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by Raychel Agramon, RN, MPM, June 20, 2020
Acne is caused by a variety of factors, one of which is excessive oil (sebum) production. While this is important for the skin, too much sebum can plug the pores and lead to breakouts.
Although humid weather and certain foods can also trigger oil production, such a change is often the result of certain hormones. With that being said, breakouts that come from this are categorized as hormonal acne.
What Triggers Hormonal Acne?
Sebum is produced to keep the body protected from friction, water, inflammation, and bacteria. However, increased production (hyperseborrhea) can occur due to the following:
Androgens, which are produced in the adrenal glands and ovaries/testes, are often implicated in hormonal acne. One example is testosterone, which increases sebum production in the body.
Another potent substance that causes oily skin (and subsequent breakouts) is 5α-dihydrotestosterone. Also known as DHT, this hormone can bind to particular receptors, including the ones present in the sebaceous glands.
Conditions where androgen levels are increased include congenital adrenal hyperplasia and polycystic ovarian syndrome (PCOS). This is also seen in individuals with androgen-secreting tumors of the ovaries and the adrenal glands. Because of the hormones’ effects on sebum production, hormonal acne is often seen in such individuals.
This hormone, which runs high a week before your period, is often the culprit for cycle-related hormonal acne. According to Dr. S. Manjula Jegasothy, the progesterone-estrogen ratio during this time can positively influence testosterone activity. This is why you experience zits before that time of the month.
Apart from aiding in the repair of healthy tissues, growth hormones (GH) can enhance androgen metabolism. As such, it plays a role in the increased sebum production in the body.
The same effects happen with Insulin Growth Factor-1 (IGF-1), which is produced through the action of GH.
According to a study, IGF-1 is a driving factor behind many women with hormonal acne. This increase is often attributed to a western diet, which is rich in carbohydrates, sugar, and fats. These foods can easily spike blood sugar, which can trigger an increased production of IGF-1 in the body. This prods more androgen release, which floods the face with more acne-causing sebum.
Apart from an unhealthy diet, an increase in IGF-1 levels is also seen in people with type 2 diabetes, chronic liver disease, and overactive thyroid (hyperthyroidism). Most of the time, these individuals develop hormonal acne as well.
Birth Control Pills for Hormonal Acne
There are many acne treatments available in the market. They include benzoyl peroxide, salicylic acid, and certain antibiotics. While they may be effective in some cases, they are not as good for hormonal breakouts. After all, these medications do not address the cause of the condition, which are the hormonal changes in the body.
With that being said, hormonal acne is best treated with meds that help ‘fix’ the fluctuation. One of the more popular choices is the birth control pill, which, as the name suggests, is primarily used to prevent pregnancy.
Also known as oral contraceptive pills (OCP), these often contain a synthetic form of progesterone. This hormone activates a negative feedback system, which leads to the decreased secretion of the follicle-stimulating hormone and the luteinizing hormone. Without these, ovulation (and subsequent pregnancy) cannot take place.
Its effects on the hormones make the birth control pill a possible choice for acne. For one, this drug may help decrease the amounts of ovarian and adrenal androgens in the system. It also helps boost the number of sex hormone-binding globulin, which can reduce the availability of testosterone in the bloodstream.
Oral contraceptive pills used in acne are often a combination of hormones. One such component is estrogen, which is highly effective in suppressing sebum production. However, using this alone can lead to reproductive problems and certain cancers.
As such, OCP estrogens are often paired with certain progestins. But since the latter can actually worsen acne, low-androgenic progestins such as norgestimate, norethindrone, desogestrel, and levonorgestrel preferred.
Newer progestins such as Cyproterone acetate and Drospirenone have become even more popular, as they are said to work better against androgens.
Several studies reveal that OCPs are indeed helpful in reducing facial oil production. Results show that after six cycles, users experienced reduced sebum production in the cheeks by 60%, and in the forehead by 30%.
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Indeed, the birth control pill proves to be a worthwhile solution for hormonal acne. Should you decide to use this, you should be on the lookout for side effects such as:
Unfortunately, not all women can safely use OCPs for hormonal pimples. After all, it is contraindicated in several conditions:
Birth Control Pill Alternatives for Hormonal Acne
With the many side effects and contraindications of birth control pills, you may be on the lookout for natural alternatives. Here are some products you can try:
Probiotics are beneficial bacteria that do wonders on the gut – and the skin. According to Kober and Bowe, they may help reduce acne by acting on IGF-1 levels in the body. Results show that fermented milk made with Lactobacilli can help decrease the said hormone by as much as four times.
Certain herbs may help reduce androgen levels in the body. Good examples include Saw Palmetto and Chaste Tree Berry, which are often used in patients with hormonal acne and PCOS.
According to Grant and Ramasamy, green tea may also help reduce hormonal breakouts. Made from Camellia sinensis leaves, this tea contains epigallocatechins (EGCG) that may work well against sebum-increasing androgens.
Changing your eating habits is one of the best ways to curb hormonal breakouts. Since an unhealthy diet boosts IGF-1 production, the best way to go is to reduce (if not eliminate) these foods from your diet.
In his interview with Huffington Post, Dr. Samer Jaber said: “I always tell people to cut out sugar and dairy.” Apart from these, he also recommends cutting white potatoes, white rice, cake, candy, soda, and processed produce from your diet.
Hormonal acne often results from androgens, IGF-1, and menstrual cycle changes. While they can be addressed with OCPs, these treatments come with a variety of side effects and contraindications. If you are not a good fit for birth control pills, you may try to address your pimple problems with probiotics, anti-androgenic herbs, and a healthy diet.
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