Hormonal Acne: Causes and Treatment Options - Dermatology

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Understanding hormonal acne, particularly when it manifests cyclically around the menstrual cycle, can be quite complex. Hormonal acne is primarily influenced by fluctuations in hormone levels, particularly androgens like testosterone, which can lead to increased oil production in the skin and subsequent clogging of pores. This is often exacerbated in women during their menstrual cycle due to hormonal changes, leading to the development of cystic acne, especially around the chin and jawline.

From your description, it seems that your acne is indeed linked to hormonal fluctuations, as you notice a pattern correlating with your menstrual cycle. This type of acne is commonly referred to as "hormonal acne" and is typically characterized by deep, painful cysts that can take a long time to heal. The fact that you have tried various topical treatments and medications without significant improvement suggests that your acne may require a more targeted approach.

There are several treatment options available for hormonal acne:
1. Hormonal Therapy: Birth control pills are often prescribed to help regulate hormonal fluctuations. They work by suppressing ovulation and reducing the production of androgens, which can help decrease oil production and reduce acne breakouts. However, as you mentioned, long-term use of hormonal contraceptives can have side effects, and it's important to discuss these with your healthcare provider.

2. Anti-Androgens: Medications like spironolactone can be effective in treating hormonal acne. Spironolactone works by blocking androgen receptors and reducing the effects of androgens on the skin, which can help decrease oil production and acne formation. This medication is often used in conjunction with other treatments for better results.

3. Topical Treatments: While you have mentioned that topical treatments have not been effective for you, it may be worth revisiting this option with your dermatologist. Ingredients like retinoids, benzoyl peroxide, and salicylic acid can help unclog pores and reduce inflammation. Sometimes, a combination of treatments may yield better results.

4. Lifestyle Modifications: Although you mentioned maintaining a healthy diet and sleep schedule, it may be beneficial to assess other lifestyle factors that could contribute to acne. Stress management techniques, regular exercise, and avoiding known triggers (such as certain skincare products or foods) can also play a role in managing hormonal acne.

5. Professional Treatments: You mentioned trying treatments like "藻針" (which I assume refers to a type of microneedling or similar treatment). While these can be beneficial for overall skin texture and scarring, they may not directly address the hormonal component of your acne. Laser treatments can help with scarring but may not prevent future breakouts if the underlying hormonal issues are not addressed.

6. Consultation with a Specialist: Given that you have seen a dermatologist multiple times without satisfactory results, it may be worthwhile to seek a second opinion or consult with an endocrinologist. They can evaluate whether there are underlying hormonal imbalances or conditions, such as polycystic ovary syndrome (PCOS), that may be contributing to your acne.

In conclusion, hormonal acne can be challenging to manage, especially when it is persistent and cyclical. A multifaceted approach that includes hormonal therapy, lifestyle modifications, and possibly professional treatments may be necessary to achieve better control over your symptoms. It is essential to work closely with your healthcare provider to tailor a treatment plan that addresses your specific needs and concerns.