Hormonal acne can be really frustrating and cause a reduced quality of life for sufferers. Hormonal acne can be distinguished from fungal acne on the type of spots and their location. Fungal acne causes smaller spots that are more evenly sized and itchy. Hormonal acne may also develop for the first time over the age of Hormonal acne may be triggered for the first time by taking hormonal pills, or from taking any progesterone containing products such as the mini pill or the Mirena coil.
For the majority of women, hormonal acne occurs because their skin is sensitive to the normal levels of androgens like Testosterone. Although considered to be a male hormone, it is normal for women to produce small amounts of Testosterone. Testosterone is an important hormone for women as it helps strengthen bones and muscles, provides a healthy libido and regulates the menstrual cycle. Women produce other androgens as well as Testosterone.
These three androgens are not very active by themselves and have to be converted to Testosterone or Dihydrotestosterone first.
Testosterone is produced by the ovaries and the adrenal glands. Skin cells, especially the cells in the sebaceous glands, also make DHT from Testosterone. Hormonal acne also occurs when there are conditions in which too many androgens are produced such as Polycystic Ovarian Syndrome.
There is conflicting evidence on this though the majority of studies show that elevated androgen levels are are frequent. Smaller studies from Brazil and Japan have also showed elevated levels of androgens in adult women with acne. The severity of acne did not vary with the degree of elevation however. However a British study from showed no elevations in androgens in women with acne. Our clinical impression is that some women do have elevated androgen levels and hormonal acne may be the only sign of this.
Other signs include excessive facial and body hair, irregular periods and hair loss. However, a large number of women have normal levels of androgens and it is believed that these women may just be more sensitive to these androgens. This is the reason they get acne. The bottom line is routine hormone blood tests may be normal in hormonal acne. Hypersensitivity of the skin means that anti-androgen treatment is still important. Also Testosterone and DHT can be produced in the skin and blood tests would not show if too much of these hormones is being produced in the skin in some people.
Androgens cause changes in the skin and directly drive inflammation. Here are the three reasons why androgens cause acne:. It is possible to test levels of androgens women by a blood test. Primary care guidelines suggest that:. Be sure to tell your doctor if you are taking any other medicines, even over-the-counter medicines. Isotretinoin is like vitamin A, so you should not take vitamin A pills or multivitamins with vitamin A while you are taking isotretinoin. Your acne may get worse when you start using isotretinoin.
This usually just lasts for a little while. You can tell your doctor if this happens to you because you might need to use other medicines along with the isotretinoin in this stage.
The dosage of isotretinoin is different for each person. During your treatment, your doctor may change your dosage. Be sure to take isotretinoin just the way your doctor tells you. If you miss one dose, don't take extra the next time. Be sure you keep all of your appointments with your doctor because your doctor needs to check on you often.
Your doctor may check your liver tests and cholesterol levels. During treatment you may have some of the following side effects. These side effects usually go away when you stop taking isotretinoin:. Decreased night vision. If you have any vision problems, you should stop taking isotretinoin and talk to your doctor right away. A few people have even more serious side effects. If they aren't treated, the problem could last forever.
If you have any of the side effects listed below, stop taking isotretinoin and check with your doctor right away:. Your skin might go on getting better even after you stop taking isotretinoin. Most of the side effects of isotretinoin go away in a few days or weeks after you stop taking isotretinoin.
If your side effects last more than a few weeks after you stop taking isotretinoin, talk to your doctor. Some patients have to take isotretinoin more than one time. If you need to take isotretinoin again, you can start taking it again 8 to 10 weeks after your first treatment is over. Do not give blood for at least one month after you stop taking isotretinoin. You must not take isotretinoin if you are pregnant or if there is any chance you might get pregnant while taking this medicine! Isotretinoin causes severe birth defects, including malformation of the head and face, mental retardation and severe internal defects of the brain, heart, glands and nervous system.
It can also cause miscarriage, premature birth and death of the fetus. You must use two forms of birth control at the same time for at least one month before you start taking isotretinoin and for all the time you are taking this medicine.
Keep using two kinds of birth control for one month after you stop taking isotretinoin. I was frustrated and furious. I said fuck it! After I quit the treatments, my self-esteem took a total nose-dive.
I was always fixated on people looking at my skin. When my flare-ups happened, I made sure to stay inside to avoid being seen. I stopped bothering with makeup because it wasn't hiding it anyway. I was so envious of women with amazing skin.
I would laugh at them for freaking out about one or two pimples and at the same time wish I were like them. Then one day, I remembered what Dr. Charles told me about never having perfectly clear skin. Something about that statement gave me the courage to accept my skin as it was. Yes, I had major flare-ups. Yes, there are scars on my face.
But this was my new normal. In fact, accepting my cystic acne actually seemed to help it get better. It dawned on me as I was writing this article that maybe my skin got better because my attitude about it changed. I no longer have anxiety about my breakouts. And I think there's a positive feedback loop at work now—less anxiety, fewer breakouts; fewer breakouts, less anxiety.
It's like the opposite of what happened when I first moved to New York and my stress seemed to cause my whole face to erupt. When I went back to Dr. Charles with my theory, he says there could be some validity to it. When my acne flares up , I just try to drink more water and slow down my pace. Now I walk with confidence instead of hiding my face from the world. Funny enough, people compliment me on my skin more than ever. I think it has something to do with the confidence and beauty I have within radiating through my skin.
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