Skin problems can be frustrating, embarrassing and even painful. Are you struggling with adult acne? If so, you may need to tune into your hormonal health.
Hormones — our body’s chemical messengers — are secreted by the glands of our endocrine system. They communicate with our body’s organs, of which the skin is the largest.
Whether it’s a few irritating extra pimples or a cluster of deep, sore red cysts, a hormonal imbalance often underlies adult dermatological despair. Even a small hormone issue can be reflected in our skin.
Let’s explore the relationship between our skin and hormonal acne. What causes the problem and what treatments options do I have open to me if I’m suffering?
What is hormonal acne?
Also known as adult acne, hormonal acne describes breakouts of spots that appear long after the teenage years. Usually occurring on the lower half of the face, hormonal acne affects adults of any age, but women are more likely to experience it than men.
Hormonal acne is often tied to fluctuations and imbalances in your hormones, in particular a rise in androgen ‘male’ hormones. Menstruation and menopause are particularly closely linked to hormonal acne.
Other common causes of hormonal acne can include polycystic ovarian syndrome (PCOS). PCOS is characterised by our bodies creating more androgen hormones like testosterone, resulting in the skin’s glands secreting more oily sebum.
What are the symptoms of hormonal acne?
The key symptoms of hormonal acne are spots around the jawline, chin and the mouth. This differs from acne that very commonly occurs during puberty, which usually appears in the ‘T zone’ — your forehead, nose and chin.
No two cases of hormonal acne will look the same, but you may notice a range of different types of spots, including:
- Whiteheads: Also referred to as closed comedones, these are closed beneath the skin, appearing as a small white spot.
- Blackheads: Small spots that appear at the surface of the skin — they turn black after interacting with the air. Also known as open comedones.
- Papules: Caused by irritation and inflammation of the hair follicles, appearing as raised red bumps.
- Nodules: Similar in appearance to papules, but larger in size.
- Pustules: Small, raised pimples that contain a yellow-ish head of pus.
- Nodules: These lie deeper in the skin and can be large and painful.
- Cysts: The most serious type of acne, these large, red lumps lie deep in the skin.
How does hormonal imbalance affect the skin?
As our body’s largest organ, it’s probably no surprise that the fate of our skin is so intimately tied to our hormones.
The skin is covered in small sebaceous glands. These secrete a substance called sebum — an essential oil for the health and maintenance of your skin. These glands contain receptors that respond to hormones in our body. They are very sensitive to certain hormones, particularly androgens like testosterone.
The more androgen hormones there are in your bloodstream, the more likely it is that they will bind to the receptors in your sebaceous glands, resulting in greater oil production — and therefore a higher chance of oily skin and clogged pores, which result in acne breakouts.
Our sebaceous glands are also sensitive to oestrogen. It is understood that this female sex hormone stops oil production; oestrogen is known to hydrate our skin, boost collagen levels and support wound healing — all good news for our dermatological health.
What are the causes of hormonal acne?
Hormonal acne is usually caused by hormonal fluctuations that lead to a relative increase in androgen hormones like testosterone. This can be as a result of the menopause, menstruation, polycystic ovarian syndrome, contraceptive pills, or certain hormonal disorders like PCOS. Your predisposition to acne can also be affected by your genetics.
During the menopause, oestrogen levels fluctuate wildly, leading to a relative increase in the amount of androgens in your body, like testosterone. Androgen hormones can cause your body’s sebaceous glands to go into overdrive; when excess levels of sebum gather around your hair follicles, this can manifest itself as acne.
Other factors that menopausal women may contend with, such as insomnia, stress and dietary changes, can be triggers for hormonal acne. You may also have a genetic predisposition to hormonal acne breakouts.
A link between the menstrual cycle and acne has been clearly demonstrated, with almost half of women reporting premenstrual flare ups. However, the precise mechanism explaining this remains unknown.
It has been suggested that it is caused by rising and falling levels of oestrogen and progesterone across the 28-day menstrual cycle. Levels of testosterone remain the same, which creates a relative increase of this androgen, leading to increased sebum production.
Polycystic ovarian syndrome (PCOS)
Scientists have affirmed a clinical association between polycystic ovarian syndrome and acne. PCOS can cause the ovaries to produce a higher-than-normal amount of androgen hormones, an imbalance which leads to the production of oily sebum in the skin.
The use of birth control pills can be both a cause and a solution of hormonal acne. Taking oestrogen and progestogen contraceptive pills can reduce the relative amount of androgen hormones in the body, thereby helping to combat acne — they are considered an effective option for treatment. However, the side effects of progestogen-only contraceptive pills can include acne, thought to be a result of androgen hormone fluctuations.
Your genetics determine the size, volume and activity of your sebaceous glands, and research has affirmed that there is a major genetic influence on hormonal acne. Those with larger, higher-activity oil glands in the skin are more likely to experience clogged pores that cause acne breakouts.
Is menopause acne a form of hormonal acne?
Breakouts of spots that occur during the menopause — which starts, for most women, between the ages of 45 and 55 — are classed as forms of hormonal acne. Menopause hormonal acne is mainly caused by the relative increase in androgen hormones that results from falling oestrogen levels.
Adult acne seen during the menopause can also be triggered by genetics and dietary changes, but also by other menopause symptoms like lack of sleep and stress.
What are the treatments for hormonal acne?
There are a number of effective treatments for hormonal adult acne. Yours may include hormone treatments, topical or oral medications, lifestyle changes, or even medical procedures.
The type of treatment most suitable for you will depend on the severity of your hormonal acne. Get in touch with your GP to discuss your hormonal acne and the most suitable way forward. Depending on its severity, they may refer you to a dermatologist to explore options for treatment.
Two of the most common and effective types of medication for moderate and severe hormonal acne in women include oral contraceptives and anti-androgen medications.
- Oral contraceptives: These contain a type of oestrogen as well as a type of progestin that target the hormones which contribute to acne. Even if you’re not sexually active, a combined oral contraceptive pill is routinely prescribed for hormonal acne.
- Anti-androgens: Certain medications (such as spironolactone, flutamide and cyproterone acetate) help to reduce hormonal acne by acting as androgen hormone blockers, preventing their effect on the sebaceous glands.
Your GP will discuss any potential side effects with you before starting a course of treatment.
Hormone replacement therapy can also alleviate hormonal acne. However, you usually won’t be prescribed hormone replacement therapy specially for skin problems, but only if you’re suffering from a number of other menopause symptoms.
One oral treatment for severe acne is isotretinoin, commonly known in the UK by its brand name Roaccutane. This treatment is taken as a capsule — it works by drastically shrinking the skin’s sebaceous glands.
Isotretinoin is highly effective in treating even the worst types of acne. However, the drug is known to cause a number of wide-ranging side effects. As such, its use is prescribed and strictly monitored by a dermatologist or specialist doctor.
If you are pregnant — or planning to become pregnant — you are not suitable for treatment with the drug. Isotretinoin is likely to harm a baby and can cause miscarriage. You’ll be required to use at least one (and ideally two) reliable methods of contraception for one month before, during and for one month after treatment.
As well as an initial blood test before starting, a course of isotretinoin requires a monthly hospital visit consisting of a blood test, weight monitoring and the proof of a negative pregnancy test.
Common side effects of isotretinoin (Roaccutane) include:
- Dry skin and lips: Apply a lip balm and oil-free skin moisturiser as appropriate.
- Skin sensitivity to sunlight: Apply oil-free sun cream of at least SPF 15 when in direct sunlight.
- Dry eyes: Eye drops can help; get in touch with a pharmacist or optician.
- Nosebleeds and dry nostrils: Carefully apply some petroleum jelly (such as Vaseline) to the inside of both nostrils.
- Aching joints: The use of painkillers may be recommended and you may want to avoid heavy, strenuous exercise.
- Headaches: Again, your pharmacist will be able to recommend a painkiller.
Serious side effects — affecting fewer than 1 in 1,000 people who take the drug — can include anxiety, aggression, severe stomach pain, bloody diarrhoea, a serious skin rash or difficulty moving your arms or legs. A very rare side effect can include yellow skin or eyes, a sign of kidney or liver problems.
In extremely rare cases, isotretinoin can also cause depression, make it worse or cause suicidal thoughts; those who have had a mental health problem are encouraged to discuss their suitability for the drug with their doctor. If you experience depression, thoughts of self harm or any of the other severe side effects whilst taking the drug, inform your doctor as soon as possible.
If you have a serious allergic reaction to the drug — which can include wheezing, chest tightness, swollen red skin, trouble breathing or a swollen face or throat — phone 999.
Other types of oral treatment for hormonal acne include antibiotics such as tetracycline, erythromycin, minocycline and doxycycline. These work by killing the germs and bacteria that contribute to acne, and are often prescribed alongside a topical treatment.
Benzoyl peroxide is one of the most common types of topical treatment for mild hormonal acne. Available as a gel or cream, it has an antiinflammatory effect and works by reducing the number of bacteria on the skin.
If your acne is mild, you may be prescribed a type of retinoid. Derived from vitamin A, retinoids work by unclogging the pores and clearing out dead skin cells. They aren’t as effective for moderate or severe acne which is deeper in the skin.
Although hormonal acne isn’t caused or solved by hygiene, certain behaviours can exacerbate the issue and have the potential to worsen your complexion.
- Don’t over-wash: Too much washing can remove oil from the skin and cause irritation. A gentle wash with warm water and mild cleanser — no more than twice a day and after exercise — will give your skin the gentle treatment it needs.
- Keep it mild: Avoid harsh exfoliating scrubs and hot water. Where possible, avoid excessive use of make up and choose water-based cosmetics.
- Avoid picking and scraping: Touching your acne excessively can cause further irritation, simply making things worse.
Medical procedures for hormonal acne are not routinely performed. However, in certain circumstances, your dermatologist may recommend such a treatment — this may include light or laser therapy or a chemical peel.
For certain types of cystic acne, a drainage and extraction procedure might be suitable. In the case of a particularly dangerous cyst, an injection may be used to decrease its size.
Balanced hormones, happy skin
Our hormones play such an important role in our health and wellbeing. Whilst the skin is often the first place that an imbalance can present itself, there are many other signs and symptoms of out-of-sync hormones.
If you’re concerned about your skin problems and suspect a hormone imbalance might be to blame, make sure to discuss the issue with your GP.
Over on the Inspired Health Wellness blog, you can explore more articles about women’s health, hormones and much more. Why not also sign up to our insight-packed newsletter?