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In our previous article, we discussed the different hormones that contribute to hormonal acne, as well as some of the most common causes. Different treatment methods are available for hormonal acne, however they could also differ based on factors such as medical history, lifestyle, and the severity of the condition. Hormonal acne treatments can broadly be categorized into three areas:
- In-clinic medical grade skin treatments
- Topical creams and ointments
- Oral medications
It is important to note that there is no one-size-fits-all treatment for hormonal acne, but in this article, we will cover everything you need to know about all the hormonal acne treatments available in Singapore.
What are the Hormonal Acne Treatments?
1. Laser treatment
Lasers are a non-invasive modality that helps in the effective treatment of severe acne breakouts. Unlike topical treatments that work at the surface level, lasers target the causes of acne in the deeper skin layers. By bypassing the superficial layers, they target the pathophysiological factors influencing the development of acne [1].
Laser therapy is able to unclog the pores by resurfacing the skin. Lasers also target the bacteria through the skin, in which the laser-induced energy ruptures the bacterial walls when absorbed, effectively killing off the acne-causing bacteria. It also helps reduce future breakouts by shrinking the sebaceous glands and thus reducing sebum production.
Additionally, lasers help reduce inflammation, reduce post inflammatory hyperpigmentation (red and brown post acne marks) and accelerate the skin's healing process by stimulating the skin cells with heat energy and increasing blood circulation, revealing a newer, clearer complexion.
2. Radiofrequency (RF) Microneedling
Radiofrequency (RF) Microneedling is a minimally invasive treatment that delivers radiofrequency energy deep into skin tissues through microneedles. Microneedling is described as a technique that uses a fine needle to create microchannels in the skin.
With RF Microneedling, radiofrequency energy is delivered into the inner layers of the skin which directly targets the overactive sebaceous glands. This enhances the effects of standard microneedling and triggers the production of collagen and elastin as part of the body’s natural healing process.
In addition to being an effective treatment for active hormonal acne, it also tightens collagen fibers, mends damaged tissues, disintegrates scar tissue, lightens atrophic acne scars and Post-Inflammatory Hyperpigmentation (PIH).
3. Intense Pulsed Light (IPL)
Intense Pulsed Light (IPL) therapy delivers many rapid, high intensity and controlled pulses of light to the skin while preventing thermal damage. Using specific wavelengths of light, it targets bacteria in pores and inflamed sebaceous glands that contribute to acne breakouts.
In addition to that, IPL therapy also works to remove facial hair which decreases future flare-ups. Bacteria often cling to facial hair and become trapped in the pores of the skin. Once bacteria get trapped in the pores, it leads to an inflammatory response, resulting in an acne lesion. Using IPL therapy to eliminate facial hair reduces breakouts significantly because there will be no hair for bacteria to cling to, which prevents future breakouts.
4. LED phototherapy
Light-emitting diode (LED) therapy uses visible light devices to destroy bacteria on the skin. The High Intensity Phototherapy Device delivers skin rejuvenation and recovery properties from red, blue, and infrared light through high-intensity SLDs (super-luminous diodes).
Blue Light Therapy (420 nm)
The blue diode light is used most commonly in the treatment of acne. In addition to its anti-inflammatory benefits, it also has an antimicrobial effect, making it effective at killing several types of bacteria that can collect in the pores to cause breakouts. Blue light therapy also helps condition the skin, getting rid of free radicals that oxidize and age the skin.
Infrared Light Therapy (830 nm)
The Infrared light penetrates the deepest into the skin and is used most often for wound healing, pain relief and anti-inflammation. This mode of LED Phototherapy yields the best results when paired with treatments such as Radiofrequency Microneedling, where it is able to reduce inflammation, stimulate healing and aids recovery.
Choosing the right wavelengths and energy density are key factors to effective LED therapy. The light may not have much effect on the skin if it cannot penetrate deep enough, which is not always possible with at-home LED therapy. In addition, there is no evidence that an LED treatment performed at home is as effective as a professional treatment where wavelengths and energy densities can be controlled.
5. Medical Grade Chemical Peel
Chemical peels use acids such as alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), poly-hydroxy acids (PHAs), and trichloroacetic acid (TCAs). This chemical solution is used to remove layers of dead skin cells from the outermost layer of the skin.
By sloughing off the outermost layer of the skin, excess oil, bacteria, dirt, and dead skin cells are removed, reducing the chances of blocked pores and revealing smoother, healthier skin beneath. Medical-grade peels work on the deeper layers of the skin, whereas over-the-counter peels tend to exfoliate at a more superficial level due to the lower concentration of mild acids.
Topical Creams and Ointments | Hormonal Acne Treatments
1. Over-the-Counter (OTC) Topical Treatment
There is an array of over-the-counter treatment options for acne which do not require any prescription. These products are typically used for treating mild to moderate levels of hormonal acne symptomized by blackheads and whiteheads [2].
Over-the-counter (OTC) acne products generally contain ingredients such as benzoyl peroxide, tea tree oil, salicylic acid, and adapalene. Available in creams, gels, facial washes, and lotions, they usually work by directly killing the bacteria in the targeted area. The common drawback is that it is often too drying, which causes the skin to become more irritated, causing more breakouts, or that at some point, the OTC treatment stops working.
When this happens, it may be time to speak to a doctor about how you can better manage your acne condition.
2. Prescription Topical Medication
OTC treatment might not be sufficient to treat some acne conditions. If OTC treatments do not work, then topical medications that require a prescription contain retinoids are more effective at treating stubborn acne [3].
Consulting a doctor is especially important because while ingredients like retinoids can help treat acne effectively, improper application often results in undesirable side effects like sensitivity, dryness, and peeling of the skin.
The use of topical antibiotic creams can also treat acne effectively by targeting the bacterial infection at its source. However, it should also be used under a doctor's supervision to avoid unwanted side effects like antibiotic resistance. Consulting a doctor also ensures that the appropriate dosage is recommended based on your symptoms and condition.
Oral Medications | Hormonal Acne Treatments
1. Prescription Oral Medications
Antibiotics
Systemic treatment such like oral antibiotics can be used as a first-line treatment in cases of moderate-to-severe acne [4]. Oral antibiotics have shown to be effective in destroying acne-causing bacteria and reducing inflammation.
Some of the side effects of oral antibiotics include antibiotic resistance, gastric discomfort, diarrhoea, nausea, and destroying good bacteria in the body. In addition, some oral antibiotics can make your skin more sensitive to sunlight.
Isotretinoin
Isotretinoin is a derivative of vitamin A that is used to treat severe acne by targeting the sebaceous glands, reducing the sebum production and clears inflammation. While it is considered the most effective treatment for severe acne, isotretinoin usage must be closely monitored by your doctor as excessive dosages of vitamin A can lead to unwanted side effects as well. Minor side effects range from irritation, itching, and rashes on the skin to dry eyes, joint pains, muscle aches, vomiting, diarrhoea, headaches, and nausea [5].
Women who are pregnant or trying to conceive should avoid isotretinoin as it may cause birth defects.
Oral Contraceptives
Oral contraceptives have been shown to reduce the effects of androgens, hormones that cause acne by increasing oil production in pores. The treatment works on the principle of using estrogen present in oral contraceptives to counteract the effects of androgens in the body [5]. As a result, acne outbreaks are less likely to occur due to reduced production of sebum.
Oral contraceptives for acne treatment, however, can cause side effects such as weight gain, tenderness in the breasts, spotting between periods, missed periods, decreased libido, and mood swings.
Key Takeaways
It is important to understand that hormonal acne conditions vary from person to person. Different treatment modalities might be effective for some but not for others. Acne treatment is a specialized field that requires the guidance of an experienced doctor who can help you understand the underlying factors and suitable treatment options.