Question:
What’s the story on hormones and acne? I’m
sure there’s a connection between my hormonal cycle and
my acne getting worse. Am I right?
Answer:
You’re right. Your acne is connected to your hormones.
But,
here’s the thing you may not know. It’s not your ‘female’
hormones that are responsible. That is, it’s not the hormones
that we typically think of as being associated with female characteristics,
like estrogen is. Instead, it’s the ‘male’ hormones
that are associated with acne.
That’s
because women have ‘male’ hormones like testosterone
present in their bodies, though at a much lower level than men
do. But, it doesn’t take as much of those male hormones
to trigger their acne as it does for the guys.
Here’s
another important point. Testosterone itself doesn’t appear
to be the culprit in acne. Instead, it’s related hormones
like dihydrotestosterone (DHT) that appear to stimulate the overproduction
of oil that is so involved in causing acne. It’s also likely
to be behind the thickened lining of the pore, another factor
involved in the development of acne.
DHT
is created when a special enzyme (5 alpha reductase) gets hold
of a testosterone molecule and changes it into DHT. The interesting
thing is that this enzyme is primarily present in the skin, and
specifically in the areas that are acne prone, such as the face,
neck and upper back. More than that, it appears that people who
have acne have significantly higher levels of this enzyme than
other people. So, when you put all of that together, the result
is…yes, your acne will flare in keeping with hormonal changes.
The
female hormonal cycle is a complex interplay of multiple different
hormones. When you add to this the individual variations that
exist from person to person, there can be a wide range of interplay
of hormones during the monthly cycle. Thus, even the impact of
‘male’ hormones will vary during the course of the
cycle – resulting in the predictable flaring of acne symptoms.
If
you have a question that you haven't been able to find an answer
to on this site, please send your question about acne to Dr.
Wilkinson.
