Even though hormonal acne is the result of the activity of male sex hormones (androgens), it more accurately refers to acne in adult women. While hormone levels stabilize after puberty in men, they still fluctuate in women. Although up to 40% of adults aged 25 and older are affected by this skin problem, 75-80% of women between the ages of 25 and 40 are particularly likely to suffer from this type of acne.
Acne is the appearance of different types of pimples on the face at certain times, such as during the menstrual cycle (before or during the period), during pregnancy, sometimes during menopause or in times of stress. This term is therefore less commonly used in men, as they are not exposed to as many hormonal changes throughout their lives.
How can I tell if I have hormonal acne?
You may be suffering from hormonal acne.
If the pimples are clustered in the lower face area, around the jaw, chin, and neck;
If you have blemishes such as red pimples (papules), white pimples (pustules), nodules, or painful microcysts caused by skin inflammation.
If the pimple outbreaks occur cyclically or due to a known hormonal change, i.e., the skin rashes are triggered or intensified during the premenstrual phase and menstruation, as opposed to juvenile acne, which disappears after puberty is over. It can also occur during special events, such as pregnancy, menopause, or when you stop taking birth control pills.
Why do I have hormonal acne?
Acne breakouts can be related to several factors, including hormonal changes. This is because changes in the production of certain hormones stimulate the sebaceous glands to produce extra sebum (seborrhea). This imbalance in the skin is an ideal place for the growth of Propionibacterium acnes, which causes inflammation of the hair follicle and the surrounding dermis.
An excess of androgenic hormones circulating in the blood – male sex hormones, the most important of which are testosterone and dihydrotestosterone (DHT) – is significant in the development of hormonal acne. These are, in fact, the main hormones that control the activity of the sebaceous glands on the entire surface of the skin. In women, androgens are secreted in small doses. However, in certain situations, excessive androgen production occurs:
Discontinuation of birth control pills: certain types of oral contraceptives are sometimes used to improve acne because they can reduce acne breakouts. This is especially true of estrogen-progestin pills (or combinations of pills), which block ovulation by replacing hormones produced naturally by the body. However, when ovulation does not occur, fewer androgenic hormones are produced, which also counterbalance the acne-promoting effects of progesterone. With the discontinuation of the pill, testosterone release in the body resumes on a large scale, accompanied by a hormonal acne outbreak several weeks to months after contraceptive discontinuation.
Note: Other progestin-type contraceptives may increase testosterone levels, thereby promoting acne.
Menstrual cycle: if there is a time when skin problems are particularly severe, it is just before or during menstruation, when estrogen and progesterone levels are at their lowest and testosterone, even if in small amounts, reaches higher levels than female hormones. Now, estrogen is known to prevent sebum production when produced in sufficient doses by directly targeting testosterone or inhibiting its secretion. When present in small amounts, estrogen and progesterone cannot exert their “anti-sebum” effects.
Pregnancy: Another time when women experience a hormonal change is pregnancy. Estrogen and progesterone levels rise sharply. However, these can lead to overactivity of the sebaceous glands and thus to an overproduction of sebum. Particularly in the first trimester, women are more prone to developing hormonally induced acne.
Menopause: This physiological phenomenon is characterized by a regular hormonal change. It occurs because the synthesis of the two reproductive hormones estrogen and progesterone gradually and drastically decreases as the ovaries stop producing them. In contrast, during menopause, testosterone levels rise and overtake female hormones. This increase in male hormones is the reason for the development of acne in some people.
Stress: stress plays an important role in the balance of hormones and thus in the amplification and frequency of acne breakouts. In times of stress, cortisol is released in large amounts. This hormone affects the skin by stimulating the adrenal glands, which are responsible for producing androgens, which in turn regulate sebum production by the sebaceous glands.
Hormonal acne can also be due to a genetic predisposition. In fact, the number, size and activity of the sebaceous glands can be inherited. While the number of sebaceous glands remains stable throughout life, their size increases with age. Hypersensitivity of the sebaceous glands can also be a cause.