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Why Is hormonal acne so hard to treat?

Why Is hormonal acne so hard to treat?

Do you know the biggest lie we tell teenagers (right after “High school is the best four years of your life”)? We tell them that acne is a teenage problem that will eventually go away.

Unfortunately, acne isn’t just a teenage phenomenon. Many women get pimples well into adulthood — according to a 2014 study published in the Journal of Clinical and Aesthetic Dermatology, 22 percent of adult women suffer from acne. In fact, many women make it through their teenage years with perfectly clear skin only to see acne sprout for the first time once they hit their mid-twenties. Why? Blame it on your hormones.

First things first: what is hormonal acne? The answer to this question is a bit complicated, because in a sense, all acne is hormonal, Suzanne Bruce, a Houston-based dermatologist and founder of Suzanne Bruce and Associates, says. “The reason acne starts during puberty is because hormones kick in and stimulate the oil glands to produce more sebum.”

However, unlike teenage acne, hormonal acne in adults tends to be concentrated solely on the lower half of the face along the jaw, chin, and neck, often flares up before or during your period, and is cystic in nature (think those painful, throbbing knots under your skin that never really come to a head), Margaret Romero, a board-certified nurse practitioner, says.

According to Romero, hormonal acne is most often caused by elevated levels of androgens (male sex hormones), such as testosterone, an increased sensitivity to testosterone (in other words, your levels might be normal but your body might just be sensitive to it), and hormonal disorders such as polycystic ovarian syndrome (PCOS).

A woman’s body chemistry is more “delicate” than a man’s, says Romero. Your hormones fluctuate all the time: when you’re on your period, during perimenopause or menopause, during or after pregnancy, if you go on or off the pill, or if you’re not getting enough sleep at night, to name just a few examples. “Even the stress from a big life event such as moving or getting married can cause your hormones to freak out,” Romero says. When that happens, your body starts pumping out more oil, which can lead to breakouts. And, Dr. Bruce adds, because men don’t experience the same hormonal fluctuations that women do, hormonal acne is more common in women than in men (lucky us).

It’s those same fluctuations that make hormonal acne so agonizingly, frustratingly difficult to treat. Topical treatments are ineffective because they don’t get at the root of the problem. Same with antibiotics — though they provide temporary relief and may clear up some bacterial acne, many women with hormonal acne find it comes back with a vengeance after they discontinue taking antibiotics. Even Accutane, the king of teenage acne treatment, doesn’t permanently beat hormonal acne. So what’s a girl to do?

Unfortunately, there’s no cure for acne — and to make things worse, the research on acne is limited, though a 2014 study did find that it can take a significant toll on your self-esteem — and it often takes trial and error to find a treatment plan that works. There is some evidence that tweaking your diet can alleviate acne. “I tell my patients to avoid a high-glycemic diet, which can help all acne, not just hormonal,” says Eric Schweiger, MD, founder of Schweiger Dermatology Group. And a 2015 study in the Journal of American Academy of Dermatology showed an association between skim milk and acne.

There is some evidence that tweaking your diet can alleviate acne.

Romero suggests cutting out all dairy, gluten, adding a vitamin D supplement, and eating only organic, grass-fed meat. “If not, you’re consuming hormones through those foods,” she says. If you suspect certain foods are worsening your acne, it may also be helpful to keep a food diary for a few weeks to be sure. All three doctors interviewed for this piece agreed that increasing the amount of face-friendly foods like leafy green vegetables, cold-water fish such as salmon, and healthy fats such as avocados, might help tame inflammation and curb breakouts.

Romero also says she’s seen some success in using progesterone cream topically to treat acne, saying that in small doses, it can help decrease the amount of testosterone in the area without causing any systemic side effects. (However, it’s worth noting that there’s not a lot of research on the safety or efficacy of this, and that many doctors don’t recommend progesterone cream as a treatment for acne.)

Beyond switching up your diet, it’s also important to make sure you’re getting enough sleep and exercise, both of which can help to regulate your hormones naturally. And stressing less (easier said than done, we know) will also help.

Many women ultimately turn to a combination of birth control and Spironolactone, a drug that was originally developed to treat high blood pressure. It’s not FDA-approved to treat acne, but doctors have been prescribing it off-label to treat hormonal acne for years. Spiro is an androgen blocker, Dr. Schweiger explains, meaning it decreases testosterone activity — which means fewer breakouts.

However, Spiro comes with its own risks: Dr. Schweiger cautions that it can cause birth defects, so you shouldn’t try to get pregnant while taking it. Second, it’s a potassium-sparing diuretic, which means that in addition to the fact that you’ll probably find yourself peeing more than usual while taking it, it could cause your potassium levels to spike dangerously high, though Dr. Schweiger says the chances of that in young, healthy women are very low. (A 2015 study that followed patients on Spiro for 15 years backs that assessment up.) Still, to be safe, some doctors monitor your potassium while on Spiro.

For some women, simply making a few lifestyle changes will help; for others, it’ll take more heavy-duty birth control pills or Spiro, and for other women, nothing helps and they battle acne well into their forties. One thing’s for sure: If you suffer from hormonal acne, you’re definitely not alone.