the Link Between Acne and Hormonal Imbalance

Q: the Link Between Acne and Hormonal Imbalance

Hello, Miss： The medical term for acne is "acne vulgaris," which includes comedones, papules, pustules, and large cysts, not all of which can be extracted. <br>There are many reasons for the development of acne, including the following major factors： 1. <br>Skin type： Some indivi

Acne and Endocrine System?

Hello, doctor! I would like to ask about the relationship between acne and endocrine factors.
During my teenage years, I hardly had any acne—maybe just one or two pimples a year.
My skin was quite oily and sweaty, but overall, it was in good condition! However, since I turned 21, I have been experiencing persistent breakouts.
I initially thought it was due to oily skincare products, but stopping them did not improve my condition.
I have also patiently consulted doctors for treatment, taking antibiotics and applying topical medications (like retinoids) for over six months, but the acne returns once I stop the medication! Particularly in the past year, I've noticed that about two weeks before my menstrual period, my acne worsens significantly, but it improves after my period ends.
Could this be due to hormonal imbalance causing my acne?
Q1: Which specialty should I consult to determine if my acne is hormone-related? Should I see a gynecologist, an internist, an endocrinologist, or another specialist?
Q2: I've heard that taking birth control pills can help reduce acne.
Are there any side effects? Do all types of birth control pills work for this purpose?
Q3: Isn't hormonal fluctuation supposed to be most unstable during puberty? Why did I not experience much acne during my teenage years but started having issues afterward?

Sandy, 20~29 year old female. Ask Date: 2001/06/07

Dr. Jin Lianchun reply Dermatology

Hello, Miss: The medical term for acne is "acne vulgaris," which includes comedones, papules, pustules, and large cysts, not all of which can be extracted.
There are many reasons for the development of acne, including the following major factors: 1.
Skin type: Some individuals have pores that are prone to excessive keratinization, leading to clogged pores, and sebaceous glands that secrete an excessive amount of oil.
2.
Hormonal imbalance: Various conditions can cause this phenomenon, which can lead to persistent acne in individuals with the aforementioned skin type.
These include: a.
Staying up past 1 AM or poor sleep quality at night.
b.
High stress levels without relief: including academic pressure, life stress, and relationship stress.
c.
Menstruation.
d.
Physical illnesses: constipation, gastrointestinal discomfort, or other ailments.
3.
Endocrine disorders: Thyroid or other hormonal issues.
Therefore, the treatment approach includes oral medications and topical treatments, along with going to bed early, managing stress, and addressing any physical ailments, all of which are essential.
For improving the first factor related to skin type, it includes going to bed early, managing stress, and the "continuous" use of one of the following topical medications: high-concentration 10-15% alpha hydroxy acids, "Acne Control," or retinoids, all of which should be applied once at night, and only one should be chosen.
Additionally, dietary restrictions should include avoiding high-fat, high-calorie foods, coffee, and spicy foods.
If acne persists despite this skincare regimen, chemical peels with alpha hydroxy acids can be added once or twice a month for maintenance.
If following the above methods for more than six consecutive months still results in acne, oral medications and topical treatments should be added.
Oral medications include first-line antibiotics, second-line anti-androgens, and third-line isotretinoin (Roaccutane).
Generally, oral medications need to be taken continuously for more than two months, and once symptoms improve, it is still necessary to maintain the "continuous" use of the aforementioned topical medications and uphold a normal lifestyle, which can lead to significant improvement.
A1: You can visit an obstetrician-gynecologist to check hormone levels.
A2: Generally, the dosage of birth control pills used to suppress acne is lower.

Reply Date: 2001/06/07

More Info

Acne is a common skin condition that can be influenced by various factors, including hormonal imbalances. Your experience of developing acne after the age of 21, particularly in relation to your menstrual cycle, suggests that hormonal fluctuations may indeed play a significant role in your skin condition. Let’s delve into your questions regarding the relationship between acne and hormonal imbalance, as well as the implications for treatment.

Q1: Which Specialist to Consult for Hormonal Acne?
To determine if hormonal imbalances are contributing to your acne, you may consider consulting an endocrinologist, a specialist in hormone-related disorders. However, a dermatologist can also provide valuable insights, especially since they specialize in skin conditions. If your acne is particularly severe or resistant to treatment, a visit to a dermatologist is advisable. They can assess your skin condition and may refer you to an endocrinologist if they suspect an underlying hormonal issue.

Q2: Birth Control Pills and Acne Treatment
Birth control pills can be effective in managing hormonal acne, particularly those containing estrogen and progestin. These hormones can help regulate menstrual cycles and reduce the production of androgens (male hormones) that contribute to acne. However, not all birth control pills are created equal; some may have a more pronounced effect on acne than others. Commonly prescribed options for acne include those containing drospirenone, such as Yaz or Yasmin.

While birth control pills can be beneficial, they also come with potential side effects, including weight gain, mood changes, and an increased risk of blood clots. It’s essential to discuss these risks with your healthcare provider to determine the best option for you.

Q3: Hormonal Fluctuations and Acne Development
It’s true that hormonal fluctuations are often most pronounced during puberty, which is typically when many individuals experience their first acne breakouts. However, hormonal changes can continue throughout life, influenced by factors such as stress, diet, and menstrual cycles. For some individuals, the hormonal changes that occur in their twenties or thirties can lead to new or worsening acne, even if they did not experience significant issues during their teenage years.

In your case, the observation that your acne worsens approximately two weeks before your menstrual period suggests a link to the hormonal changes associated with your menstrual cycle. This is often referred to as premenstrual acne and is thought to be related to increased levels of progesterone, which can stimulate oil production in the skin.

Additional Considerations
In addition to hormonal factors, other contributors to acne may include:
- Diet: Some studies suggest that high glycemic index foods and dairy products may exacerbate acne.

- Stress: Stress can lead to hormonal fluctuations that may worsen acne.

- Skin Care Products: While you mentioned that stopping your skincare products didn’t help, it’s essential to ensure that any products you use are non-comedogenic (won’t clog pores).

Conclusion
Acne can be a complex condition influenced by hormonal imbalances, particularly in women. Consulting with a dermatologist or endocrinologist can provide clarity on the underlying causes of your acne and the best treatment options. Birth control pills may be a viable option for managing hormonal acne, but it’s crucial to weigh the benefits against potential side effects. Lastly, understanding that hormonal fluctuations can occur at various life stages can help you navigate your skin health more effectively. Always consult with a healthcare professional before starting any new treatment or medication.

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