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Case Studies In Hormonal Acne Management

By: Laura Cooksey
Posted: April 1, 2014, from the April 2014 issue of Skin Inc. magazine.
Case Studies In Hormonal Acne Management

Hormones are chemical messengers that regulate almost every aspect of the human body, including the maturation of the oil glands in the skin. It is when these oil glands mature that they develop the capability of becoming acne lesions. However, not everyone experiences acne—hormones are not the root cause of acne, only part of what can exacerbate it. Acne is actually caused by the inherited propensity of retention hyperkeratosis—dead skin cells that stick together at an accelerated rate along with other debris. This forms an impaction inside the follicle called the microcomedone, the beginning of all acne. If a person is acne-prone already, hormonal fluctuations just fuel the fire by producing more sebum that flows into an already-blocked pore. Sebum can be quite irritating to the follicle wall, sometimes producing inflammation inside the pore.

Causes of hormonal fluctuations include:

  • Puberty;
  • Stress;
  • Menstrual cycles;
  • Certain birth control pills and methods;
  • Pregnancy;
  • Peri- and post-menopausal hormonal fluctuations;
  • Eating certain high-androgen foods, such as peanuts, corn and canola oil, shrimp and organ meats;
  • Medical conditions, such as polycystic ovary syndrome (PCOS) and rosacea fulmins;
  • Certain medications, such as thyroid medications; and
  • The time of year.

With so many hormonal fluctuations coming at clients from all corners, how do acne-prone individuals ever achieve clear skin? The correct use of exfoliating and antibacterial products will prevent microcomedones from forming in the first place. Mandelic, glycolic and/or salicylic serums—depending on the type of acne—used in combination with benzoyl peroxide (BPO) gel will get the job done. Following are case studies of acne-prone clients with extreme hormonal fluctuations that affected the severity of acne. Included are step-by-step treatments and home-care regimens for each of these clients.

Case Study: No. 1—Client with PCOS

PCOS is characterized by polycystic ovaries—featuring cysts that develop in the ovaries, as well as irregular or no menstrual periods, irregular ovulation and high levels of androgens in the body, which exacerbate acne. Because of the constant influx of androgens, this client was informed that her skin may not get completely clear, but it could improve. It was recommended that she take zinc monomethionine to help bring down her inflammation levels.


Treatment: weeks 1–2.

Mild 5% TCA/lactic peel—two layers

Home care regimen.

Morning: Cleansing gel; moisturizing toner (she was allergic to aspirin, so no salicylic toner); 8% mandelic serum every other day; sunscreen