Acne does not go away with age
Dr. Alan R. Shalita, who co-authored "The Effect of the Menstrual Cycle on Acne," found that contrary to the adage that, "You'll grow out of acne", premenstrual acne only seems to get worse with age.
This study examined a group of 400 women ages 12 to 52. The investigators observed that 53 percent of women over age 33 experienced a higher rate of premenstrual acne than women under age 20-- who only reported a 39 percent increase in premenstrual acne.
Dermatologist Diane Thiboutot, MD, associate professor of medicine at the Milton S. Hershey Medical Center , Hershey , Pa. , proposes to clarify acne treatment options for women.
Dr. Thiboutot explains that control of acne is an ongoing process and that all acne treatments work by preventing new acne. While most women suffering from adult acne seek standard treatments such as topical preparations or antibiotics, 60 percent of these femmes either do not respond to standard acne treatments or build up a tolerance to frequently prescribed medications such as antibiotics.
Causes of Adult Acne
It is not yet known exactly what causes adult acne, but several dermatologist like Dr. Alan R. Shalita, link adult acne to hormone fluctuations. Acne in a woman is often linked to her menstrual cycle. Women with premenstrual acne outbreaks, such as pimples on the lower face and neck, seem to respond particularly well to treatment with medications that either reduce or block androgen production.
Androgen hormones create male traits in women such as a deepening of the voice, an increased libido or hirsutism that causes excessive or abnormal growth of hair. They also stimulate the oil glands. The oil mixes with skin cells and bacteria, causing inflammation in the skin that can result in the arrival of zits.
What to Know Before Your Begin Hormone Therapy for Acne
Polycystic Ovary Syndrome
Before you begin a hormone treatment for acne, you should confirm that you are not suffering from polycystic ovary syndrome, or PCOS. According to the American Academy of Dermatology, worldwide, about 15% of the women of reproductive age have PCOS.
Polycystic ovary syndrome is a hormonal imbalanced characterized by irregular menstruation, obesity, infertility, acne and hair growth on the face, chest, and back (hirsutism). Like acne, PCOS is caused by an imbalance in androgen hormones.
Dermatologists should work closely with your gynecologist to reduce the risks of infertility, cardiovascular disease and insulin-resistant diabetes.
Before your dermatologist prescribes hormone therapy, she may perform a standard screening that includes two hormones - testosterone and DHEAS (dehydroepiandrosterone sulfate).
It is important that you stop taking oral contraceptives for at least one month before any tests are performed because birth control pills can suppress androgens.
Acne Hormone Treatment Options
Dr. Diane Berson, MD, a clinical Assistant Professor at the Department of Dermatology, New York University , New York states that once a woman is diagnosed with hormonal acne, treatment options include oral contraceptive pills, corticosteroids and spironolactone. These treatments act by decreasing sebum production.
Oral Contraceptive Pill
The oral contraceptive pill, OCP, is the keystone of hormonal therapy. The OCPs most successfully employed in controlling acne contain a hormone called progestin, which has low androgenic activity, combined with 35 micrograms of ethinyl estradiol, an estrogen. You can find generic forms of this pill under names such as norgestimate or desogestrel.
Oral corticosteroids, such as prednisone and dexamethasone may help improve acne by decreasing androgen production in the adrenal gland.
Oral spironolactone is a steroidal antiandrogen that prevents excessive oil production by blocking androgen receptors.
Additionally, spironolactone decreases androgen production in both the ovaries and adrenal glands, resulting in fewer acne flare-ups. Doctors usually prescribe oral contraceptives with spironolactone to reduce spironolactone's side effects of breast tenderness and menstrual irregularities.
Risk Factors with Hormone Therapy
Dr. Thiboutot counsels, "As with any therapy, there are risks and rewards. The risks of hormonal therapy require regular breast and pelvic exams to guard against the increased risk of certain types of cancers. It is vitally important that dermatologists work with the patient's gynecologist to determine the most appropriate treatment and follow-up especially in women over the age of 40 or those who might be smokers"
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