Acne, better known as scourge of adolescence, does not really get away after entering adulthood. Especially for women at 18 to 60 years, it is a wretched strive with esoteric hormonal actions and even more a frustrating scouring at local pharmacies for a unique cure. Most of the women struggling with adult acne either do not act in response to topical preparations or unfold a tolerance to frequently prescribed antibiotics. In this situation hormonal treatment could be proved to be a windfall for female acne victims.
Cause of Adult Acne in Women
Although it is still obscure why acne shows up during adulthood, numerous dermatologists nowadays believe hormonal fluctuation is mainly responsible for this traumatic skin disorder. Premenstrual acne lesions at lower face, neck, and back area are found to be more responsive to hormonal treatments that either lessen or completely terminate the secretion of male hormone; androgen.
Plausible Relationships between Acne and Hormonal Signals
The male hormones, also known as androgens, are believed to play a key role in adult acne explosion. The secretion of androgens from adrenal glands and ovaries are brought about by gonadotrophins. Androgens include 5-dihydrotestosterone, testosterone, androstenedione, and dehydroepiandrosterone-sulfate. These impart the male hormonal traits in women such as enhanced libido, deepening of voice, etc. Male hormones are responsible for excess oozing of sebum (oil) from sebaceous glands deep beneath the epidermis. Sebum gets implicated with dead skin cells and Propionibacterium acnes bacteria and cause inflammation and swelling of hair follicles resulting acne pimples. Hormonal treatment could easily control the over activity of causal hormones, healing this skin ailment.
Polycystic Ovary Syndrome and Acne
Polycystic ovary syndrome is a gynecological disorder caused by hormonal imbalance. As per the report published by American Academy of Dermatology, around 15% of women worldwide, at their reproductive age face this problem. This ailment is characterized by acne, obesity, infertility, irregular periods, hirsutism, and elevated blood insulin levels. It is found that high level of androgen and testosterone are mainly responsible for this disease. Female acne could be an indication of this condition, which is otherwise known as Stein-Leventhal syndrome. So, it is extremely important that female adult acne patients confirm that they are not suffering from polycystic ovary syndrome before starting any hormonal treatment for acne.
Acne Treatment Options
It is found that for female acne patients treatments directed at hormonal cause have often come up with optimal results, whereas standard treatments for the same patients have not been that fruitful. This happens because hormonal treatments cease the stimulating activity of androgens over the sebaceous glands; thereby preventing the acne formation before they show up. The whole treatment procedure covers oral contraceptives, corticosteroids, and spironolactone.
Oral Contraceptive Pills
Oral contraceptive pills are often made up of progestins or a combination of estrogen and progestins. These medications directly influence our body mechanism to cut back the production of androgen, thereby reducing the formation of acne outbreaks.
Estrogens mainly work by:
- Diminishing the secretion of dehydroepiandrosterone-sulfate, testosterone, and androstenedione, which are ovarian and adrenal androgens;
- Inhibiting the level of enzyme 5-alpha-reductase, which in turn brings down the production of 5-dihydrotestosterone;
- Boosting up the level of sex hormone binding globulin (SHBG), which thereby reduces testosterone level in our blood.
Progestins differ from estrogens in their reactivity as androgenic agent. For hormonal treatment of acne one should always prefer progestins with lowest androgenic activity. Progestins are the drug of choice for countless women all over the world as an important therapeutic option for acne. A few aspects of usage of these medications are as follows:
- These are immensely useful as additional therapeutic agent along with topical medications for mild acne;
- These could be useful for moderate acne as well in combination with antibiotics and topical treatments;
- In case of severe acne condition, these could be chosen as safe contraceptive pills for female acne sufferers who are undergoing treatment with isotretinoin.
These hormonal treatments are effective in holding back the inflammation due to acne. Prednisone and dexamethasone are two oral corticoids which are generally prescribed when women are affected by acne due to overactive adrenal glands.
This is a synthetic steroidal antiandrogen which inhibits unnecessary sebum discharge. Spironolactone binds androgen receptors and thus blocks the androgen biosynthesis both in the ovaries and adrenal glands.
Side Effects of Hormonal Treatments
The most significant side effects of oral contraceptives include breast tenderness, headache, and nausea. Intensity of these side effects varies depending on the overall health condition of the patient and often tends to mitigate by second menstrual cycle.
Oral corticoids affect the patients with bone thinning and weight gain.
Side effects of oral spironolactone based hormonal treatments mainly include irregular periods and breast tenderness.