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Hormonal Acne

Dr. Steve Jepson explains.

Many women suffer from acne at the age of 30 or 40 or even 50! If you are one of them, you may or may not have had acne as a teenager. It may just be a problem in your adult years. You have probably talked to several doctors about it, have been given prescriptions of various sorts, have tried many skin care products all purporting to help with acne, yet you still have pimples on your face right now (and probably a few deep cystic ones, too). You are likely convinced that it has something to do with your hormones and have suggested that it’s hormonal to several doctors including a dermatologist or two. They may have even agreed with you, but didn’t give you any hormonal solutions other than antibiotics and expensive prescription skin creams that dried your skin but didn’t control your acne. If this is your story – then here are some solutions.

I have found that adult female acne is almost always hormonal. And there are solutions – hormonal solutions! Here are three different ways that hormone imbalance can cause acne – each with its own unique remedy.

1. Progesterone deficiency – if your acne cycles with your menstrual period (usually you break out with acne mostly in the 1-2 weeks before your period) and if you also suffer from some degree of PMS, then your acne is most likely due to progesterone deficiency. This is also the most common form of hormonal acne for women over 50 (your ovaries stop producing progesterone with menopause). Progesterone has a protective effect on your skin. If you don’t have enough, you will product more oils, more oils will clog your pores, and clogged pores result in acne – usually the deep cystic kind. The solution – natural progesterone (in the form of a cream or lozenge) for three weeks of your cycle each month. Note that synthetic progesterone (such as Provera or medroxyprogestin) does not help acne and in fact can make it worse. Birth control pills and the most popular IUD also usually worsen this type of acne (because they contain synthetic progesterone.)

2. Testosterone excess – this is a common cause of acne in younger adult females (20s and 30s). Either your ovaries produce too much testosterone or your skin produces too much of a testosterone derivative called DHT (dihydrotestosterone). Generally this type of acne will occur through your entire cycle, is often associated with oily skin and unwanted facial hair, and commonly (but not always) can affect the chest and back. The solution – a DHT blocking medicine called Spironolactone taken orally is very effective for this type of acne and is my first choice. Birth control pills can also help with this type of acne, but I only recommend these if you also need birth control (due to other unwanted side effects.)

3. Stress and Cortisol excess – many of you may have noticed that your acne gets worse at times of stess. This is also a hormonal form of acne. Stress causes your adrenal glands to produce a hormone called cortisol. Cortisol causes acne. This type of acne usually only lasts as long as your stress lasts. But many of you probably suffer from chronic stress and can consequently suffer from chronic stress-induced acne. The solution – exercise is the best cortisol-reducing stress management treatment. There is also a natural supplement called Phosphotidyl Serine that can help lower your cortisol. And I encourage at least 64oz of water consumption daily to help modulate the effects of cortisol on your body

What about Antibiotics for adult acne since they are commonly prescribed for this problem? Often women will take them for months and months on end to keep their acne under control. And indeed, they usually do work. But they are merely a Band-aid. They do not address the underlying hormonal problem. It’s better to address the hormonal problem directly and save antibiotics for times of more serious infections while avoiding potential antibiotic side effects.

Hormonal acne is quite easy to identify. A combination of acne history, menstrual history, and hormone testing (I prefer saliva testing) can almost always identify your particular hormonal issue. Once identified, treatment is inexpensive and effective, though it can take 6-8 weeks to achieve control.

We do offer Hormonal Acne Evaluations at my office as well as premium doctor-grade acne skin care products. Please call my office or visit my website for more information.

Dr. Steven Jepson MD

Utah Dermatologic & Medical Procedures Clinic

154 E. Myrtle Ave (5065 S) #102 in Murray


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