Hormonal Acne
Most of us have been there. I know I have. I also now know that I was lied to when I was younger because acne does NOT only happen in your teens. It happens in your teens, postpartum, during perimenopause and menopause, and sometimes even just because. Let’s see what we can do to treat it.
First Up, Why Does It Happen?
Hormonal acne is pretty self-explanatory. It’s usually a cause of a hormonal imbalance, typically excess testosterone or dihydrotestosterone (DHT). DHT is the chemical compound that testosterone converts to via the enzyme 5-alpha-reductase. DHT is the major androgen that is responsible for the increased sebum production associated with hormonal acne. Some girlies are simply prone to having a higher/faster conversion to testosterone to DHT while other times I may want to do additional tests and rule out other conditions which may be causing this.
What Can I Do to Prevent It?
Lucky for you, there’s plenty on the market these days to help clear acne. We’ll talk about both the pharmaceutical and natural options that are at you disposal.
First up, let’s talk pharmaceuticals. Although a topical cleanse containing salicylic acid or benzoyl peroxide is effective for mild acne, I honestly don’t see it do much for hormonal acne. It definitely helps, but from my experience, it’s not going to fix anything on its own. Same goes for other topical treatments like face masks, retinol, and exfoliants. For hormonal acne we need something a little more aggressive. The most commonly prescribed drug for acne is the birth control pill. This will regulate your hormones for the time that you’re on it, and should, in theory, reduce your acne. Sometimes it’s a bit of trial and error getting to see which OCP works best for you. Another common prescription is spironolactone. This medication is classifed as a potassium sparing diuretic and was previously used as a blood pressure medication, but rarely gets used for that anymore. Spironolactone acts as a 5-alpha-reductase inhibitor, blocking the pathway of conversion of testosterone to DHT, which lowers DHT and decreases acne production. 50mg is typically prescribed as a starting dose and can be increased by your dermatologist, as needed.
Now let’s discuss some natural alternatives. Okay, so from an alternative medicine perspective, any congestion or outbreaks in the skin tell us that there is congestion in the body. The way I practice medicine is looking at the whole picture and not just what’s happening to your skin. In Traditional Chinese Medicine (TCM), the liver organ manifests in the skin, so through that ideology, if there is any acne, eczema, or psoriasis, you would start by promoting liver detox. This should, in turn, clear your skin. Other practitioners believe in the gut-skin axis which is ‘the bidirectional axis between gut microbiome and skin health’ (1). Basically, if your gut microbiome is off, this will also cause breakouts in the skin. Then finally, studies have also shown a relationship between our brain and skin, called the, you guessed it, brain-skin connection. This goes past just hormonal acne but all other dermatological conditions such as atopic dermatitis, contact dermatitis, psoriasis, and other types of acne. In a nutshell, research has shown that when we’re stressed, the skin is the immediate stress perceiver and target of stress responses, leading to an outbreak. Ultimately, when it comes to treating acne, I like to approach it by combining all these ideas and supporting the body as a whole.
Liver Support
First, we can focus on liver detox. This was also talked about in the previous post about estrogen dominance. If you want to read more on that, click here. Basically, promoting liver detox is simply supporting the body’s already natural detox process. We should focus on eating whole, minimally processed foods and reducing refined sugar and alcohol intake. Supplements containing milk thistle, dandelion root, and artichoke leaf are also beneficial in helping to strengthen this process. And lastly, we can do acupuncture to help stimulate the flow of Qi and resolve any liver Qi stagnation that is occurring in the body.
Gut Support
Next, we need to take a look at the gut. We can definitely run specialty lab testing like GI Map or food sensitivity tests, but let’s start simpler first. Questions I ask my patients at every visit include, “how often are you pooping?” “is your poop well-formed?” “do you experience any straining?” “is your bowel movement a healthy size and volume?” the answers to all these questions indicate to me how your digestion is and what we need to work on. Typical symptoms of poor digestion include constipation, diarrhea, reflux, stomach pain, bloating and excessive gas. Providing a high quality probiotic is something I typically recommend, along with herbs to help with digestion, such as marshmallow, licorice, cinnamon, or senna, depending on what your symptoms are. Treating the gut can be very complicated and may take months, but it’s super important to focus on this in order to fully heal your hormonal acne.
Mind Support
When it comes to the brain-skin connection, the key thing is understanding how to regulate your nervous system. These days, most of us have a heightened sympathetic nervous system, which is what provides us our ‘fight or flight’ response. This is great, at certain times - NOT 24/7. We need to focus on supporting our parasympathetic nervous system, which is oftentimes noted as the ‘rest and digest’ system. When our parasympathetic nervous system is working properly, we tend to feel more calm and relaxed, less anxious, and our digestion will be functioning better (see how that’s connected too?!). Supporting your nervous system can be hard. There’s a lot of mind-body techniques designed to help with this, herbs like Chamomile and Skullcap can help calm our brains and our bodies, and doing activities that are enjoyable are great ways to promote that parasympathetic nervous system to work better.
As you can see, there are many avenues we can go down when treating your hormonal acne. If you want to go the traditional Western route and take birth control or Spironolactone, I support it! But I’m also here if you want to take a more holistic approach and treat your whole body, rather than just your symptoms.
References:
https://pubmed.ncbi.nlm.nih.gov/35625774/#:~:text=The%20gut%2Dskin%20axis%20refers,mediators%20and%20the%20immune%20system.