 years, the wearing of masks has no doubt exacerbated this in everyone including those over 30.
During pregnancy and around menopause, fluctuating hormonal changes can again cause acne to flare up and affect women.
Causes
There are four main factors behind the formation of acne lesions. Hormones are one major factor.
The four components of acne involve the units at the base of the hairs in the skin;
1. Production of the hormone testosterone rises during puberty. This causes greasy skin because it increases the production of sebum, the oily substance secreted at the base of hairs to protect and lubricate the skin.
2. The hair follicles become blocked, forming comedones or ‘clogged pores’. The overproduction of skin cells that would normally be pushed up and lost from the skin surface also adds to this process.
3. The comedones can be made worse by bacterial infection.
4. The immune system reacts to the bacteria, resulting in inflammation.
Not all acne is inflammatory. Simple comedones – whiteheads and blackheads are not inflamed and do not cause pain or swelling, if they become inflamed, they can become cysts or pustules. Pimples called papules, pustules, nodules, and cysts – in order of rising severity – are inflamed. Inflamed lesions can be painful, sore and red. The lesion and the area around it may be raised.
Lesions often appear on the face, neck, back, shoulders and chest area. Depression can be a complication of acne because of the impact on self-esteem.
The role of hormones in acne formation
The major causative factor is the hormone testosterone. Testosterone levels go up in the teenage years as part of puberty. This causes male development in boys and gives muscle and bone strength in girls. The hormone also has the effect of increasing sebum production at the base of the hairs. This is because the glands that secrete the oil are sensitive to testosterone.
Other hormones play a part in acne too. For women, hormonal changes relating to pregnancy or the menstrual cycle can also trigger acne. Falling estrogen levels may increase the risk of acne around menopause. The role of progesterone remains unclear.
Conditions that affect hormone levels for example polycystic ovary syndrome (PCOS) can trigger acne.
Acne in Menopause
Growing numbers of woman are reporting acne beyond their teenage years and into their 30’s, 40’s, and 50’s, and around menopause. Most cases of adult female acne are mild to moderate and due to hormonal fluctuations.
Researchers note that women who experience acne around menopause usually have androgen levels within the normal range but falling estrogen levels. It may be this imbalance that gives rise to acne flares.
As hormones reach a ‘tipping point’ the new hormonal ratios lead to additional stimulation of the sebaceous glands, triggering outbreaks.
Most adult female acne is persistent, continuing from puberty after the age of 24 years, but between 20-40% of cases start after puberty.
It is not clear why, but some life changes can cause a flare up – perhaps read stress skin blog.
Acne mild, moderate, or severe?
Existing classifications suggest,
· Mild acne involves mostly blackheads and whiteheads, there are fewer than 20 comedones or 15 inflammatory lesions, or a total of 30 lesions.
· Moderate acne involves both inflamed and non-inflamed lesions, some of which may leave scars. There are 20-100 comedones, or 15-50 inflammatory lesions, or a total of 30-125 total lesions.
· Severe acne features widespread inflamed lesions. It can impact both appearance and self-esteem and it can cause scars.
All forms of acne can be distressing.
Even mild acne can affect a person’s self-esteem. This is not only due to its appearance, but also the fact it often affects young people when they begin developing relationships.
Myths about what causes acne.
There are many myths about the causes of acne.
There is no evidence that chocolate and other diet factors including nuts or greasy foods cause acne. When people associate reaching for chocolate and an increase in acne it is more likely the cause of the needing to reach for the chocolate or comfort food due to emotions. Thereby more likely stress is the cause of both consuming the chocolate or greasy food and the acne (see stress skin blog).
Some research has found weak links between acne and milk products.
There is some evidence linking acne with diets that contain lots of foods with a high glycemic index. These include simple carbohydrates, found in white bread, chips, white potatoes and sugary drinks.
These foods can increase blood sugar levels, and this may have an impact on hormone levels that then impact the risk of developing acne. The next section on Glycation maybe helps to explain more.
Glycation
When we eat food, the body breaks down carbohydrates into sugars like glucose and fructose, which are the essential fuel for cells and energy metabolism. Glycation is the non-enzymatic reaction between sugars and proteins, lipids, or nucleic acids. This process was first described by food chemist Mallard in 1912. Since then, the involvement pf glycation has been an intensive field of research.
Advanced Glycolic End products (AGEs) are proteins or lipids that have become glycated as a result of exposure to sugars. Studies on the contribution of glycation to diseases have primarily focused on its relationship to diabetes and its complications. However even at normal glucose levels some degree of glycation occurs, and the damage thereby accumulates slowly over time, in addition to diabetes AGE’s have been linked to other diseases such as Cataracts, Alzheimer’s, dialysis-related amyloidosis, atherosclerosis and Parkinson’s.
For healthy people with normal blood glucose levels glycation happens gradually and slowly over a lifetime. Diet and lifestyle choices can affect glycation. AGE formation is increased with age, smoking, poor diet, and UV exposure.
How to help slow glycation;
1. Good home regimes in skin care implemented from an early age.
2. Daily SPF & Antioxidants.
3. Regular professional interventions and integrated skin care approaches.
4. Exfoliation but not over exfoliation.
5. Beauty sleep.
PRACTICAL TIPS FOR CONTROL OF HORMONAL ACNE
What we can do to help at Ohh!
1. Cleansing & the Double cleanse
Cleanse once in the morning & double cleanse in the evening – the first cleanse removes all excess sebum and grime and/or make-up from the skin to allow the second cleanse to penetrate where it is needed.
2. Choose a pharmaceutical/cosmeceutical cleanser, containing a combination of anti-inflammatory, anti-bacterial, antioxidant and hydrating is important also. The Skin Geek Salicylic Wash is my go-to for exactly this. Combined with the Skin Geek Cleansing Mitts for added assistance.
3. Choose a copper or silk pillowcase (see my blog).
4. Do not pick or squeeze – you will only cause damage, allow more bacteria to enter and spread the problem.
5. Mineral make-up and SPF, my go to would be the CLINICCARE Dermo Corrective Cream with an SPF of 50 and self-adjusting pigment to give protection and a light foundation. It has active ingredients which are working away under your skin. Or the clear Sun shield Cream SPF 30. (foundations and BB creams which contain sun shield only have an SPF of 15 which is not adequate).
6. Lymphatic drainage massage, the Skin Geek Cryo Roller, the sub-zero hero!
7. Diet, ‘we are what we absorb’ (another blog) but think essential fatty acids, Zinc, Vitamins A, C, E, and soluble fibers. Try supplements probiotics can help boost the gut bacteria (see probiotic blog for more info).
8. Increase water intake throughout the day to help flush and hydrate the skin. The skin is our largest organ however the body takes water to other vital organs first and the skin last.
9. Professional treatments, from gentle enzymatic exfoliating peels, to deeper more targeting AHA/BHA peeling, and pharmaceutical/cosmeceutical skin care regimes. AHA is water soluble, BHA is oil soluble and can be invaluable in aiding the problems with oily/congested skin concerns. For gentle enzymatic peel, my go-to is the CLINICCARE Instant Painless Peel, this is also provided in a snap sample of 2ml, as part of your full homecare bundle and I do include the snap sample in the purchase of the EGF Sheet Masks.
10. DO NOT over exfoliate (see the blog on exfoliation for more info), you will cause more harm as too much washing and scrubbing can remove oil from the protective barrier of the skin and irritate it more. The skin will respond by producing more oil and so worsening the acne. Instant painless peel should be used no more than once per week! It is a great kick starter to a new skin regime or to boost your skin regime, with the ‘Pure’ soothing EGF sheet mask applied following the enzyme peel.
Outside of Ohh!
Doctors can help people whose acne is more severe; this could be treated by oral antibiotics such as tetracycline. Minocycline, erythromycin, and doxycycline. Antibiotics for acne need to be continued for 3 months for full results. Topical antibiotics as well as the oral antibiotics may be prescribed.
Women with moderate to severe acne who do not respond to oral antibiotics may be prescribed anti-androgen hormone therapy or birth control medication.
Isotretinoin
Severe acne may require a prescription treatment for example the drug isotretinoin. This is an oral treatment that needs to be taken for 16-20 weeks. Usually only prescribed by a dermatologist. It is effective against severe acne, but it has side effects, and its use must be closely monitored. It is crucial not to uses isotretinoin if you are planning on becoming pregnant or if you could be pregnant as there is a risk to the unborn child.
Women must have a pregnancy test before starting the medication and use reliable contraceptives before and during its use.
Sexually active women of childbearing age must use two forms of contraception before during and after treatment with isotretinoin.
Dermatologists may recommend using one or a combination of the following;
· LED light therapy
· Chemical peels
Both of which we provide at Ohh!
Remember we are here to help at Ohh! You can drop us a message, or book a no obligation consultation for tailored advice. Here to assist your happiness and health and ensure you Stay Fabulous, Jacqui x
