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| |  DG DISPATCH - AAD: Women and Acne: The Hormonal Connection By Maggie Schwarz Special to DG News
WASHINGTON, DC -- March 5, 2001 -- Many adult women experience mild to moderate acne that is unresponsive to traditional treatments. To find effective treatment for adult-onset acne, dermatologists often look to a woman’s hormones. At the American Academy of Dermatology’s 2001 Annual Meeting here, Diane Berson, MD, of New York University School of Medicine, talked about the role hormones play in adult-onset acne and hormonal therapy.
The Role of Hormones in Acne Hormonal acne is most often influenced by androgens. When androgens overstimulate the sebaceous glands, around the time of menstruation, women tend to have acne flare-ups. Stress, too, can affect androgen levels, resulting in further breakouts. Most women with acne demonstrate normal androgen serum levels. Some have excess facial hair, male pattern alopecia, hair loss, and/or hair thinning. Women with these symptoms may be producing increased androgens, and a hormonal work-up including evaluation for adrenal, ovarian or pituitary abnormalities may be indicated. "In addition to hirsutism and alopecia, women with hormonal acne may have irregular menstrual cycles, obesity, infertility or diabetes," said Dr. Berson.
Therapy for Hormonal Acne Once diagnosed with hormonal acne, treatment options include oral contraceptive pills, corticosteroids and spironolactone, all of which decrease sebum production. Oral contraceptive pills are the first-line hormonal treatment for acne. Two newer progestins in oral contraceptive pills, desogestrel and norgestimate, are less androgenic than are those in older formulations. Recently, the United States Food and Drug Administration approved the first oral contraceptive pill for mild to moderate acne. Other low-dose formulations can also improve the condition. Women with overactivity of the adrenal glands can be treated with oral corticosteroids, such as prednisone or dexamethasone, Dr. Berson said. These agents improve acne by decreasing adrenal androgen production. Oral spironolactone, a steroidal antiandrogen, prevents excessive oil production by blocking androgen receptors. Spironolactone also decreases androgen production in the ovaries and adrenal glands, resulting in fewer flares. Spironolactone is usually given in conjunction with oral contraceptives to decrease side effects (for example, breast tenderness and menstrual irregularities). "Acne is emotionally devastating at any stage, but as women age they often find it deters their personal and professional lives," said Dr. Berson.
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