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What is Hormonal Acne and Why do I have it?

Hormonal  acne  is exactly what it sounds like - acne tied to fluctuations in your hormones. Although it’s typically associated with hormone fluctuations during puberty, hormonal acne can affect adults of any age. Hormonal acne is especially common among women, with many factors contributing to it, such as menstruation and menopause.

Adulthood may seem to mean that you are in the clear from acne, but this may not always be true. Up to 40% of teenage acne continue to suffer from acne throughout adulthood. Hormonal acne is most common in adult women between the ages of 20 and 40. The fluctuating hormones in the body caused by menstruation and menopause can cause angry breakouts.

What is Hormonal Acne?

The pathogenesis of acne is complex and multifactorial, in which excessive sebum production and its composition play a major role [1].

The main contributing pathogenic pathways of acne are follicular epidermal hyperproliferation, plugging, excess sebum production, the activity of Cutibacterium acnes (formerly known as Propionibacterium acnes) as well as inflammation [2].

Although hormonal acne is technically not a medical term, it is typically described as hormonal acne when a person gets breakouts during specific periods, for example around their period, or when their body is going through huge hormonal shifts for various reasons, such as with a condition like Polycystic Ovary Syndrome (PCOS).

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What are the Hormones Implicated to Have a Role in Acne?

There are several hormones that regulate sebaceous gland activity that have been associated with the development of acne. These hormones include androgens, estrogens, progesterone, growth hormone, and insulin to name a few. Out of all the hormones that can affect acne, androgen have most influence. 

Androgens

Androgens are a naturally occurring steroid hormone in the body and have an important physiological role in women, acting both as precursors for estrogen biosynthesis and directly via the androgen receptor [3]. Androgens are essential for female reproductive function and health, and the most significantly biologically active androgen is testosterone.

High levels of androgens, or hypersensitivity of the sebaceous glands to a normal level of androgens causes an increase in sebum production [4]. This increased sebum production due to androgen activity in the sebaceous follicle has been shown to be a prerequisite for acne.

Androgens may also enhance follicular hyperkeratosis independent of their effect on the sebaceous glands. Androgen receptors and enzymes involved in androgen biosynthesis are also present in the portion of the follicle where plugging first begins. This is how androgen may be involved in initiating the formation of the earliest lesions of acne and microcomedones [5].


Most Common Causes of Hormonal Acne

Menstruation

A significant percentage of women experience acne symptoms during their menstruation and studies have shown the link between perimenstrual flares to acne [6]. As the menstrual cycle progresses, hormone levels fluctuate. As the period approaches, estrogen and progesterone levels drop steeply at the same time.

This, in turn, causes existing testosterone levels to be higher, which then lead to the sebaceous glands producing more sebum. This results in the pores being more prone to being clogged with sebum and therefore leading to acne breakouts.

These hormonal fluctuations just before the period of menstruation may also be responsible for other symptoms including moodiness and even sore breasts.

Polycystic Ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women and affects nearly 10% of teenagers and young women.

It is typically characterized by hyperandrogenism, chronic anovulation, and polycystic ovaries. Women with PCOS often experience dermatologic manifestations of hyperandrogenism, including hirsutism, pattern alopecia as well as acne [7].

PCOS prevents the body from receiving the pituitary gland's signals to produce an increase in amounts of hormones like estrogen, progesterone as well as testosterone. As a result, these hormone levels dip while there is a contrasting rise in testosterone levels which leads to an overproduction of sebum.

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Menopause

Menopause is a process that occurs due to a decline in the female reproductive hormones, estrogen and progesterone. The menopausal transition most often begins between the ages of 45 and 55. Natural menopause is defined as the permanent cessation of menstruation, confirmed after 12 consecutive months of amenorrhea (the absence of menstruation). When acne is observed around perimenopause or menopause, it is termed menopausal acne [8].

Perimenopause is defined as the stage that leads up to the actual menopausal phase. During this phase, estrogen begins to fall below testosterone levels in your body. Due to this, male hormones exert a greater influence on your body than female hormones- which could influence the new onset or recurrence of acne.

During this period, the ovary remains hormonally active and secretes varied amounts of androgens and estrogen. The estrogen levels however rapidly decline, making testosterone levels appear higher. This causes the balance to be skewed and it is known as postmenopausal hyperandrogenism, which often leads to acne formation [9].


Obesity

Obesity is frequently accompanied by peripheral hyperandrogenism and insulin resistance, which may correlate with increased sebum production and the development of severe acne [10].

High body mass index (BMI) and obesity have also been shown to be linked to a heightened risk of acne. A Western diet with a high glycemic index has also been linked to the development of acne in people who suffer from obesity.

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So How can You Treat Hormonal Acne?

Though the exact timeline for hormonal acne varies from person to person, being proactive can help prevent recurring breakouts. With an understanding of the various factors and causes contributing to hormonal acne, stay tuned for our next article where we’ll discuss the different treatments for hormonal acne.