Acne in Women

Adult women beyond the age of 20 tend to break out into acne. Sometimes these outbreaks can be for the first time. This type of acne in women is said to be related to hormonal imbalances.  During puberty girls have increased secretion of androgen – the male hormone. As adults, women experience hormonal changes during their menstrual cycle, pregnancy and menopause. During these times, acne outbreaks can occur.  

Why is Acne Caused in Women : Hormonal Imbalance

Hormones affect acne in women. Excess sebum is produced by the sebaceous glands. Skin cells begin to shed, become sticky and clog hair follicles. The acne bacteria P.acnes increases in such women. Skin inflammation takes place. All these occurrences are influenced by hormones.

Androgen, the male hormone is found in women and men. It causes over stimulation of the oil glands and alters the lining of hair follicles. Most women have normal levels of androgen that their body does not react to adversely. When there is an over reaction to androgen, this can cause sudden acne in women. Excess androgen levels in women are accompanied by infrequent or irregular, deepening of the voice and growth of excess body and facial hair in women. 

More than 50% of all women experience acne outbreaks as adults. Most of the breakout (60-70%) is during menstrual cycles. Although acne in women as adults is frustrating, it can be effectively treated. 

Stopping birth control pills can also cause hormonal changes that trigger acne. 

Treatment for Acne in Women

The right topical medications can control acne outbreaks. Doctors prescribe various hormonal treatment options solely for women like – androgen receptor blockers and oral contraceptives, etc. Most of these medications have many side effects and hence they must be taken only under strict medical supervision. 

acne in women

Birth control pills

Oral contraceptives are often prescribed when hormonal imbalance is the cause for acne in women. These pills control the production of testosterone by the adrenal glands and ovaries, therefore controlling sebum production. Oral contraceptives help augment sex hormone-binding globulins. These inhibit conversion of testosterone into dihydrotestosterone. Oral contraceptives also reduce androgen levels. 

Oral contraceptives are also beneficial when Accutane is prescribed, to treat pregnancy. Accutane causes serious birth defects and oral contraceptives prevent pregnancy during this time. Women who are sexually active and have acne can take birth control pills that will serve both purposes. Those who are over 35 years are smokers or are prone to migraine headaches must not take oral contraceptives that contain estrogen. Low-dose oral contraceptives are also effective in treating acne.

Nausea, breakthrough bleeding, breast tenderness, headaches, fatigue, bloating, mood changes, weight gain, irritability, loss of libido, vaginal infections and high blood pressure are the common side effects of birth control pills. Less common but more dangerous side effects are heart problems, blood clots and increase risk of certain types of cancer.
Studies have found that at times tetracycline and other oral antibiotics can reduce the efficacy of birth control pills. 

Anti-Androgens

Spironolactone is an androgen receptor blocker and is prescribed for women who have greater levels of androgen. Spironolactone blocks body cells from reacting to androgen. This in turn reduces acne outbreak. This medication is said to be more effective when it is taken along with an oral contraceptive. 

 

Spironolactone is also prescribed when oral antibiotics, oral contraceptives and topical medications are not effective in combating acne. This could mean that your androgen levels have increased and you require an anti-androgen therapy. This treatment is effective for women with deep acne cysts and recurrent outbreaks. The dosage is generally started at 25-50mg once a day and increased slowly.

Some side effects include menstrual irregularities, breast tenderness, fatigue and headaches. If taken by pregnant women, spironolactone can cause a male fetus to feminize.   Inform your doctor if you are already taking treatment for high blood pressure for spironolactone is also used to treat this condition.

Flutamide is also an anti-androgen treatment that is used when acne in women becomes unmanageable. It is prescribed for a minimum of 3-6 months. Doctors do not prescribe this unless absolutely required for it causes severe liver damage. 

Cyproterone acetate

This is given to women to suppress testosterone and dihydrotestosterone. It is available as both lotions and tablets and reduces oil production. It can be used with other topical medications for acne. Studies have found that this medication improves acne symptoms. A serious side effect is liver toxicity, osteoporosis when used for long periods and risk of blood clots when taken with birth control pills. 

Topical retinoids

Topical retinoids are prescribed for mild or moderate acne inflammations. These are also safer to use over long periods. 

Precautions

Pregnancy must be first considered when prescribing any medication acne in women due to hormonal imbalance. Several topical and oral medications are dangerous for pregnant women. Treatment must be tailored to suit the type of acne and its severity. Adult women tend to have dry skin and topical medications used on this can cause further skin inflammation and irritation. Topical medications can be difficult to tolerate if outbreaks are due to rosacea in adult women. 

Hormonal therapies must be given only after careful screening of patients. This therapy is contraindicated for women with a personal or family history of breast cancer, blood clots, strokes, heart problems, high blood pressure and abnormal vaginal bleeding.