Hormonal Factors Key to Understanding Acne in Women


Information presented at American Academy of Dermatology’s 70th Annual Meeting by Bethanee Jean Schlosser, MD, PhD, FAAD, assistant professor of dermatology and director of Women’s Skin Health at Northwestern University, Feinberg School of Medicine.

Although teenagers are the age group most commonly thought to struggle with acne, dermatologists are finding that late-onset or adult-onset acne is becoming increasingly common in women in their 20s, 30s, 40s, and even 50s.

Although there is no one single cure that works in all clients with acne, dermatologists can recommend client-specific treatment regimens to control acne and minimize future breakouts. In women, hormonal therapies are commonly used to treat acne safely and effectively.

How hormones influence acne

Primary causes of acne include:

  • Excess sebum, or oil gland, production (influenced by hormones);
  • Skin cells that shed, become abnormally sticky and accumulate in, or clog up, the hair follicle (influenced by hormones);
  • An increased number of the acne-causing bacterium Propionbacterium acnes (P. acnes); and
  • Skin inflammation.

The role of androgens includes the following

  • Androgens, the male hormones present in both men and women, can contribute to acne flares by overstimulating the oil glands and altering the development of skin cells that line hair follicles in the skin.
  • Although the majority of women with acne have normal androgen levels, hormonal testing is recommended for females who have acne accompanied by excess facial or body hair, deepening voice, or irregular or infrequent menstrual periods.

Treating acne in women

Following are factors to consider.

  • Therapy must be tailored to the client’s specific type and severity of acne—mild, moderate or severe.
  • Pregnancy considerations must be taken into account when prescribing acne medications, as several oral and topical medications should not be used when trying to conceive or during pregnancy.
  • Adult women may be more likely to have dry skin as they get older, and topical acne medications may cause more skin irritation in clients with dry skin.
  • Some adult women with acne also may show signs of rosacea (another common skin condition characterized by redness and inflammation), which would make some topical acne medications harder to tolerate.

Following are some facts about the use of topical retinoids for acne.

  • In acne clients of any age, dermatologists consider topical retinoids (medications that contain vitamin A derivatives) as first-line therapy for mild-to-moderate inflammatory acne accompanied by blackheads and whiteheads.
  • Schlosser noted that topical retinoids also are the preferred therapy for overall long-term prevention of new acne.

Following are some facts about the use of hormone therapies for acne.

  • Combination oral contraceptives have been found to effectively clear acne in women either when used alone or in conjunction with an anti-androgen medication, such as spironolactone.
  • Many different oral contraceptives have been shown to be effective in treating acne. Oral contraceptives approved by the U.S. Food and Drug Administration (FDA) for the treatment of hormonal acne contain ethinyl estradiol plus either the progestin norgestimate, norethindrone acetate, or drospirenone.
  • These oral contraceptives work together to alter levels and activity of hormones that can trigger acne.
  • Clients must be carefully screened before using any hormonal therapy for acne, because there are numerous contraindications (or factors that increase the risks of a particular medication).

Tips for acne clients

  • Schlosser advises patients to use noncomedogenic and sensitive skin products in order to reduce the formation of new acne lesions and to minimize skin irritation.
  • Mild cleansers should be used twice a day.
  • Avoid cleansers or other skin care products with scrubbing particles or a gritty texture, because they can irritate the skin.
  • Use a noncomedogenic moisturizer daily.
  • Apply the appropriate amount of topical acne medications (enough for a very thin layer, generally a pea-sized amount for the face) to the skin. Using more medication than is recommended will not produce better results, but may cause more irritation or dryness.
  • When starting treatment with topical retinoids, Schlosser advises that the therapy should initially be applied three times a week in order for the skin to get accustomed to it. Over time, the frequency of the medication should be gradually increased with the goal of using a topical retinoid every night.
  • Avoid picking, squeezing, popping, or otherwise manipulating acne lesions to minimize trauma to the skin and help reduce the risk of scarring and secondary bacterial infections.

“With acne, it’s important for patients to understand that there are no quick fixes, and none of the therapies used to treat acne work overnight,” said Schlosser. “Clients need to be consistent when using their acne medications and realize that they may not see the full effects of their treatment regimen for eight to 10 weeks—and in many cases, some type of maintenance therapy is required for long-term clearance of acne. ”

More in Physiology