Treatment options for hormonal acne

Acne is a skin disease and although it is one of the most common skin conditions, it is still fraught with shame and powerful psychosocial consequences.

The main cause of acne is to be found in a disturbed hormonal balance or in an excess of male sex hormones (androgens). But there are not only hormonal treatment methods, but also a variety of natural or superficial methods and means to combat the symptoms of acne and to achieve a better attitude towards life overall.

What causes hormonal acne?

Acne is an inflammatory skin condition that can have a variety of causes. These include nutrition, genetics and psychosocial factors such as stress and hormones. Although individual factors can predominate, they can also overlap and reinforce each other. Many experts assume that almost every form of acne is caused by fluctuations in the hormonal balance.

Hormone-related acne is caused by an imbalance in hormone levels. In particular, an excess of androgens , i.e. male sex hormones such as testosterone, have an unfavorable effect on the function of the sebaceous glands. Androgens are not only found in men, but also in women. Upon reaching sexual maturity, both sexes produce particularly high levels of androgens.

During puberty , 70 to 95 percent of the population have to struggle with symptoms of acne in the meantime. The immediate cause of acne is usually excessive sebum production (seborrhea) combined with excessive keratinization of the facial skin (hyperkeratosis). The cornifications block the flow of sebum and the affected skin pore becomes inflamed.

Due to the blockage, more and more sebum accumulates and together with the inflammation of the skin pores this provides an ideal breeding ground for bacteria that are naturally on our skin anyway. The bacterium Propionibacterium acnes , which also gave the disease its name, thrives particularly well.

It metabolizes the fatty acids with which the sebaceous glands supply it, producing inflammatory substances that cause and worsen the symptoms of acne.

PCO syndrome as a possible cause

Polycystic ovarian syndrome or polycystic ovarian syndrome ( PCOS ) is a hormonal disease affecting about 5 to 10 percent of all women of childbearing age. The eponymous proliferation of cysts in the uterus is caused by an excess of androgens that impede a normal menstrual cycle.

While the uterus normally releases fully developed eggs into the fallopian tubes, in affected women this process is disrupted and the immature eggs remain in the uterus as cysts . Those affected by PCOS therefore often do not have regular periods or are even infertile.

The excessive production of androgens in women with PCOS can also lead to oily skin, increased body hair and weight gain, especially around the waist. Since it is an androgen excess, PCOS can also trigger or promote hormone-related acne .

Like so much that affects our hormone balance, the causes of PCOS have not been finally clarified. A diagnosis is usually made on the basis of the symptoms, but it is not uncommon for PCOS to go undiagnosed at all, since both causes and symptoms are somewhat diffuse or even holistic and overlap with other diseases. PCOS could be the cause of hormone-related acne in 19 to 37 percent of all women .

Symptoms of hormonal acne

The clogged and inflamed skin pores result in redness, blackheads, pimples, pustules, papules and lumps, all of which can cause uncomfortable tenderness. During puberty, these inflammations form primarily in the T-zone of the face (forehead, nose, chin).

In adulthood, symptoms often move further down toward the cheeks and jawline, or even onto the chest and back. Physicians refer to acne in adolescence as acne vulgaris , adult acne as acne tarda , i.e. late acne.

Basically, the symptoms of hormonal acne can be divided into mild, moderate and severe. With mild acne , open or closed blackheads develop on oily skin .

In moderate acne , pustules (pus spots), papules (bubbles) and nodules develop. In the case of severe acne , these symptoms intensify again and large, inflammatory nodules , abscesses (lumps of pus) and fistulas (ulcers) develop. The skin becomes extremely oily and the various forms of inflamed sebaceous glands can be painful and leave scars .

However, not all pimples or pustules have to indicate hormonal acne. The occasional occurrence of pimples alone is no reason to assume acne. Hormone fluctuations and the resulting blackheads are completely normal and do not always require treatment .

However, if the pimples appear at certain times, such as at the beginning of a period, or if they persist and get bigger, a dermatologist should be consulted. For all forms of acne and also lighter pustules, careful and conscious skin care is recommended in addition to or in addition to dermatological treatment. For more tips on this, see the post below.

Why women are affected more often than men

During puberty, boys and young men are more affected by hormonal acne than girls and young women. On the one hand, this is due to the androgens, which increase particularly during puberty, and on the other hand, because male skin is somewhat thicker and oilier and therefore promotes cornification.

In the course of adult life, however, the hormonal balance in men levels off, while the hormonal balance in adult women also fluctuates more strongly in the course of their menstrual cycle, before menopause, during pregnancy or as a result of taking hormonal contraceptives. In adulthood, women are therefore more likely to be affected by hormonal acne than men and account for up to 80 percent of the patients being treated .

Acne after stopping the pill

Depending on the product, the birth control pill or hormonal contraceptives can inhibit the production of androgens and therefore ensure a clearer complexion. After stopping the pill, however, the androgen level in the body increases significantly again and temporary post-pill acne can occur.

After stopping the pill , the hormone balance levels off again after a certain period of time, which can be several months to longer than a year. The over-produced testosterone will return to normal levels and the acne should resolve as well . However, you don't have to wait idly for this natural ending to the hormonally induced acne. There are a number of treatment and care methods available, which are discussed below.

Conventional forms of treatment

In the case of mild and moderately severe hormonal acne, a superficial treatment of the pimple with creams, lotions and gels that have an anti-inflammatory, drying or antibacterial effect is recommended. Antibiotics can also be used for severe and chronic moderate acne.

The stronger the symptoms of hormone-related acne, the deeper the inflammation, lumps, abscesses and fistulas lie under the skin . They can no longer be reached for a superficial treatment and must be treated from the inside out . In addition to taking antibiotics, there are other conventional forms of oral therapies, three of the most popular of which are briefly presented here.

retinoids

Retinoids are closely related to the body's own vitamin A and are suitable for treating acne in its weaker forms. They are usually applied externally to the affected areas of the skin as creams, gels or lotions . There they have a strong drying effect or hinder sebum production, thus taking away the nutrients from the pro-inflammatory bacteria and at the same time counteracting the formation of sebum blockages.

However , dried out skin is also susceptible to other diseases and is particularly sensitive to light . Therefore, during therapy with retinoids, special attention should be paid to maintaining a good skin care routine and wearing sunscreen .

13-cis-retinoic acid or isotretinoin is also used in severe forms of acne or after other therapies have failed. Isotretinoin-containing medications are available as topical creams, but also as tablets to be taken by mouth.

However, isotretinoin therapy can lead to other skin disorders such as skin flaking, redness and rash, and even liver dysfunction . Therapy should therefore be carried out under the supervision of a dermatologist. During pregnancy there is also a risk of malformations in the embryo , which is why therapy with retinoids is ruled out during this time.

The pill

Estrogen-containing contraceptives reduce androgen production in the female body and can therefore also be effective against acne. However, the effect can be delayed for up to three months after starting to take the pill. Pills that are supposed to have a particularly positive effect on the complexion contain the estrogen derivative ethinylestradiol . As preparations containing hormones, birth control pills also penetrate deeply into the female body and can lead to undesirable side effects such as a loss of libido or a reduction in bone density .

antiandrogens

Antiandrogens have a blocking effect on the body's androgen production and can therefore also be used against acne. The active ingredient spironolactone is mainly used to treat heart failure and liver cirrhosis. For women, however, it is known as an androgen blocker and is also suitable for treating hormonal acne or PCOS . However, this treatment can lead to serious side effects such as depression or intestinal disorders, which is why not every dermatologist is happy to prescribe the active ingredient.

Diet for hormonal acne

While certain diets are not considered to be a cause of hormonal acne, there is some evidence that they can increase acne symptoms. Conversely, of course, this also means that avoiding certain foods can alleviate the symptoms of acne and improve the complexion .

Other foods such as water or green tea should be consumed more to improve the complexion and reduce inflammation. The intake of phytoestrogens is also recommended. These are secondary plant substances that, like the real estrogen, have a positive effect on the ratio of male and female sex hormones and thus prevent skin impurities, inflammation and pimples. Phytoestrogens are contained, for example, in soy (tofu), beans, pumpkin seeds, flaxseed or peas .

A healthy intestinal flora also helps to maintain a balanced hormone balance. This can be supported by a balanced, high-fiber diet and the additional intake of pro- and prebiotics .

With nutrition, as with other holistic aspects, there are often no clear cause-effect relationships to be identified, but the mass of good or bad experiences often speaks an equally clear language. However, it is important to keep in mind that statistical correlations and experiences of those affected are not necessarily transferrable one-to-one to all people.

From a holistic perspective, it is important to emphasize that all people are different and have different needs. Also, while making a change in one aspect of your lifestyle in isolation can have a positive effect in and of itself, it can be overshadowed by other aspects such as stress, preventing it from having the full effect.

Anyone who keeps having problems with acne should therefore start looking for a holistic lifestyle that suits him or her and observe his or her body closely to find out what is individually good for you.

sugar and short-chain carbohydrates

Foods with a high glycemic index are considered to be a contributing factor to the development of acne. A high value on the glycemic index (GI) means that these are foods that raise blood sugar levels particularly quickly. In particular, white bread, sweets and other foods with a high sugar content as well as ready-made products have a high GI value and should therefore be avoided .

These foods cause blood sugar levels to rise rapidly and, in response, insulin levels to rise . Insulin is responsible for the transport of sugar from the blood into the respective cells of our body. In the cells, the sugar acts as energy while stimulating the release of insulin-like growth factor (IGF-1) hormones. The increase in these hormones, in turn, leads to an increase in sebum production and keratinization of the skin , or they promote the development of acne symptoms.

Acne can therefore improve significantly if sugary and short-chain carbohydrates are avoided. Some studies have already confirmed this connection.

Avoid cow's milk products

A large-scale meta-study, i.e. a study that evaluates other studies, analyzed data from more than 75,000 people between the ages of 7 and 30 and found a clear connection (a correlation) between the intake of cow's milk products and an increased risk of acne .

It was irrelevant how much or how often dairy products were consumed. In order not to let the symptoms of acne develop in the first place or at least not to intensify them, dairy products should therefore be avoided. The vegan alternatives can be used as a substitute for muesli or coffee.

Goat or sheep 's milk are also considered harmless , as they do not increase inflammation in the body. The situation is completely different when consuming protein powders, for example to build muscle. These often contain whey protein , which is strongly suspected of promoting the onset of acne symptoms .

fiber

As discussed above, foods that convert quickly to sugars or are naturally high in sugars can increase the formation of acne or encourage the formation of pimples on the skin beneath what is medically known as acne.

The same applies vice versa: a particularly low-sugar, balanced and high-fiber diet not only helps to get the intestinal flora in order and maintain it, but also prevents inflammation and thus acne . Fruits and vegetables are among the main components of such a diet.

Omega-3 fatty acids , such as those found in fish or chia seeds, are also considered to be particularly anti-inflammatory . On the other hand, omega-6 fatty acids, which are particularly high in rapeseed or soybean oil, are not recommended, as they can potentially promote inflammation.

Natural Treatment Options

In addition to conventional treatment methods and lifestyle changes, there are also numerous natural ways to treat hormonal acne. As with the other methods described, one should not expect miracles here and exercise patience, because the effects often only appear a few months after the start of therapy.

vital substances

Vitamins are of particular importance not only for general but also for skin health. A supply of vitamins via dietary supplements can therefore also prevent and alleviate the formation of acne symptoms.

Vitamin A has a moisture-regulating and anti-inflammatory effect. Vitamin A is also used to treat acne as prescription retinoids or in less concentrated, over-the-counter forms (see above).

The entire vitamin B complex also has a positive effect on skin moisture and the skin's ability to regenerate. However, the body cannot store these vitamins, so they have to be taken in again and again through food (e.g. legumes, sauerkraut, eggs, fish or nuts) or taken in delayed form. In particular, vitamin B3 (see below: Niacinamide Serum ) is suitable for the treatment of skin problems due to its inhibition of sebum production.

Vitamins C, D and E also have positive effects on inflammation, the natural skin barrier and the skin's ability to regenerate. Vitamin D can also have a hormone-regulating effect and is therefore particularly suitable for combating acne.

Natural antiandrogens

Antiandrogens are not only available as chemical products, they are also found naturally in certain vegetables such as broccoli or cabbage. Diindolylmethane (DIM) , for example, can also be extracted from broccoli. Similar to zinc, DIM naturally blocks the production of androgens and therefore helps treat hormonal acne.

Use cosmetics without harmful additives

Skin prone to impurities is sensitive and should therefore be cared for with particular care. Some conventional cleansers and cosmetics are not recommended for acne-prone skin due to their aggressive nature, which can worsen inflammation or overly dry skin. Instead, it is better to use sensitive products such as those used by allergy sufferers .

Hydroxycarboxylic acid (short: AHA)

A lpha - hydroxycarboxylic acid (AHA) is derived primarily from citrus fruits and is an ingredient in many over-the-counter creams, face masks, and other over-the-counter skin care products.

AHA helps to loosen and remove dead skin cells or cornifications that impede the flow of sebum . If the sebum can drain off better, this removes the breeding ground for the bacteria and counteracts the inflammation of the skin pores. Acids like the AHA also have an exfoliating effect that can lighten existing scars and help loosen the black dots that a pimple often leaves behind.

Drink plenty of water

In principle, this tip applies always and everywhere . Adequate water intake of 2 to 2.5 liters is highly recommended for healthy skin. The cutaneous water content of the skin is associated with the development of various skin diseases and especially when acne is treated with agents that dry out the skin, this should be counteracted by adequate water intake.

Dry skin is more sensitive to light and is less able to protect itself against infections or the spread of bacteria, for example. Water also plays an important role in the functioning of the liver and kidneys and thus in the body's own detoxification function .

chaste tree

Monk's pepper (Vitex Agnus Castus) helps women with premenstrual syndrome in particular, but can also be used to treat acne due to its hormone-regulating effect. Monk's pepper has a regulating effect on hormones from the group of gonadotropins (affecting the sex glands) and can help to bring the hormone balance back into order.

It can therefore contribute to a balanced ratio of female and male sex hormones. Such regulation of the hormonal balance prevents the excessive production of sebum and can therefore alleviate the symptoms of acne .

reduce stress

Stress is caused by particularly stressful situations such as emotional conflicts. It is also noticeable during particularly intensive working days or when an unpleasant event is imminent. But everyday situations such as shopping with a child or acting under time pressure also cause stress.

This stress is expressed hormonally as a release of cortisol . This can upset the entire hormonal balance and cause imbalances, which in turn promote the symptoms of acne.

Those who pay close attention to themselves, their bodies and their everyday lives will therefore not be surprised that in a French study, more than half of 3,305 respondents indicated stress as a trigger for acne . The advice that is easy to give but difficult to implement for everyone affected by hormonally induced acne is therefore: reduce stress as much as possible.

Consciously planned rest and relaxation breaks in everyday life as well as reserving an anti-stress day dedicated entirely to relaxation and well-being can help to reduce stress

skin care

A good skin care routine should be part of any acne treatment. It can even be an adequate treatment for mild forms of acne. In stronger forms, it should be used in addition to other therapies.

Skin prone to acne is often particularly sensitive to certain ingredients in conventional cosmetic products. But there are also numerous plant-based cosmetics that have a soothing effect on acne symptoms such as pimples and inflamed skin pores or hair follicles .

Those affected have had particularly positive experiences with cosmetics made from clay , which absorbs excess fat, or with cosmetics containing zinc oxide, which have an antibacterial, anti-inflammatory and sebum-reducing effect. Witch hazel extract is also contained in some cosmetics and supports the healing process with its pore-refining effect.

Mild cleaning

Thorough cleaning of the skin in the morning and evening can have a great effect, especially with mild forms of acne. Sensitive cleaning products , such as those recommended for allergy sufferers or neurodermatitis, are particularly recommended. The disinfecting effect of alcohol, such as that found in rose water , can also be used. However, it is important to ensure that the agents are not too aggressive.

The best form of cleansing depends on the individual needs of each skin and it is also worth trying different products and routines. Cleansing oils, for example, are particularly gentle, but for some skin types a product with a stronger drying effect may be more advisable.

Niacinamide Serum

Niacinamide Serum is based on nicotinamide. This form of vitamin B3 has a sebum-reducing and anti-inflammatory effect and is therefore particularly suitable for treating acne symptoms. It also affects melanin formation. These dyes can help to noticeably improve the complexion of the skin on the face.

fruit acids

Fruit acids (see above: alpha-hydroxycarboxylic acid - AHA), especially as components of peelings, can help to loosen and remove calluses and pimple residues and develop an anti-inflammatory effect .

Retinol serum or creams

Retinol serums or creams are based on retinoids similar to vitamin A (see above) and have a clarifying effect (old, callused skin is removed) and refine the pores, which promotes the drainage of sebum. They can therefore be used against the symptoms of acne. They also have a smoothing, lightening and matting effect, which not only improves the complexion, but can also significantly improve it in those affected by acne.

jojoba oil

Jojoba oil penetrates the skin very well without making it too greasy. It also has an antioxidant effect and binds free radicals , which improves the complexion overall and contributes to good skin care. In addition, jojoba oil also has anti-inflammatory, antiseptic and antimicrobial properties that make it particularly suitable for combating mild and moderate forms of acne.

glycolic acid and salicylic acid

Exfoliants containing glycolic acid or salicylic acid dissolve the top layer of skin and remove dead skin cells . This counteracts the blocking of the skin pores by sebum and allows it to drain off better. They can also be used to remove the dark spots that often remain after pimples. The salicylic acid penetrates deeper into the skin pores than the glycolic acid and therefore promises better effectiveness.