Hormonal factors key to understanding acne in women

Teenagers are the age group most commonly thought to struggle the most with acne, but dermatologists are finding that late-onset or adult-onset acne is becoming increasingly common in women in their 20s, 30s, 40s and even 50s.

Although there is no one single cure that works in all patients with acne, dermatologists can recommend patient-specific treatment regimens to control acne and minimize future breakouts. In women, hormonal therapies are commonly used to treat acne safely and effectively.

How Hormones Influence Acne:

Primary causes of acne

• Excess sebum, or oil gland, production (influenced by hormones).
• Skin cells that shed become abnormally sticky and accumulate, or clog up, in the hair follicle (influenced by hormones).
• Increased number of the acne-causing bacterium Propionbacterium acnes, or P. acnes.
• Skin inflammation.

The role of androgens

• Androgens, the male hormones present in both men and women, can contribute to acne flares by overstimulating the oil glands and altering the development of skin cells that line hair follicles in the skin.
• The majority of women with acne have normal androgen levels, but hormonal testing is recommended for females who have acne accompanied by excess facial or body hair, deepening voice, or irregular or infrequent menstrual periods.

Treating Acne in Women: Factors to consider

• Therapy must be tailored to the patient's specific type and severity of acne: mild, moderate or severe.
• Pregnancy considerations must be taken into account when prescribing acne medications because several oral and topical medications should not be used when trying to conceive or during pregnancy.
• Adult women may be more likely to have dry skin as they get older, and topical acne medications may cause more skin irritation in patients with dry skin.
• Some adult women with acne also may show signs of rosacea (another common skin condition characterized by redness and inflammation), which would make some topical acne medications harder to tolerate.

Topical retinoids

• In acne patients of any age, dermatologists consider topical retinoids (medications that contain vitamin A derivatives) first-line therapy by for mild-to-moderate inflammatory acne accompanied by blackheads and whiteheads.
  • Dr. Schlosser noted that topical retinoids also are the preferred therapy for overall long-term prevention of new acne.

Hormone therapies

• Combination oral contraceptives (also known as "the pill") have been found to effectively clear acne in women either when used alone or in conjunction with an anti-androgen medication, such as spironolactone.
• Many different oral contraceptives have been shown to be effective in treating acne. Oral contraceptives approved by the U.S. Food and Drug Administration (FDA) for the treatment of hormonal acne contain ethinyl estradiol plus either the progestin norgestimate, norethindrone acetate or drospirenone.
  • These oral contraceptives work together to alter levels and activity of hormones that can trigger acne.
• Patients must be carefully screened before using any hormonal therapy for acne because there are numerous contraindications (or factors that increase the risks of a particular medication). Contraindications for use of oral conceptive pills include, but are not limited to:
  • Personal history of breast cancer.
  • Heart attack, stroke or blood clots.
  • Uncontrolled high blood pressure.
  • Abnormal vaginal bleeding.
• Patients also need to be monitored regularly while using hormonal therapies.

Tips for Acne Patients:

• Dr. Schlosser advises patients to use non-comedogenic or sensitive skin products in order to reduce the formation of new acne lesions and to minimize skin irritation.
• Mild cleansers should be used twice a day.
• Avoid cleansers or other skin care products with scrubbing particles or a gritty texture, as they can irritate the skin.
• Use a non-comedogenic moisturizer daily.
• Apply the appropriate amount of topical acne medications (enough for a very thin layer, generally a pea-sized amount for the face) to the skin. Using more medication than is recommended will not produce better results, but may cause more irritation or dryness.
• When starting treatment with topical retinoids, Dr. Schlosser advises that the therapy should only be applied three times a week for the skin to get accustomed to it. Over time, the frequency of the medication should be gradually increased with the goal of using a topical retinoid every night.
• Avoid picking, squeezing, popping or otherwise manipulating acne lesions to minimize trauma to the skin to help reduce the risk of scarring and secondary bacterial infections.

"With acne, it's important for patients to understand that there are no quick fixes, and none of the therapies used to treat acne work overnight," said Dr. Schlosser. "Patients need to be consistent when using their acne medications and realize that they may not see the full effects of their treatment regimen for eight to 10 weeks -- and in many case, some type of maintenance therapy is required for long-term clearance of acne. "

Facts:

• A study examining the prevalence of acne in adults over age 20 found that acne affects more than 50 percent of women between the ages of 20-29 and more than 25 percent of women between the ages of 40-49.
  • The study found a disproportionate number of adult women were affected by acne compared to similar-aged men.
• A 2011 clinical study examining photos of women from age 10-70 for visible signs of acne found that 45 percent of women aged 21-30 had clinical acne, 26 percent of women aged 31-40 had clinical acne, and 12 percent of women aged 41-50 had clinical acne.