Hormonal acne and adult acne are two terms that are used interchangeably, and which largely describe the same acne problem. In the case of hormonal acne, hormonal fluctuations and increased sensitivity to current hormones can lead to increased acne. This most often applies to patients with adult acne – a term that includes patients over 25 years of age with permanent or new acne problems. Hormonal acne is seen more often among women than men. "Adult female acne" is also used in English literature.
Hormonal acne is most commonly located on the face, especially on the chin, along the edge of the jaw and partly on the neck. Some may also have acne on the upper part of the body, including the neck.
It is mainly androgens ("male sex hormones") that cause hormonal acne. They do this by stimulating the sebaceous glands in the skin, which in turn leads to increased sebum production. The result is oilier skin and clogged pores. Sebum also provides nourishment for bacteria found in and on the skin. These bacteria further contribute to acne development.
Testosterone is an example of an androgen. Such androgens can, among other things, increase with stress. Men receiving testosterone therapy may also experience acne problems. Other hormones that can play a role in hormonal acne are insulin, IGF-1 and cortisol ("stress hormone").
Hormonal acne differs from "ordinary" acne in, among other things, age of onset (often older patients), significant gender difference, varying amount of acne (for example, increased acne before menstruation) and onset in connection with major hormonal changes in the body (including during pregnancy and menopause) ).
Hormonal acne is thus a fairly common and often temporary condition, strongly linked to the hormonal changes that occur during life. Investigation is therefore rarely indicated. Hormonal investigation, on the other hand, may be relevant if several potentially hormone-related ailments are uncovered; male pattern baldness/hair loss among women, menstrual disorders, infertility, voice changes, and more. Polycystic ovary syndrome (PCOS) is an example of a condition that can cause hormonal acne. Birth control pills should be paused 4-6 weeks before the hormone examination.
The treatment of hormonal acne is largely similar to other acne treatment; prescription lubrication treatments, antibiotics or isotretinoin. As hormonal acne often occurs in oily skin, it is important to avoid skin and hair products that are not oil-based. The products should be "non-comedogenic" and thus not clog the pores.
Among women with hormonal acne, hormone-directed treatment with birth control pills or spironolactone can also be helpful. Birth control pills work, among other things, by reducing androgen levels. These changes are slow and it can take up to half a year to a full year before you see the effects of birth control pills. Hormone-directed treatment can be tried alone, or in combination with other treatment. Contraception consisting of progesterone only (for example mini-pills, contraceptive sticks and contraceptive injections) should be avoided, as it can worsen the acne problem.
Lifestyle changes can also help reduce hormonal acne. Weight loss, reduced stress and sufficient sleep are examples of such lifestyle changes. It is uncertain whether dietary changes, for example reduced intake of sugar, chocolate and milk, are of importance. When using drugs that affect the hormonal balance, including testosterone and corticosteroids (e.g. prednisolone), these should be reassessed. Anabolic steroids should be avoided.
In other words, the treatment of hormonal acne includes various treatment measures. A multidisciplinary approach is recommended, where GPs, gynecologists and dermatologists are often involved, among other things.
