Hormonal Acne: Understanding the Causes and the Treatments Available
- Hormonal acne in adults, acne that occurs or persists after the age of 25, is more common in women and largely associated with fluctuations in hormone levels.
- Adult acne may have other causes in addition to hormone fluctuations, with the most common being stress, diet, and family history.
- There are a number of over-the-counter and prescription medications used to treat hormonal acne, including oral contraceptives, topical retinoids, and oral or topical antibiotics.
- Alternative treatments for hormonal acne include chemical peels, microdermabrasion, topical tea tree oil, and changes in diet.
Acne is a fairly common skin condition most often associated with puberty and adolescence. For some patients, however, acne outbreaks continue into adulthood, while for others acne might not even begin to appear until they reach their mid-twenties or later.
For patients over the age of 25, new or persistent acne is termed adult acne or acne tarda. Given adult acne is often tied to fluctuating hormones, it’s also commonly referred to as hormonal acne.
What Is Acne?
According to the American Academy of Dermatology (AAD), acne is the most common skin condition in the United States. Acne blemishes or lesions come in a variety of shapes and sizes, including:
- Pimples (also called pustules)
- Papules (small, raised bumps that do not contain pus)
Outbreaks of acne can occur anywhere on the body, but are most common on the face, neck, shoulders, upper arms, back, and buttocks.
What Are the Features of Adult Acne?
In adult acne, pimples and papules are more common. Another feature of adult acne is that it tends to occur around the chin, the jawline, and the neck. Adult acne is more common in women than men and becomes less frequent as patients age.
What Are the Possible Causes of Adult Acne?
More so than men, women are especially prone to experiencing fluctuating hormone levels, which has been linked to acne. Women often experience changes in hormones coinciding with their menstrual cycle, and many (75% according to one report, 70% according to another) report outbreaks during the premenstrual time period.
Hormonal acne in women also occurs during pregnancy and before or during menopause.
Taking birth control pills (oral contraceptives) will sometimes improve acne, while stopping to take birth control medications may lead to changing hormones and outbreaks.
The AAD has identified stress as a possible cause of hormonal acne. Stress has been linked to the production of androgens (male sex hormones such as testosterone), which may in turn stimulate the hair follicles and oil glands in the skin, leading to outbreaks of acne. Numerous studies have found elevated levels of testosterone in women experiencing adult acne.
Patients can have a family predisposition to acne according to the AAD. One study found that 50% of patients with adult acne report a first-degree relative (parent or sibling) who experienced adult acne.
Skin Care Products
If you experience adult acne, it’s important to check the labels of skin and hair care products, including cleansers and sunscreens, to ensure the products you are using do not promote outbreaks of acne. Ideally, you should choose products that specifically state on the label that they do not clog pores. According to the AAD, the label may also say “oil-free,” “non-comedogenic,” or “non-acnegenic.”
A number of medications have been linked to acne in general or adult acne specifically. Among the medications that can cause acne include antiepileptic drugs (phenobarbital or carbamazepine), lithium, and corticosteroids (prednisone).
Certain health conditions, especially those tied to changes in hormone levels, have been linked to hormonal acne. Some conditions linked to acne include:
- Polycystic ovary syndrome (PCOS)
- Vitamin D deficiency
- Insulin resistance
What Treatments Are Available for Adult Acne?
A wide variety of topical and oral medications are available for the treatment of adult acne. In addition, there are several topical skin treatments that can be performed by trained professionals to improve acne in adults.
Antibiotics have been a mainstay of acne treatment for a very long time now. The theory supporting antibiotics is that they kill a certain type of bacteria closely linked to adult acne, in addition to having anti-inflammatory properties that further aid to control outbreaks.
Benzoyl peroxide is one topical antibacterial treatment that is available with and without a prescription. Benzoyl peroxide can be purchased in a wide array of formulations, including cleansers and lotions.
Another topical prescription antibiotic called clindamycin can be used alone or in combination with benzoyl peroxide. There are many commercially available prescription combinations of the two antibiotics, making application easier for the patient.
Prescription oral antibiotics may be beneficial in the treatment of acne when topical products have failed. The most common choices are doxycycline, minocycline, and azithromycin.
Retinoids are medications derived from vitamin A that work to treat acne by regulating the growth of skin cells. There are a wide variety of oral and topical retinoids available both with and without a prescription.
Topical retinoids are currently considered the standard of care in the treatment of acne. The following are several topical retinoids available:
- Tretinoin (Retin-A®, Atralin®, Tretin-X®)
- Adapalene (Differin®)
- Tazarotene (Tazorac®)
Adapalene is the only one of these products currently available without a prescription. They all come in a variety of strengths and formulations.
For adult acne, tretinoin could be a great choice as it’s frequently used to treat wrinkles as well as acne.
Oral retinoids such as isotretinoin (Accutane®) are rarely used and considered a last resort treatment because they’ve been associated with a large number of side effects, including the potential for birth defects in pregnant women.
Birth control pills can be a great option for women with hormonal acne who are of childbearing age. Because adult acne is so often tied to the menstrual cycle in women, regulating hormones can be a particularly effective solution.
Oral contraceptives containing one of the following are typically used for the treatment of hormonal acne in women:
- Drosperinone (Yasmin®, Yaz®, Beyaz®)
- Norethindrone (Jolivette®, Camila®, Nora-BE®)
- Norgestimate (Ortho-Cyclen®, Ortho-Tri-Cyclen®)
- Desogestrel (Mircette®)
Patients who are cigarette smokers and/or have a history of blood clots may not be able to receive oral contraceptives.
For women who have failed topical acne therapies or have documented high testosterone levels, treatment with oral antiandrogens may be beneficial.
One of the most commonly prescribed antiandrogens is Spirinolactone (brand name Aldactone). Taken just once a day, Spirinolactone can help reduce androgen levels in women, subsequently reducing outbreaks of acne as well.
In high doses, Spirinolactone is used to treat high blood pressure in patients with Congestive Heart Failure. Therefore, even at low dosage, if you happen to have low blood pressure, you should consult your doctor regarding its usage.
Topical Skin Treatments
Two procedures are commonly performed by a licensed aesthetician that can help reduce the appearance and effects of adult acne. Chemical peels, which use topical products such as retinoic acid or salicylic acid, cause exfoliation of the outer layer of skin.
Microdermabrasion is a gentler topical treatment, which can sometimes be performed at home but is best done by a professional. During this procedure, the aesthetician uses a wand to apply tiny crystals to the face to exfoliate the outer layer of skin.
Both of these procedures are safe and noninvasive options, which may be especially appealing for patients who experience adverse effects from oral medications or harsher topical medications.
Are There Any Herbal Products That Can Be Used to Treat Adult Acne?
The most commonly recommended herbal product that has shown benefits for patients with adult acne is tea tree oil. Tea tree oil is related to benzoyl peroxide (a medication discussed above), but tends to be less irritating.
Tea tree oil is often sold undiluted, so it’s important for patients to check the label and dilute the oil if necessary. Pure tea tree oil can be diluted by adding a few drops to 1-2 milliliters of witch hazel. The solution can be applied as a spot treatment to the face with a cotton ball once or twice a day.
There are also some commercially available products that contain diluted tea tree oil. Patients can check their local beauty counter or pharmacy and read the label on any product to learn of it’s active ingredients. Burt’s Bees and Desert Essence are two companies that make skincare products containing tea tree oil.
Patients who use tea tree oil should avoid overuse, as this can dry out the skin. They should also avoid excessive sun exposure, as tea tree oil can make the skin more sensitive to UV rays.
Can Diet Have an Effect on Adult Acne?
Diet can definitely be a factor in the development of adult acne. The following are some recommendations regarding dietary changes that can have a positive impact:
- Avoid refined carbohydrates like chocolate or junk food.
- Avoid too much dairy, especially skim milk, and switch to a non-dairy milk like almond or soy milk.
- Avoid excessive sodium, which is common in many processed and packaged foods.
Where Can Patients Go for More Information?
If you are experiencing hormonal acne and your skin is not responding well to at-home treatments, you should follow up with a board-certified dermatologist to evaluate your individual situation and determine which treatments, including prescription medications, will work best for you.
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