FEMALE ACNE AND HORMONES
by Geoffrey Redmond, MD
Acne is Extremely Common
What Causes Acne?
Acne, the Teenage Years and Beyond
Treating the Hormonal Cause of Acne
Skin Care for Acne
Non-Prescription/Prescription Acne Treatments
Hormonal Treatment of Acne
Acne and Extra Hair
Acne and Polycystic Ovary Syndrome (PCOS)
A Final Note
Hormonal Treatment of Acne
Many women with marked acne do not get enough clearing with these standard acne treatments. In this situation, treatment directed at the hormonal cause may produce much clearer skin. These approaches are not often used by dermatologists, who treat most acne. If you have persistent acne and want to consider this form of treatment, you may need to see a physician with special expertise in female hormone problems who might be a endocrinologist or a gynecologist. Be sure to check first because not all doctors who deal with female hormones work with acne.
At the Hormone Center of New York, when I see a woman who has had acne which won’t go away, the first step is to measure hormone levels in order to determine the specific hormonal factors which are causing her acne. Treatment varies depending on the individual but usually involves lowering free testosterone and protecting the oil glands from this hormone. Counteracting the hormonal cause of acne often clears up the skin when the conventional measures have failed.
Oral contraceptives can be part of the treatment because they lower free testosterone. The addition of medications which block testosterone can dramatically clear the skin. Spironolactone (Aldactone®) is usually quite effective. Though often used with an OC, spironolactone can also be used by itself. Spironolactone was originally developed as a blood pressure medication. It blocks aldosterone, a blood pressure-raising hormone. Because testosterone is chemically similar to this hormone, it is also blocked by spironolactone.
Finasteride, sometimes useful for other testosterone problems in women, probably will not help acne and there is serious worry about its safety in pregnancy. This is discussed in detail in the section on treatment of unwanted hair. [Hormones and Unwanted Hair] Although birth defects have not been reported with use of spironolactone to my knowledge, they are theoretically possible since it blocks testosterone, so it is important not to get pregnant while taking this medication also.
A new OC, Yasmin® contains drospirenone, a close cousin of spironolactone, as its form of progesterone. It is not labeled for acne in the United States at this time and is equivalent to a rather low dose of spironolactone. Dose is definitely important with spironolactone; low doses are less effective.
Any acne treatment takes at least a few weeks to work. Once a breakout has occurred, healing is gradual. The best thing is to prevent the breakouts from happening in the first place. This is why acne treatments should be used all the time, not just when lesions appear.
Accutane
The last resort is isotretinoin (Accutane®), a potent form of vitamin A. This drug has made a great difference for some people with bad acne but it can have serious side effects and so must be used very carefully with close monitoring. Absolute avoidance of pregnancy is essentially since fetal isotretinoin exposure can produce serious birth defects. Fortunately, once it is out of the body, isotretinoin will not affect pregnancy outcome. While isotretinoin has a place, in my experience, hormonal treatment is much easier to tolerate and often gives a better result. This is because androgen blockers not only cut down on breakouts but often give a brighter, feminine appearance to complexions which have been damaged by acne.
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Acne is Extremely Common
What Causes Acne?
Acne, the Teenage Years and Beyond
Treating the Hormonal Cause of Acne
Skin Care for Acne
Non-Prescription/Prescription Acne Treatments
Hormonal Treatment of Acne
Acne and Extra Hair
Acne and Polycystic Ovary Syndrome (PCOS)
A Final Note
