You thought that when you hit your 20’s it would be the end of your acne woes. Right? Unfortunately for many women this is not the case. As the female body goes into and out of baby-bearing mode, many major hormonal changes take place that put women at risk of getting adult acne.
What to look out for
There are certain signs of acne-causing hormonal imbalances that a woman should look out for. If you have any of the following, you should go and see a dermatologist:
- If you have never had acne and it suddenly appears in adulthood or reappears after it has cleared up earlier.
- If your acne is not responding to any treatments.
- If your acne gets worse during menstruation or pregnancy.
- If you starts developing “masculine” traits such as excessive hair growth or hair loss.
- If your skin starts to darken under your armpits and in your body folds.
- If the middle part of your torso becomes obese.
All of the above could be indications of hormonal abnormalities in your adrenal or pituitary glands or in your ovaries.
It’s blaming men!
Let’s face it, many of the problems women experience are caused by men, and surprise, surprise it is the so-called “male” hormones that cause acne in adult women. Androgen (the male hormone) is present in both women and men. Androgen causes acne because it stimulates the sebaceous follicles where acne lesions start.
Teenagers usually have relatively large amounts of androgen present in their bodies. This is why acne is often mistakenly thought of as only a “teenage condition”. Excess androgen leads to the over-stimulation of the sebaceous follicles and the result is acne. The androgen level is supposed to stabilise as the teenager reaches adulthood and any acne problems normally clear up.
Acne in adults
You’re in your 20’s or 30’s and suddenly your womanly glow is replaced by an acne rash. Acne in mature females is thankfully usually only mild to moderate. The treatments that you might have used as a teenager will no longer be effective, because this time your acne is associated with a hormonal change.
Over-the-counter products will not be enough to treat adult acne in women. You will need to see your dermatologist who will give you a thorough medical examination and will prescribe an appropriate medical treatment.
Typical signs of hormonal acne:
- Acne that comes and goes with the ebbs and flows of the menstrual cycle. This is caused by changes in the body’s hormonal balance.
- Acne that flares up during pregnancy.
- You are suffering from chronic emotional or physiological stress. Stress can cause physiological stress that affects the hormone production and aggravate acne.
Help! I’m turning into a man!
Many other embarrassing or uncomfortable conditions can accompany adult acne. The following conditions indicate hyperandrogenism � an excess production of the “male” hormone androgen:
- Absent or irregular periods.
- Excess facial hair that grows in the pattern of male facial hair � that is, above the top lip, on the chin and on the side of the face.
- Female pattern baldness that looks like male baldness because it starts at the central scalp.
- A deeper, more masculine voice.
- Darkening of skin in your armpits and in your body folds (for example, the inside of your elbows).
Hyperandrogenism could be the cause of acne that occurs suddenly and severely. A female with acne or any of the symptoms above, should be examined for the possibility of an underlying problem with her adrenal or pituitary glands or with her ovaries. Diabetes can also affect the hormonal balance.
Treating hormonal acne in women
If you are a healthy woman with hormonal acne, then your dermatologist should be able to treat it for you. However, if you have an underlying disease of the ovaries, pituitary or adrenal glands or you have diabetes, then your acne should be treated in conjuction with the appropriate specialist physician.
Healthy women with acne will be given a treatment by their dermatologist that suits their specific needs and medical history. Treatment options include:
Oral contraceptive pills � The “pill” is an oestrogen-progesterone combination that alters the female’s hormone pattern. Low-dose oral contraceptives are one of the oldest ways of treating mild to moderate hormonal acne. The pill can be taken for extended periods of time to control hormonal acne, unless the woman wants to fall pregnant. Many women do not like the pill because of its side-effects that can include weight gain, nausea, menstrual spotting and breast tenderness.
Oral corticosteroids � These are anti-inflammatory drugs that belong to a class of drugs produced by the adrenal glands. Oral corticosteroids can be prescribed to suppress androgen production and they can also suppress inflammation in severe acne. Weight gain and bone thinning are two of the main downsides of these drugs.
Antiandrogens � These drugs will reduce the androgen production in the ovaries and the adrenal glands and will block androgen reception by the cells in the sebaceous follicles. This will stop acne from forming. Side effects include irregular menstruation and breast tenderness, but these can be eased by taking the drug in conjunction with an oral contraceptive.
Revision date: June 18, 2011
Last revised: by Sebastian Scheller, MD, ScD