Hormonal acne can be really difficult to treat, and often the only medical treatment that will be offered is the oral contraception pill which acts like a band aid to the underlying hormonal imbalance. Once the pill is stopped, the acne returns (if it had cleared at all!). Hormonally influenced acne can cause breakouts that flare up around ovulation or period time. Breakouts are usually around the chin, neck and mouth area but can affect the whole face and even the chest or back in some cases.
These breakouts are usually a problem with the skin’s oil glands, caused by hormones. We have small holes in our skin (called pores) that connect to oil glands under the skin surface. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple develops. The follicle becomes inflamed leading to cysts, papules and pustules. Secondary to this- bacteria can breed in the clogged hair follicle causing more inflammation and infection which worsens acne even more.
The problem is that our hormones have a role to play in how much sebum and oil is being produced. Hormonally driven acne is often the result of a hormonal imbalance of our androgen hormones. This could be as simple as having a high androgen hormone level. High androgen levels can cause excessive sebum production, leading to breakouts. In some people, the hair follicles themselves can be responsible for converting androgens into a stronger form inside the follicle itself and this further worsens acne.
This androgen-driven type acne tends to be very cystic in nature. It often spreads along the jawline, under the chin and around the mouth but can be present anywhere on the face, back or chest. A high sugar diet or having the condition Polycystic Ovarian Syndrome (PCOS) can contribute to this hormonal pattern – both are associated with a higher level of insulin, which causes a higher androgen hormone level and can lead to excessive sebum production under the skin. Often a higher androgen level will cause a longer or irregular menstrual cycle, but not always.
However, we cannot always blame acne on androgen hormones alone as our other hormones oestrogen and progesterone also have a role to play. In some cases the level of progesterone or oestrogen in the body can be out of balance, and this allows the androgen hormones to exert their influence on skin health. A low progesterone level is another common cause as it allows androgens to become more freely available to the body and is most likely responsible for premenstrual breakouts. High oestrogen can also be a problem as this can mess up our insulin levels, creating a higher androgen level and therefore breakouts at the same time. It is impossible to look at any of these hormones in isolation – we need to take into account how your oestrogen, progesterone and androgen hormones are working in relation to each other to work out where our treatment priorities lie.
Hormone testing to determine your hormone profile is the most effective way to ensure you are following the right treatment plan for your acne. This is something that we do with our patients to ensure they are receiving an effective treatment tailored specific to their hormonal needs. If you would like more information please get in contact with our Naturopaths.
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