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For millions of women, it happens like clockwork every month: cramping, bloating, mood swings, and acne. Experts know that acne is influenced by hormones, but research on the subject has been relatively limited — until now. A recent study conducted by dermatologist Alan Shalita, MD, confirmed that nearly half of all women experience acne flare-ups during the week preceding their period.

This particular kind of acne — hormonal acne — may fail to respond to traditional therapies, such as topical retinoids and systemic or topical antibiotics. Several clues can help your doctor identify hormonally-influenced acne:

• Adult-onset acne, or breakouts that appear for the first time in adults

• Acne flare-ups preceding the menstrual cycle

• A history of irregular menstrual cycles

• Increased facial oiliness

• Hirsutism (excessive growth of hair, or hair in unusual places)

• Elevated levels of certain androgens in the blood stream

While hormonally influenced acne typically begins around age 20–25, it can strike teens and mature women as well, and is most persistent in women over the age of 30. These patients usually experience lesions on the lower face, especially the chin and the jaw line. While some may have breakouts on the chest and back, most have blemishes exclusively on the face. Hormonally-influenced acne is usually moderate and limited to inflammatory papules and small inflammatory nodules and occasional comedones. But how does it start?

Adult Hormonal Acne – Puberty: Where it all begins. Starting sometime before adolescence (around the age of nine or ten) the adrenal glands begin to produce dihydroepiandrosterone sulfate (DHEAS), an androgen. Other androgens — the “male” hormones at work in a woman’s body — such as testosterone and dehydrotestosterone (DHT), join in at the onset of puberty. All of these hormones stimulate the sebaceous glands to secrete more of the skin’s natural oil, or sebum. This is why oily skin and acne are so prevalent among teenagers. Naturally, since boys have more “male” hormones, teen acne tends to be more severe in males.

The treatment of acne in teenagers can be challenging, because their hormones are in a constant state of flux. They may initially respond very well to first-line treatments, such as topical retinoids and benzoyl peroxide, perhaps accompanied by an oral antibiotic. As their bodies develop, however, they may undergo severe hormonal shifts — and stop responding to the current medications. Courses of acne treatment may need to be adjusted more often with teenagers to accommodate these hormonal changes. More about teen acne.

Adult Hormonal Acne – A vicious cycle. Many women pass into adulthood without “outgrowing” their acne. Others may not develop it until their 20s or 30s, experiencing persistent breakouts the week before their period. Why? During the course of a normal menstrual cycle (if a woman is not taking any kind of hormonal birth control pill), estrogen levels peak at mid-cycle, then decline as she nears her period. After ovulation, the ovaries begin to produce progesterone, another hormone which stimulates the sebaceous glands. And with the extra oil comes acne. Hormones are also responsible for acne in a percentage of pregnant women, as well; the sebaceous glands go into high gear during the third trimester, causing oily skin and frequent breakouts. Some women even experience acne after menopause, when estrogen levels begin to taper off and testosterone becomes the dominant hormone.

Adult Hormonal Acne – What can be done? According to Dr. Shalita, the “wait and see” attitude is particularly ineffective for hormonal breakouts: “Acne that worsens during a woman’s monthly cycle isn’t something that women will grow out of as they get older. Seeing your dermatologist to determine the best treatment plan for acne flare-ups is recommended for the most successful result.”

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