Acne After Puberty: When to See an Endocrinologist - Internal Medicine

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Acne is a common skin condition that can persist beyond puberty, and it can be particularly distressing when it involves large, hard lesions and post-inflammatory hyperpigmentation. Given your description of the acne, including the presence of dark spots and hard nodules, it is understandable to be concerned about potential underlying hormonal issues or other medical conditions.

Firstly, it is important to recognize that acne can be influenced by various factors, including hormonal changes, genetics, diet, and skin care practices. In adults, particularly those who have passed puberty, persistent acne can sometimes indicate an underlying hormonal imbalance, such as polycystic ovary syndrome (PCOS) in women, which can lead to increased androgen levels and subsequent acne. Other conditions, such as adrenal gland disorders, can also contribute to adult acne.

The fact that you have been experiencing acne for five years and are noticing new lesions, particularly after dietary changes, suggests that it may be worthwhile to explore both dermatological and endocrinological evaluations. Here are some considerations for your situation:
1. Dermatological Evaluation: It is advisable to consult a dermatologist first. They can assess your skin condition, recommend appropriate topical or systemic treatments, and help manage the acne directly. Treatments may include topical retinoids, benzoyl peroxide, antibiotics, or hormonal therapies such as oral contraceptives for women. The dermatologist can also provide guidance on skincare routines that may help reduce breakouts and pigmentation.

2. Endocrinological Evaluation: If the dermatologist suspects that your acne may be related to hormonal issues, they may refer you to an endocrinologist. An endocrinologist specializes in hormonal disorders and can conduct tests to evaluate your hormone levels. Common tests might include measuring levels of androgens (like testosterone), insulin, and possibly other hormones that could indicate conditions like PCOS or adrenal disorders.

3. Tests and Assessments: If you see an endocrinologist, they may recommend blood tests to check hormone levels, as well as imaging studies if necessary (such as an ultrasound of the ovaries). They will also take a detailed medical history and may inquire about other symptoms that could indicate a hormonal imbalance, such as irregular menstrual cycles, weight changes, or excessive hair growth.

4. Lifestyle and Dietary Considerations: While you mentioned that you typically do not consume certain foods, dietary factors can influence acne. Some individuals find that high-glycemic foods or dairy products can exacerbate their acne. Keeping a food diary to track any correlations between your diet and acne flare-ups may be helpful.

5. Psychological Impact: Persistent acne can also affect mental health, leading to issues such as anxiety or depression. It may be beneficial to discuss these feelings with a healthcare provider, as they can provide support or refer you to a mental health professional if needed.

In summary, while your acne may have a hormonal component, it is crucial to start with a thorough evaluation by a dermatologist who can provide targeted treatment. If hormonal imbalances are suspected, then a referral to an endocrinologist for further assessment would be appropriate. Addressing both the physical and psychological aspects of acne is essential for effective management and improving your overall well-being.