All You Need To Know About Hormonal Acne: A Singaporean Aesthetic Doctor Explains

Acne… oh, acne… It can be super frustrating as it really affects our appearance.

Hormonal acne can affect anyone at any age. It is named as such because changes in our hormone levels can cause it. You may be wondering how hormonal acne can be treated. For instance, you may be considering:

  • home remedies,
  • OTC creams or 
  • medical treatments.

Read on to find out in more detail how you can get hormonal acne treated!

Firstly, what is hormonal acne?

hormonal-acne

Hormonal acne is caused by fluctuations in hormone levels. In fact, it occurs more commonly in women than in men. This is because women experience more frequent hormone fluctuations, for instance, during periods, pregnancy and also menopause. During those times, your estrogen levels dip, hence, possibly causing breakouts.

Testosterone is also strongly linked to hormonal acne. Their levels tend to surge during puberty, causing more oil production. Without proper care, that could lead to teenage acne.

What are the signs and symptoms of hormonal acne?

signs-symptoms-hormonal-acne

Hormonal acne affects the lower half of your face in particular. In most cases, they appear around your chin and jawline. Other than that, hormonal acne is usually:

  •         Bright red
  •         Inflamed
  •         Deeply indurated
  •         Cystic in nature

What causes hormonal acne?

causes-hormonal-acne

The formation follows a series of events:

Increase in sebum production

Sebum is naturally produced by sebaceous glands found near the base of hair follicles. It protects and lubricates the skin. That said, hormone surges during puberty increase oil production above the normal level. This can lead to clogged pores and form comedones.

Clogged pores

As our skin grows and sheds off the superficial layer, pores can become 'exposed'. Thus, it creates an opportunity for dirt, oil and dead skin cells to build up in the pores. Hence, this causes the pores to be clogged over time. This is why, without proper care, stubborn blackheads and whiteheads can form easily.

Bacterial infection

Propionibacterium acnes (P. acnes) is the acne-causing bacteria that live on your skin [1]. It can cause infection in clogged pores, causing pimples to form as a result. The severity will depend on the strain of bacteria and, thus, the treatment may be different. I will discuss this more in the next section!

Pus build-up

When there is an infection, the body tries to fight it by encapsulating the infection with white blood cells. The build-up of dead white blood cells, bacteria, tissue debris and serum naturally forms pus around the area.

How to differentiate between the different severity of acne?

types-severe-hormonal-acne

By using a grading scale, doctors are able to assess the severity of the acne. It looks at the scope and type of lesion.

Mild acne is referred to as [2]:

  • non-inflammatory (comedones),
  • occasional breakouts of small pimples.

Small pimples include types such as papules and pustules. 

Moderate acne is classified as having:

  • deep-seated nodules,
  • mild scarring,
  • several papules and pustules

Severe acne has an extensive spread of:

  • pustules,
  • erythematous papules,
  • multiple deeply indurated nodules and cysts,
  • scarring.

What are the treatments available in Singapore?

Home remedies

home-remedies-hormonal-acne

For moderate to severe acne, home remedies may not be enough to treat your condition. However, it can still be sufficient enough for mild acne, as it controls oil glands and prevents breakouts. 

Ceramides form a lipid-rich barrier that helps to moisturise the skin. Thus, it holds the skin together for better healing. Niacinamide, more widely known as Vitamin B, helps to promote:

  • the formation of ceramide,
  • helps to lighten acne marks,
  • reduces inflammation and
  • regulates oil production.

Meanwhile, AHA and BHA (also known as salicylic acid) are examples of light-duty peels. Doctors recommend that you include these in your daily skincare routine. It helps to unclog pores. Likewise, retinol gently strips dirt off the pores. Similar to AHA and BHA, retinol helps to increase the turnover of the skin as well as prevent clogged pores. 

Benzoyl peroxide is a type of cream that is readily available in pharmacies. It works by penetrating the pores and killing the acne-causing bacteria with oxygen. Similarly, salicylic acid in cleansers and formulated creams effectively dries up pimples and helps remove dirt, oil and dead skin.  

When home remedies are inadequate in helping you achieve your goals, you may want to consult a doctor. The doctor will review your existing skincare and change your routine. At this point, your doctor may add on prescription creams or medications. 

Oral Medications

oral-medication-hormonal-acne

To list, oral medication can include:

  • antibiotics
  • combined oral contraceptives
  • aldactone
  • oral isotretinoin

Oral antibiotics are commonly prescribed to reduce bacteria and inflammation. Combined oral contraceptives are approved by the FDA to treat acne problems in women. 

Meanwhile, Aldactone is a medication that blocks the action of testosterone on sebaceous glands, regulating oil production. In addition, oral isotretinoin works on the most severe forms of acne that do not respond to any other treatment.

Like many drugs, these medications may produce side effects. An experienced doctor will be able to discuss and assess the benefits over the risks. This will be done before prescribing a suitable medication for you.

Chemical peels

chemical-peel-hormonal-acne

Salicylic peels and Jessner's peels are widely used to treat acne. Generally, these peels are:

  • usually stronger,
  • dries pimples up,
  • penetrate comedones effectively.

These peels are bactericidal. Thus it reduces the risk of infection and inflammation. As a result, they can prevent new breakouts [3]. Despite that, be sure to consult a doctor regarding your skin condition before going for a session. This is to ensure that the chosen type of treatment is the most effective for your condition.

Laser treatments

laser-treatment-hormonal-acne

There are different kinds of lasers available to treat acne. An increasing number of studies have shown good improvements in treating active acne with laser [4]. However, there is no consensus in any specific type of laser being the best.

Nonetheless, the lasers generally help to:

  • reduce inflammation and
  • promote the turnover of the skin.

Furthermore, it decreases the downtime caused by pustular acne and regulates oil production to prevent breakouts. 

In my practice, I use PicoPlus laser to treat active acne. The different lenses and wavelengths allow me to treat the different stages of acne. For example, gold toning emits light at 595nm is targetted to reduce inflammation as well as redness. Meanwhile, the dual focus lens allows for a deeper penetration that can treat acne scarring.

Steroid injection

steroid-injection-hormonal-acne

Steroidal injections are reserved for the most desperate times when instant improvement is desired for cystic, nodular acne. Steroid injection reduces inflammation and the size instantly. However, it may be a temporary measure if the infection recurs. 

For moderate to severe acne, the presence of pustules and deep-seated nodules can lead to scarring. For that reason, a combination of treatments is used to treat acne aggressively. This includes:

  • lasers,
  • chemical peels and
  • oral medications.

When should I consult a doctor?

When you have moderate to severe acne, it is unlikely that home remedies will help you to a meaningful extent. In fact, some home remedies may be detrimental to your skin, worsening your acne. Therefore, whenever you are in doubt, consult a doctor for your skin's condition and the suitability of the remedy. Seeking medical advice early helps to prevent and minimise permanent scarring. If you feel that your acne is making you feel more self-conscious, it is time to get a consultation.

What is the cost of the treatments?

Types of treatments:

Price:

Oral medication

$50 - $200

Laser treatments

$200 onwards

Chemical peel

$120 - $250

Steroid injection

$60

How long will it take to see the effects of treatment?

long-effect-hormonal-acne-treatment

The time period until you start to see results depends on a few factors. They are:

  • The severity of your skin condition
  • How aggressively it was treated

No treatment will show immediate results. Conversely, with most treatments, you may experience a 'purging' phase. This occurs when the skin exfoliates aggressively. Furthermore, even in the most severe cases of acne, it will take roughly 2-3 months for you to see visible improvements. This is provided that it is treated adequately with a combination of oral medications and lasers.

Does it go away on its own with time?

Research has shown that the prevalence of hormonal acne declines with age [2]. Therefore, there is a good chance that hormonal acne will resolve on its own.

However, adult-onset acne can result in pimple marks that take some time to recover. Thus, resulting in permanent scarring. Having said that, if you feel that your acne is severe, be sure to consult with a doctor. They will be able to advise you on how to treat your acne and prevent future scarring.

Do’s and don'ts for hormonal acne

dos-donts-hormonal-acne

Below is a list of what you should and should not do when treating hormonal acne.

Do’s 

  • hydrate and exfoliate your skin regularly
  • use products that contain active ingredients that target your concerns
  • use non-comedogenic products
  • seek early medical care to avoid permanent scarring
  • apply sunblock where necessary

Don’ts

  • Pick on the acne
  • Use rich creams that can clog pores
  • Use abrasive scrubs

What kind of foods should you avoid?

There are many studies drawing possible links between the different kinds of food to the development of hormonal acne. However, foods such as meats, chocolate, greasy food and dairy products all show a very weak contribution to the development of acne.

So, are the myths about hormonal acne true?

hormonal-acne-myth

Poor hygiene leads to acne breakout

While there is no evidence to support the claim that poor hygiene causes acne, an increased effort to regularly clean and unclog pores can help to improve acne.

Hydration

Similarly, there is also no evidence to suggest that hydrating the body can help to clear up acne. This may be due to the fact that hydrating the skin adequately can help to prevent excessive production of sebum. This includes drinking 8 cups of water daily as well as daily moisturising.  However, this can also backfire if the moisturiser is comedogenic.

Stress indeed does cause acne

There is some evidence that can scientifically explain how stress affects the condition of the skin and causes acne [5]. Furthermore, there have been many studies that have proved the strong correlation worsening acne with increases in stress levels.

All in all

In brief, hormonal acne can affect anyone at any age. With this in mind, for every type of treatment, there will always be benefits and risks to consider. There are many treatments options available in Singapore, hence, you should consult a doctor to know which is more suitable. Moreover, early treatment will help to prevent future acne scarrings. 


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Dr Sau Po Yi is an Aesthetic Doctor with Sozo Aesthetic Clinic. Besides that, she joined the field of aesthetic medicine because she believes she can be a real patient advocate. Furthermore, she was awarded by the Singapore Medical Council with Certificates of Competence in multiple aesthetic programs.

Find out more about Dr Sau Po Yi's take on treating hormonal acne here.

Also, read more from Dr Sau Po Yi in her Q&A here.


Read more: 8 Dermatologist Clinics in Singapore for Your Skin Concerns (2020)


References:

 1. McDowell A, Patrick S, Eishi Y, Lambert P, Eady A. Propionibacterium acnes in Human Health and Disease. BioMed Research International. 2013;2013:1-3. doi:10.1155/2013/493564

 2. Acne: Overview. Nih.gov. Published September 26, 2019. Accessed November 12, 2019.

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Medically reviewed by Dr Po Yi Sau on 31/10/2019.
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