Acne & Hormones
Hormones often drive acne breakouts; in fact, dermatologists blame rising levels of hormones for the acne that plagues nearly every teenager, according to the American Academy of Dermatology (AAD). But some people, especially women, continue to suffer from acne well into adulthood. For them, fluctuating hormone levels and a possible hypersensitivity to particular hormones appear to cause acne.
The AAD reports that several interrelated factors, including overproduction of sebum, a skin oil, cause acne. Male hormones called androgens stimulate the sebaceous glands, located deep below the surface of the skin, to produce sebum. Women normally have a small amount of androgen hormones, including testosterone, circulating in their bodies.
If women have too much androgen, or if their sebaceous glands are particularly sensitive to the hormone, the glands can over-produce sebum, which then clogs pores and leads to pimples. In one study cited in 2002 in the medical journal "Skin & Aging," researchers found nearly two-thirds of women being treated for adult acne had high levels of at least one androgen-type hormone. Estrogen, meanwhile, helps to inhibit sebum production from the sebaceous glands. Low levels of estrogen combined with high levels of androgens can cause acne.
Women with polycystic ovary syndrome (PCOS) frequently have bad acne breakouts. In these women, hormone levels are far out of balance; levels of androgens are too high while estrogen is too low. Symptoms of PCOS include ovarian cysts, missing or irregular periods, male-pattern hair growth on the face and chest, and severe acne. However, most women who have hormone-driven acne have not been diagnosed with PCOS.
Fortunately, women with acne that's resisted other treatments have an option that will help them normalize their hormone levels: birth control pills. Oral contraceptives effectively reduce levels of androgens, therefore curbing the effects of excess androgens on the skin's sebaceous glands. A review of medical studies published in 2009 by the prestigious Cochrane Database concluded that oral contraceptives containing both estrogen and progestin can treat acne. Two brands of birth control pills, Estro-Step and Ortho Tri-Cyclen, have been approved to treat acne.
Oral contraceptives can be used long term to treat acne. However, most dermatologists will not prescribe oral contraceptives to fight acne before trying other treatments, including antibiotics and prescription-strength benzoyl peroxide ointments. In addition, women who are over 35, smoke, have high blood pressure or who have a history of migraines may not be good candidates for oral contraceptive acne treatment, according to the AAD.
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