The co-author of this article is Eduardo Montaña, MD, MPH. Dr. Montagna is a pediatrician from Georgia. He received his master's degree in health care and a doctor from Emory University in 1985 and 1989.
The number of sources used in this article is 19. You will find a list of them at the bottom of the page.
Violations in the hormonal background can affect the intensity of the manifestation of acne, and can even cause it. Although adolescents often face the problem of acne, acne also occurs in people at 20, 30, 40, and even at 50. There are several ways to normalize the hormonal background in acne, including medication, lifestyle changes, and folk remedies. Learn all of these methods to discuss them with your doctor or to choose the one that suits you on your own.
Why acne appears when hormones are unbalanced
The skin is the target organ for steroids, so acne and hormones are closely related. Androgens can affect the size of the sebaceous glands and lead to disruption of their work, more precisely to hypersecretion. An increase in the production of sebum causes a change in its composition and a significant reduction in the amount of linoleic acid. Due to this process, in turn, follicular hyperkeratosis appears, in which skin cells begin to divide intensely. Dead epidermal flakes clog the ducts of the sebaceous glands that exit into the hair follicles. In this area, an environment is created that meets all the requirements for the active growth and reproduction of conditionally pathogenic microflora, including acne bacteria. As a result of their life acne appears.
What hormones cause acne
For the production of androgens in the body of a woman, the ovaries, adrenal cortex, subcutaneous fatty tissue (to a lesser extent) are responsible. Androgens are necessary for the full development in the puberty, but their overabundance in adulthood leads to global changes that affect the appearance, reproductive health, metabolic processes and menstrual background.
From which hormones affect acne, the following list is distinguished:
Elevated testosterone is a background factor in the development of female acne, while progesterone is responsible for how difficult the hormonal acne will be. Dihydrotestosterone is a more active testosterone that increases the number of receptors in the skin and the sensitivity of the sebaceous glands to them. It also stimulates the secretion of sebum, changes its properties. Prolactin does not belong to steroid hormones, however, it helps to reduce the production of estrogen, which is reflected in the hormonal background. Acne due to hormones received various names: "postmenopausal", "premenstrual", "endocrine", "late", "hyperandrogenic".
Hormonal acne on the face may appear due to impaired functioning of the ovaries or adrenal cortex, and be acquired or hereditary. The causes that affect the appearance of acne can be both an increase in the level of androgens and their normal amount, but able to turn into more active forms or penetrate into target organs, one of which is the skin.
Polycystic Ovary Syndrome
Excessive production of androgens and hormonal acne are more often the result of a disease of the polycystic ovary syndrome. Healthy ovaries produce two main hormones - estrogen and progesterone and a small amount of androgens. The latter are necessary during pregnancy for the formation of a male fetus. The syndrome develops for many reasons, in particular with complicated pregnancy, head injuries, endocrine disorders. In 70% of women, the disease is closely related to the hormone of the pancreas - insulin, which is responsible for regulating blood sugar levels. When there is too much insulin in the ovaries in the blood, the active production of androgens begins. Male hormones disrupt the ovaries, resulting in the formation of cysts. One of the external signs of polycystic is acne on the face.
How prolactin affects acne
Hormonal acne in women can be a consequence of an increased level of the hormone prolactin, which is responsible for the formation of mammary glands, the production of milk during breastfeeding. In addition, high prolactin inhibits the growth of follicle-stimulating hormone, without which estrogen is not produced. Prolactin is also a stimulator of androgen production. An insufficient concentration of estrogen and high growth of male hormones directly affect the appearance of acne.
Prolactin rises for the following reasons:
- frequent stresses
- strict diets
- taking antidepressants and steroid drugs,
- kidney and liver disease
- pathology of the pituitary gland, etc.
Even a slight imbalance between hormones associated with taking medications, steroid drugs, the menstrual cycle can cause the occurrence or relapse of acne.
Signs of hormonal acne
Hormonal acne in women is localized mainly in the face and less often in the upper torso. They are comedones and inflammatory elements (papulopustular rash). Acne in women can be single, which is typical for the mild stage of the disease or multiple in the form of red tubercles and pustules.
The most severe form is conglobate acne in the form of nodes and cysts, after the resolution of which deep scars remain.
Acne due to hormonal failure is often adjacent to other symptoms of hyperandrogenemia: seborrhea, menstrual irregularities, excessive male hair growth on the face, abdomen, around the nipples and arms.
Progesterone and androgens
In women, along with an excess of steroids, there is also a dysfunction of skin metabolism caused by an increased level of progesterone or an excessive sensitivity of the receptors to the action of androgens. Prolactin, formed by the pituitary gland, even with a slight increase in blood concentration, changes the response of tissues to insulin and sex hormones.
Insulin and sex hormones
Due to changes in fat metabolism, acne may be associated with hypothyroidism (low thyroid function). In type 2 diabetes mellitus, due to the resistance of cells to insulin, it forms more than required. Hyperinsulinemia (excess in the blood) reduces the formation in the liver of globulin, which binds sex hormones.
As a result, a lot of free testosterone circulates in the bloodstream, it is actively turning into dihydrotestosterone, in which the ability to influence the formation of acne is twice as high.
And here is more about hormonal failure in men.
Excess hair growth
The most common external sign of an excess of male sex hormones in girls and women is increased hair growth on the chin, upper lip and side surfaces of the cheeks (mustache, beard and sideburns). Dense hairs are also found on the abdomen, in the perineum, on the inner surface of the thighs, legs. Their density and length is due to the sensitivity of the hair follicles to androgens and a hereditary predisposition.
The second most common symptom is obesity. It is caused by a violation of fat and carbohydrate metabolism, insulin resistance (insulin resistance).
What hormonal imbalance can lead to
A prolonged increase in androgens in women not only leads to a cosmetic defect, but also increases the risks:
- proliferation of the inner layer of the uterus (endometrial hyperplasia) with severe uterine bleeding,
- cervical cancer
- type 2 diabetes progression,
- coronary heart disease
- arterial hypertension
- metabolic syndrome.
What will indicate, in addition to acne, problems in men
An excess of testosterone usually leads to the early appearance of secondary sexual characteristics in children - hair growth on the face, under the armpits, in the perineum, a rough voice, an increase in the size of the external genital organs.
In adult patients, a high level of male sex hormones is accompanied by:
- increased aggressiveness
- sudden changes in the emotional background,
- bouts of pain in the heart
- involuntary respiratory arrest during sleep (apnea),
- prostate adenoma
What tests to take for hormones with acne
Depending on the symptoms, a dermatologist or gynecologist (andrologist) may prescribe an individual set of hormonal tests. Most often, at the first stage, the doctor prescribes standard hormones.
- pituitary thyrotropin and thyroxine - reflect the work of the pituitary and thyroid gland,
- cortisol and adrenocorticotropin - show the level of functional activity of the adrenal glands,
- free, total testosterone, dehydroepiandrosterone, a protein that binds sex steroids - are necessary to evaluate the functioning of the sex glands, in women hydroxy progesterone, antimullers and estradiol are additionally examined,
- pituitary prolactin - the formation of sex hormones depends on its concentration,
- follicle-stimulating and luteinizing - stimulate follicular maturation, synthesis of progesterone, testosterone.
Watch the video on acne tests:
Rules for preparation for delivery and deadlines
In women, tests are prescribed on days 4-6 of the menstrual cycle. Sometimes a doctor may recommend re-diagnosis 2-3 days before the expected menstruation. It is important to follow these rules when donating blood:
- come to the laboratory in the morning before breakfast,
- per day exclude alcohol intake, overeating, sports, visiting the sauna, beach, solarium, intense emotional stress,
- for a week to discuss with the doctor the possibility of using medications and the abolition of hormonal drugs, including for contraception,
- immediately before the analysis it is forbidden to smoke (for 3 hours), undergo X-ray diagnostics, take physiotherapeutic procedures.
Test results and further treatment
If hormonal imbalance is detected, it is necessary to establish its cause. The formation of sex hormones occurs in the ovaries, testicles, adrenal glands. This process is controlled by the pituitary gland, hypothalamus.
Based on the results of the initial diagnosis, further laboratory testing, pelvic ultrasound, MRI of the brain, and adrenal tomography can be prescribed. Exclusion of diabetes mellitus (glucose in blood and urine, glycated hemoglobin) is required.
Example of pelvic MRI
The most common cause of hyperandrogenism in women is polycystic ovarian changes. In this case, the use of contraceptives is indicated, which inhibit the synthesis of testosterone - Yarina, Diane 35, Jes.
In men, the background process for acne can be adrenal pathology, taking hormonal drugs to build muscle, and changing the function of the gonads. If the diagnosis did not reveal deviations from the norm, then microflora culture (smears of the skin in the rash zone), tests for intestinal dysbiosis, subcutaneous tick (demodecosis) are recommended.
Nutrition Rules Against Acne
Regardless of the reason, patients are shown a diet that can stop the development of acne:
- food is taken 5-6 times a day,
- basis of the diet - fresh vegetables and fruits, berries,
- allowed lean meat and boiled fish, seafood,
- rejection of milk and its replacement with sour-milk drinks and cottage cheese,
- a complete ban on sugar, white flour and alcohol, spices, spicy and fried foods,
- replacement of animal fats with vegetable oil (2 tablespoons per day), nuts (not more than 50 g),
- with obesity, one day a week should be unloading: on kefir, apples, cottage cheese or vegetables.
And here is more about obesity from hormonal failure.
Blood tests for hormone levels are indicated for patients with persistent acne, signs of hormonal imbalance. Examine the function of the sex glands, pituitary gland, thyroid gland, adrenal glands. In women, most often they find an increase in free testosterone and prolactin, and in men - cortisol and total testosterone.
Based on the results of the examination, therapy is prescribed or additional diagnostic methods are required. All patients with acne are shown diet food to restore metabolic processes.
Before treating hormonal acne, a dermatologist, together with a gynecologist, examines the patient in order to identify the causes of the disease:
conducts a survey on the presence of gynecological diseases, oral contraceptives, excludes diseases such as demodicosis, rosacea, perioral dermatitis, prescribes a biochemical blood test to determine the condition of the liver and kidneys, prescribes a laboratory study of the hormonal profile, and reveals the nature of hyperandrogenemia (ovarian or adrenal).
Perhaps before treating acne with hormonal failure, an ultrasound of the pelvic organs and MRI of the adrenal glands will be necessary. In most cases, with suspected hormonal acne, treatment will require the consultation of a gynecologist and endocrinologist and appropriate examinations.
When hormonal acne in women is diagnosed, treatment involves an individual approach. Both systemic and local preparations are prescribed A mandatory point is the observance of acne toilet, as this allows to reduce treatment time, dosage of drugs and improve skin condition.
The general principle of how to deal with acne is aimed at reducing the level of male hormones, or stimulating estrogen and treating a disease that triggered a hormonal failure.
Drugs are used that slow down the production of androgens in the adrenal glands and ovaries, block steroid receptors in the dermis, and inhibit the conversion of testosterone to the more active form of dihydrotestosterone. For this purpose, combined oral contraceptives are prescribed.
The use of oral contraceptives
From a large list of drugs than treating hormonal acne in women it is considered effective, contraceptives based on ethinyl estradiol (estrogen), which reduce the level of androgen concentration in the blood, are isolated. As a result of taking medications, the secretion of the sebaceous glands is reduced and thus hormonal acne can be cured.
However, with hormonal failure, therapy is predominantly carried out with drugs based on drospirenone, dienogest, cyproterone acetate, desogestrel, whose properties are similar to the female hormone progesterone. These are female progestogen hormones that are produced in the body by the ovaries and slightly adrenal glands. They reduce the activity of androgens, prevent testosterone from turning into active dihydrotestosterone and reduce the sensitivity of androgen receptors in the skin.
The 4th generation of combined contraceptives includes drugs containing ethinyl estradiol and drospirenone: Jes, Yarina, Midiana, Dimia. They not only eliminate acne, but also contribute to weight loss, which is why they are most suitable for women suffering from acne and prone to overweight.
Midiana and Yarina are drugs with a low dosage of ethinyl estradiol. They are used according to the established scheme for 1 tablet for 21 days. The next course after a week break. The total duration of therapy is designed for 6 months. During the treatment process, not only a significant reduction in acne is noted, but also that the skin becomes smoother, matte, its structure improves and the secretion of sebaceous glands decreases.
Jess and Dimia microdoses of ethinyl estradiol are used for 24 days, followed by a 4-day break.
Until now, the most effective drug with which the fight against hormonal acne, especially severe, is Diane-35, combining ethinyl estradiol and cyproterone acetate. The analogs of Diana-35 are contraceptives Chloe and Bellune 35. All drugs belong to the 3rd generation of oral contraceptives. Cyproterone acetate is the substance with the strongest antiandrogenic effect, but its intake is limited and cannot last more than 6 months due to the high risk of side effects. After the start of taking, seborrhea, oiliness of the hair noticeably decreases, it will be possible to cure acne in 3-6 months. 1 tablet is used per day from the beginning of the menstrual cycle. The effectiveness of treatment can be judged after the first 3 months of use with mandatory monitoring according to the results of analyzes.
Dienogest and desogestrel
Dienogest-based birth control pills (Janine, Silouet, Klayra) are officially indicated for the treatment of acne. Siluet and Janine also contain ethinyl estradiol and are taken according to the standard scheme. Klaira is several types of multi-colored tablets with different hormone content, so taking this contraceptive is multiphase.
Using desogestrel-based contraceptives is another way to get rid of hormonal acne. Это такие препараты как Регулон и Новинет. Схема приема классическая.
Combined contraceptives only lead to a decrease in sebum production, so it is recommended that they be combined with external agents based on azelaic acid, benzoyl peroxide, and antibiotics. These are such drugs as Baziron AS, Skinoren, Differin. Do not fight acne on your own. Only by acting comprehensively on all parts of the process of the occurrence of acne vulgaris can acne be treated effectively. Therefore, treatment is carried out by two doctors - a gynecologist and a dermatologist. A gynecologist prescribes drugs to normalize the ratio of hormone levels, a dermatologist uses local drugs that affect hyperkeratosis and destroy bacteria. Only combination therapy can ensure long-term remission and obtain such good results in the treatment of acne, which are difficult to achieve using any one method or tool.