42. Females only - Why am I getting hormonal acne?
Doctor Jacob here, and we're talking about why certain women get hormonal acne.
As you might remember, hormonal acne - also adult onset female acne - is a type of acne consisting of deeper seated pimples, typically located at the jawline, but sometimes on the cheeks as well, on the chin and sometimes at the upper neck. In fact, if you think about men, these areas that I just mentioned are the exact same areas in which men can grow a beard, and that is not a coincidence.
Take a step back from the world of acne for a moment. Many women are very similar. We come from the same biogenetic construct. There are only minor differences, for example XX chromosomes versus XY. Let me pose a question which may seem random: why do men have nipples? The answer is because women must have nipples to support the rearing of young, and humans, as with all mammals, the female of the species produces milk. As a result, men have diminutive nipples which don't function well. The same is true with women's oil glands in the beard zone. Some women who are lucky in this respect don't have functioning oil glands in the beard zone at all. No matter how much of whatever hormone this woman takes, you cannot activate these oil glands because they are essentially miniaturized and not there to any significant degree. But many women have dormant oil glands within the zone of what would be a man's beard. With the right hormonal milieu, these oil glands can then awaken, churning out oil which results in deeper seated cysts called adult onset female hormonal acne. This typically happens about a week before menstruation. A week before the period the oil glands respond to some androgenic stimulation from some of the progestins that are floating around, and thus pump out some oil or sebum; the pores gets clogged up because they're kind of deep pores, and that's about it - we get the acne.
This explains why certain forms of hormonal contraception, such as a birth control pill which is not acne-friendly, or the IUD such as Mirena in some women can trigger hormonal acne, but in others - completely innocent.
Unfortunately, the pattern of oil glands, whether or not they're there in adult women and whether they respond to hormones, is predetermined, it's inherited from one's parents. So there's not much we can do to change that. Thus, what we typically do when we try to treat adult onset female acne is to modulate the hormones in some way. So if the patient's taking a birth control pill which is not so good for acne, not so acne-friendly, we can change that to a more acne-friendly pill. If the patient is not on birth control, we might add birth control, or even better, we may treat it with an oral medication called spironolactone. We'll talk all about spironolactone in the next episode.
I am Doctor Jacob, we'll see you next time.
Mild Acne - Moderate Acne - Severe (Cystic) Acne - Hormonal Acne - Acne During Pregnancy - Acne & Breastfeeding - Retinol - Anti-acne Cleanser - Anti-acne Toner - Benzoyl Peroxide - Zinc Monomethionine & Fish Oil - Pimple Spot Treatment - Blemish Treatment - Scar Treatment - Sunscreen - Moisturizer - Avoiding Exacerbators - Comedogenic Ingredient List - Azelaic Acid - Birth Control Pills - Clindamycin - Doxycycline - Isotretinoin - iPledge - Spironolactone - Minocycline - Bactrim (SMX/TMP)