Hormones are chemical messengers that regulate almost every aspect of the human body including the maturation of the oil glands in our skin. When the oil glands mature, they develop the capability of becoming acne lesions. Because of this, there are some hormones that are major players when it comes to the development of acne. Even though everyone has hormones and hormonal swings, not everyone experiences acne. This is because hormones are not the root cause of acne, and only part of what can exacerbate it. Acne is actually caused by the inherited propensity of retention hyperkeratosis – dead skin cells sticking together at an accelerated rate and clogging the pore along with other follicular debris. This forms an impaction inside the follicle called the microcomedone – the beginning of all acne.
The Role of Androgens in Acne Formation
There are two main hormones when it comes to acne – androgens and insulin. I will first address androgen hormones and acne.
Believe it or not, the acne-prone do not generally have higher levels of androgens in their bodies (with the exception of women with PCOS – Polycystic Ovarian Syndrome). In the case of androgens, it is not the levels of androgens that are the problem – it is the way the skin reacts to androgens that causes problems. Acne-prone skin is way more sensitive to the effects of androgens than normal skin.
So, what are androgens? They consist of precursors DHEA and androstenedione which convert to testosterone. Then, with the help of an enzyme called 5-alpha reductase, testosterone is converted into a much more potent hormone called dihydrostestosterone. It is dihydrostestosterone that stimulates keratin and sebum production that affect the acne-prone pore. And, the enzyme, 5-alpha reductase, is also responsible for increasing sensitivity to testosterone. It also happens to be much more active in the acne-prone.
So why is an increase of sebum and keratin such a problem for acne-prone skin? Their skin has proportionally more squalene in their sebum. The problem is that squalene is a fragile unsaturated fat which is very easily converted to squalene peroxide. Squalene peroxide happens to be highly comedogenic (pore-clogging) and inflammatory. Squalene peroxides are also free radicals further depleting the pore of oxygen. When there is not enough oxygen, the anaerobic bacteria, p. acnes, is truly allowed to proliferate adding fuel the already raging acne fire. It also results in interleukin-1 being released which causes inflammation and adds to the hyperkeratization process and formation of microcomedo (the beginning of the acne lesion).
The Role of Insulin in Acne Formation
Insulin becomes a problem when it is elevated, which is very common among the acne-prone. Too many fat and carbs in the diet along with high-glycemic foods (sugary foods) are just a couple of the factors that cause elevated insulin. But how does it cause more acne? Elevated insulin triggers a cascading hormonal reaction that floods the bloodstream with DHEA and other androgen precursor hormones. The skin converts these hormones into testosterone and dihydrotestosterone which increase sebum and keratin production; and as explained before, results in acne formation.
The Options for Getting Clear
Most acne sufferers are not given a successful strategy to get and keep their skin clear. Their search for the answer leads them down many dead-end streets that includes doctors’ offices, medi-spas and salons. Most dermatologists will start patients on a regimen of antibiotics which may give them temporary relief, but the acne bacteria will soon become resistant and within a few weeks will be back to where they started. At this point a different antibiotic may be prescribed; however, the ramifications associated with the frequent use of antibiotics, is well documented. There are long-term health threats as sociated with this modality especially antibiotic resistance. MRSA alone kills more Americans every year than emphysema, HIV/AIDS, Parkinson’s disease, and homicide combined.
Other prescriptions such as birth control pills and/or spironolactone may be given to manage hormonal fluctuations; but does not address the root cause of acne – retention hyperkeratosis. There can be profound side effects to taking hormonal drugs and should be avoided if there are better alternatives. When this fails, the next common approach is to try prescription retinoids which are applied topically. While this approach does address retention hyperkeratosis, most patients have such an adverse reaction to them including irritation, skin hypersensitivity and peeling, they abandon the use of them pretty quickly.
The last treatment that should be considered is Accutane, a drug that is taken orally which causes the sebaceous glands to cease the production of oil (sebum). Accutane might be considered by someone with very serious nodular or cystic acne who has exhausted all other forms of viable treatment. However, there are extremely serious potential side effects, including an array of mental, skeletal and internal organ ailments. Women of child bearing age must be on two types of birth control and must be monitored because of the many documented birth defects attributed to its use. Despite these serious health threats, Accutane often doesn’t work. We have many clients who have been on two, three and even more five-month bouts of Accutane and continued to have acne.
A Safer Strategy For Hormonal Acne
With understanding of a just a few key concepts, skin care professionals can be highly successful in treating acne. These concepts will explain why so many acne systems, including dermatologists’ protocols, miss the mark. Acne is primarily a dead skin-cell problem (retention hyperkeratosis); and most acne, no matter what form it takes, starts with microcomedones. This means the solution lies in products that penetrate the pore and prevent dead skin cells from building up in the first place. That is why every acne clients’ home-care routine is so crucial — it’s all about preventing these microcomedones from forming. Products that can accomplish this include alpha-hyroxy acids like glycolic and mandelic, beta-hydroxy acids like salicylic, vitamin a acids like retinaldyhyde and retinol and benzoyl peroxide. Benzoyl peroxide not only kills bacteria with an infusion of oxygen within the pore, it actually peels the inside of the pore.
The first key concept is to give the right products for the skin type and acne type of the client. Because skin types and conditions vary greatly, different products and/or strengths of products need to be tested on the individual to check for sensitivity and/or tolerance.
The other key concept is to take skin adaptation into account. This means adjusting their home-care regimen about every two weeks so the skin does not over-adapt to product use. If their skin gets too used to their current regimen, their skin will stop responding. It is best to start slowly with products and gradually increase wearing time and/or frequency of use. It general takes around three to six months to clear the skin, cystic acne clearing up the most quickly. Once their skin is clear, the client can go on maintenance and regimen adjust is usually no longer necessary.
Hormones can wreak havoc on acne-prone skin, but there are safe and tried-and-true ways to get it clear and keep it clear. An acne-sufferer does not need to take dangerous prescription drugs or use irritating prescription products to get clear. Finding an acne specialist who will coach them through the clearing process along with giving them some simple lifestyle modifications will get and keep hormonal acne under control