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Hormonally Induced Acne

Hormonally Induced Acne

As many of us are aware, acne is very common and presents in various subtypes. Hormonally induced acne, one of the more common subtypes of acne, is, unfortunately, both under-recognized and under-treated.

Generally, hormonally induced acne is characterized by deeper sometimes tender pimples occurring on the jawline, chin, forehead, and trunk of female acnepatients. Typically this acne subtype flares reliably in relationship (before, often) to one’s menstrual cycle (but not always). Menstrual cycles may be regular or irregular. Importantly, if one’s menstrual cycles are irregular, in conjunction with acne and hirsutism (excess hair growth), one should consider evaluation by an endocrinologist or gynecologist for polycystic ovarian syndrome (PCOS) or other disorder.
In my experience I divide hormonally induced acne into the following typical presentations:
1) Teens with significant acne flaring during the week before menstrual cycle
2) Young women (age 20’s-30’s), often with no history of teenage acne, with rather abrupt onset of deeper tender pimples
3) Pregnant women
4) Peri-menopausal acne (sometimes occurring several years before or after menopause as well), women in the 40’s or 50’s with tender deeper pimples generally occurring on the chin, jawline and neck.
5) Women of all ages who recently (2-3 months prior to onset of acne) switched birth control to include one of the following progesterones: norethindrone, levonorgestrel, etonorgesterel, among others.
Treatment of hormonally induced acne can be a bit of a challenge. Topical treatment generally is insufficient to improve hormonal acne, although mild hormonal acnemay be improved by clindamycin, azelaic acid, niacinamide, dapsone or other antimicrobials/anti-inflammatories. Coordinating with one’s primary care physician, dermatologist, pediatrician, and/or gynecologist is crucial, as optimizing the selection of a low-androgenicity oral contraceptive can make a huge difference in the treatment of hormonal acne. The optimal progesterones for hormonal acne include desogestrel, norgestimate, and drospirenone. Lastly, spironolactone, a diuretic often employed in the off-label treatment of hormonal  acne, may be used as mono-therapy or in combination with an oral contraceptive.
The final comment to make about hormonally induced acne is regarding the use of isotretinoin. Now, I love isotretinoin as much as the next dermatologist, however one must recognize its limitations as well. Although hormonal acne will improve during an isotretinoin course of therapy, it will generally recur after the treatment has completed. As a result, before female patients commence a course of isotretinoin, it is often sensible to optimize hormonal acne treatment to determine if the isotretinoin course is actually necessary.
If the above sounds like you or someone you care about, know that effective therapies exist and the prognosis is great.

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My visit to Dermcare was my very first visit to a dermatologist. The staff was extremely welcoming and informative. Dr. Raynham reassured my concerns and offered great solutions to all of my skin problems! I later learned of the GAP year program for pre-medical students & quickly joined the team!

Cassandra (Natick)

I have been a Helen Raynham patient for many years and continue to receive the very best care and professionalism. The staff is excellent and Dr. Raynham continues to identify potential problem areas and correct them very early. – an excellent dermatology practice.

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The people could not be any more accommodating. From Dr. Raynham, all the nurses and staff, I thank them for ensuring the best possible results under an initial stressful prognosis.

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Patient Testimonials

They instilled peace and confidence as I prepare for surgery.

Vin Daily

Everyone is so friendly and welcoming. Dr. Raynham took care of my keloid scar, like no other Doctor did. Her kindness, sincere caring, and concern make everything great! My keloid scar was getting worse and worse until Dr. Raynham took care of it. She is the best and very professional. Excellent service. Highly recommended.

Veronica B.

We had a very pleasant experience at Dermcare. Dr. Raynham was efficient, responsive and an excellent communicator. The staff members were helpful and responsive as well. No complaints.

Jennifer F

I have been extremely pleased with the professionalism of Dr. Raynham and the team at Dermcare.
Dr. Raynham’s skill is amazing and her kind and caring personality is so appreciated.
Very grateful for the care from all at Dermcare.

A Gunes

We had a very pleasant experience at Dermcare. Dr. Raynham was efficient, responsive and an excellent communicator. The staff members were helpful and responsive as well. No complaints.

Jennifer (Cambridge)

My visit to Dermcare was my very first visit to a dermatologist. The staff was extremely welcoming and informative. Dr. Raynham reassured my concerns and offered great solutions to all of my skin problems! I later learned of the GAP year program for pre-medical students & quickly joined the team!

Cassandra (Natick)

I have been a Helen Raynham patient for many years and continue to receive the very best care and professionalism. The staff is excellent and Dr. Raynham continues to identify potential problem areas and correct them very early. – an excellent dermatology practice.

Lynn (Cambridge)

The people could not be any more accommodating. From Dr. Raynham, all the nurses and staff, I thank them for ensuring the best possible results under an initial stressful prognosis.

John (Chelmsford)

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