Adult Female Hormonal Acne, Causes and Treatment

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Adult Female Hormonal Acne

Acne in females may be influenced by hormonal changes associated with menstruation, pregnancy, stress, ovarian disease or endocrine imbalance. Most of the hormonal changes are temporary. Sometimes they are caused by a condition that requires medical treatment. When a female has acne that (1) appears for the first time in adulthood or reappears in adulthood after clearing up earlier, (2) is unresponsive to acne treatments, (3) gets worse during pregnancy or menstruation, or (4) is associated with "masculine" patterns of hair growth or hair loss, darkening of skin in armpits or body folds, or central body obesity, she should be examined by a dermatologist. Indications of hormonal imbalance may require examination for adrenal, ovarian or pituitary abnormalities.

Hormones and Acne

The hormones that have the most influence on acne are the androgens—so-called "male" hormones although they are present in both males and females. The androgens are a causative factor in acne because they have a stimulating effect on sebaceous follicles where acne lesions have their origin.

Androgens tend to be present in relatively large amounts during adolescence as the teenager matures. The androgenic influence on sebaceous follicles is substantial at this time—a reason that acne is often thought of as a "teenage condition." As the body matures and androgen levels stabilize in adulthood, acne clears in the majority of cases.

Hormones and Acne in the Adult Woman

Adult women can be unpleasantly surprised when acne reappears in their 20s or 30s—or appears for the first time. While the acne is often mild to moderate, it may not respond to tried-and-true acne treatments that worked when the woman was a teenager. The cause of this adult acne is probably a hormonal change. The required treatment will be one that takes hormones into account. This type of treatment cannot be purchased over-the-counter at the pharmacy. It is a medical treatment prescribed by a dermatologist after appropriate medical examination.

Typical examples of hormonal acne in healthy adult women are:

Acne comes and goes during the menstrual cycle as hormonal balances go through many changes in the body.

Acne "flares" during pregnancy as the body’s hormonal balances shift to accommodate changing physiologic needs. This photo illustrates acne flare during pregnancy:

Acne may be associated with chronic emotional or physiologic stress. Stress may cause physiologic changes that affect hormone production.

Acne in adult women may be associated with other conditions that can indicate an underlying abnormality that influences androgen levels:

Absence of periods or irregularity.

Excess facial hair (hirsutism) is a "male pattern" of facial hair that may indicate an overproduction of androgens.

Female pattern baldness (androgenic alopecia) mimics male-pattern baldness in many respects and may indicate excess androgen production. As seen in this photo, female pattern baldness is usually on the central scalp:

A deepening "male type" voice, or darkening skin in the armpits or body folds, may indicate excess androgen levels.

Hyperandrogenism (excessive production of androgens) can be a contributing factor to the development of acne in any female whose acne is severe, sudden in onset, or associated with hirsutism or irregular menstrual periods. A female with acne and any of these symptoms of hyperandrogenism should be examined for the possibility of an underlying disease of the adrenal glands, ovaries or pituitary gland. Diabetes can also affect hormonal balance.

Treatment of Hormonal Acne in the Healthy Female

Hormonal acne in a healthy female can be effectively treated by a dermatologist. An underlying disease of ovaries, adrenals or pituitary, or diabetes, should be treated by an appropriate specialist physician.

A variety of treatments are available for hormonal acne in the healthy female. The dermatologist selects the treatment best suited to the needs of the patient, based upon the patient’s medical history and examination. Treatment options include:

Oral contraceptive pills are estrogen-progestin combinations formulated to alter the female hormone pattern. Because of their effects in altering androgen production, low-dose oral contraceptives have been prescribed by dermatologists for many years in the treatment of hormonal acne. The Food and Drug Administration recently approved an oral contraceptive specifically for the treatment of mild to moderate hormonal acne. Oral contraceptives can be taken for extended periods of time to control hormonal acne if the woman has no plans to become pregnant. Side effects of low-dose oral contraceptives can include nausea, weight gain, menstrual spotting and breast tenderness.

Oral corticosteroids are anti-inflammatory drugs that belong to a class of drugs produced by the adrenal glands. When adrenal glands are overactive in producing androgens, oral corticosteroids such as prednisone and dexamethasone can be prescribed to suppress androgen production. Oral corticosteroids are also prescribed to suppress inflammation in severe acne. Side effects of oral corticosteroids can include weight gain and bone thinning.

Antiandrogens are a class of drugs that (1) reduce androgen production in ovaries and adrenal glands, and (2) block androgen reception by cells in sebaceous follicles. Reduction of excess androgen and reduction of androgen available in the sebaceous follicle are anti-acne effects. Antiandrogens used in the treatment of hormonal acne include spironolactone and, less commonly, flutamide. Side effects of irregular menstruation and breast tenderness may be eased by taking the drug together with an oral contraceptive.

References

AAD Press Release "Women and Acne: The Hormonal Connection (March 3, 2001)

Strauss JS et al. Diseases of the sebaceous glands. In: Freedberg IM et al (Eds.). Fitzpatrick’s Dermatology in General Medicine, 5th ed. New York: McGraw-hill; 1999:769-784.