Hormonal Acne

For some people, treatment-resistant acne is caused by excessive production of hormones called androgens. Clues that help the doctor diagnose hormonally influenced acne are adult-onset acne, hirsutism (excessive growth of hair or hair in unusual places), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens.

The doctor may prescribe one of several drugs to treat women with this type of acne. Low-dose estrogen birth control pills help suppress the androgen produced by the ovaries. Low-dose corticosteroid drugs, such as prednisone or dexamethasone, may have an anti-inflammatory effect and suppress the androgen produced by the adrenal glands. Finally, the doctor may prescribe an anti androgen drug, such as spironolactone, which helps prevent androgens from causing excessive oil production. Spironolactone also stops androgen production in the ovaries and adrenal glands. Side effects of anti androgen drugs may include menstrual irregularities, breast tenderness, headache, and fatigue.

Women suffering from adult onset acne or worsening acne during adult years, typically seek standard acne therapies such as topical preparations, antibiotics or Accutane. Unfortunately, about 60 percent of these women either do not respond to standard acne treatment or build up a tolerance to frequently used medications.

Anti androgen and/or hormonal treatment of acne, limited to women, offers a different approach that is proving helpful when other treatments are ineffective.

• It is not known what triggers adult onset acne. The development of hormonal irregularities in the menstrual cycle may be a factor, or ovarian cysts may cause hormonal abnormalities that increase androgen productivity, resulting in acne breakouts.
  
  
• Women who benefit most from hormonal treatment are typically in their 20s or 30s, and have a history of failed treatment, or an intolerance to standard acne therapies (both topical and systemic). In addition, many have a history of menstrual irregularities, premenstrual acne flare-up, and facial oiliness. This method is generally not used in the most severe forms of acne, nodular/cystic acne.
  
  
• Most acne treatments require prolonged care, from months to years. Once improvement is achieved, a maintenance dose is usually necessary. Women who develop adult acne typically have the problem for years, frequently through menopause.
  
  
• The modalities used most in treatment are oral contraceptives and anti androgens (spironolactone or flutamide).
  
  
• The hormonal approach is becoming more mainstream, and it is not uncommon to use the two hormones together.
  
  
• Spironolactone is a medication used primarily for the treatment of high blood pressure. Recently it has been used to treat acne and excess hair growth in women. Spironolactone and flutamide act by blocking the effects of testosterone (androgen) on the oil glands and hair follicle. It is the male hormone testosterone which triggers the acne. The result is a reduction in oil production and facial hair growth, and the improvement of acne and excessive hair growth.
  
  
• The optimal dose of spironolactone varies in different individuals and may require some adjustment. The benefits are usually apparent in two to three months, but frequently within one month. This drug has been used for over 25 years and has proven quite safe and is generally well tolerated.
  
  
• Serious side effects with spironolactone are extremely rare. The most common side effect is irregularity of menstrual cycles, but if the patient is taking birth control pills, this should cause minimal problems.
  
  
• In addition to clearing acne, spironolactone treats premenstrual syndrome (PMS) and acts as a diuretic, which may counter some of the weight gain typical of birth control pills.