From Dr. Sarah Villafranco, Founder of Osmia Organics.
Hormonal acne is a sweeping term often used to describe acne that is difficult to treat, cystic in nature, or has a connection to someone’s menstrual cycle. The truth is that hormones are a part of almost all acne, menstrual fluctuations in breakouts are to be expected in women who struggle with acne.
Generally, physicians refer to most types of acne as “acne vulgaris”, an umbrella term that includes acne of all different etiologies (and quite possibly the worst name for a condition that already affects people’s self-esteem?). In most people with acne, there are multiple factors that add up to the symptoms of the disease. In one person, the culprits may be stress, diet, and bacterial colonization with Propionibacterium acnes. In another person, symptoms may be caused by a genetic predisposition to increased sebum production and thickened hair follicles. And in yet another case, acne could be due to a hyperandrogenic state (increased circulating testosterone) like polycystic ovarian disease or hypothyroidism (these are the cases in which it’s most important to check hormone levels and make any necessary adjustments).
Management of acne is a changing landscape, and there is a broad spectrum of treatments. For years, dermatologists have used fairly aggressive medications like benzoyl peroxide and salicylic acid in combination with either topical or oral antibiotics. The idea was to decrease inflammation and get rid of acne-causing bacteria, and it worked for some, but many people found that their skin responded to being stripped of oils by creating more sebum, resulting in more breakouts.
Current conventional treatment usually consists of antibiotics and Retin-A or a newer generation retinoid. This combination has good success for some people, but is not without drawbacks, from antibiotic resistance to skin irritation. Oral contraceptives are still a mainstream treatment, and have a reasonable success rate, albeit with some more serious risks like blood clots or certain types of cancer. Spironolactone is possibly the lowest risk treatment and is definitely helpful in high-androgen states, where higher levels of testosterone can be contributing to acne.
The shocking thing, though, is how few dermatologists start with the basics: What do you eat? How do you manage stress? What skincare products are you using, and how? Many practitioners fail to address the most basic concepts in human health and wellness, rushing to prescribe an anti-acne regimen without trying the most non-invasive tactics first.
When I talk to people who are struggling with acne, those are the first questions I ask. It’s amazing how many of them are able to heal themselves with a little guidance about eating a non-inflammatory diet, managing stress more successfully, and using simple, clean skin products that don’t pull too much oil from the skin. It may take four months instead of four weeks, but using natural ingredients like sulfur-rich Dead Sea mud, anti-inflammatory oils like black cumin seed, and antibacterial oils like thyme and lemon can have lasting effects on acne-prone skin. Combined with the right diet and supplements (like evening primrose oil for menstrual acne), and proper medical care for any underlying conditions, this softer, more natural approach to treating acne can have a profound effect. In fact, there’s a growing population of patients out there who have tried much of what conventional dermatology has to offer over the course of decades without lasting success. Only when they address the problem with their whole health in mind do they finally see their skin (and their confidence) begin to heal.
So, if your acne is truly hormonal, you’ll need to work with a health care provider to test levels of things like testosterone and thyroid hormone and make any necessary adjustments. If you’re just managing run-of-the-mill “acne vulgaris”, you might consider a more nourishing approach instead of the skin-stripping methods of the past. In either case, your success may largely depend on how you support your skin from the inside out, with informed dietary choices and proactive stress management. So grab your kombucha and a meditation pillow and get ready to heal your skin!