In the USA, acne affects between 40-50 million people. So, the good news is that you are not alone! As an acne sufferer, it can feel really lonely. But in reality it’s just not true! If we were to look at all of the women, that are currently taking birth control just to manage their skin, then it would open up millions more cases of unresolved acne.
There seems to be a lot of confusion about hormones and acne, so let’s start to clear that up. I often hear “but isn’t all acne hormonal?” and “then what type is mine?” So here are the facts:
Acne is caused by a cascade of events that:
- block the hair follicle (yep, we all have them on our face, neck and chest)
- cause too much oil, and a stickier version to flood that follicle
- create a yummy perfect environment for bacteria to party
- create inflammation of in the area (which makes a pimple red, angry and painful)
“But my skin isn’t oily, it’s dry and I am still breaking out!”
This is often the case. Out of the three basic skin types, oily skin is the LEAST common. Which means that most of you breaking out, have a lipid dry or sensitive skin. I will explain more about that shortly….
So, in a nutshell, here is what is happening if you have hormonal triggers:
- you are breaking out usually around the lower face (jaw-line, chin, neck)
- your acne is better or worse for birth control (synthetic hormones)
- your pimples are usually blind and very tender
- you have noticed a pattern, and are breaking out around the same time each month (during your period, or just before, or even at ovulation)
- your acne started at the same time your period did
- you have recently become a mamma
Other signs that your acne has a hormonal edge:
- you have recently stopped taking birth control
- you have irregular periods or a cycle that is outside of the usual 28 days
- you have significant PMS symptoms
In the skin biz, there is a grading system for acne. Generally speaking, hormonal acne is classified as grade 4 (characterised by the signs/symptoms above). Now, that’s not to say that there aren’t many other factors at play, such as stress, diet, gut/liver function etc. It just gives us an indication that there is something awrygoing on with your hormones, that needs further investigation.
Meet Mr DHT, or to be precise dihydrotestosterone – He’s masculine, strong and it’s likely he’s got a bit of a hold on you…
Now, many of you experiencing hormonal breakouts, may be converting too much testosterone to DHT (yes, ladies too). DHT can be between 10-30 times more potent that testosterone.
Some nasty habits that Androgen hormones (testosterone & DHT) do;
- increase inflammation
- slow wound healing
- weaken the skin’s natural barrier defence
- increase production of sticky oil
- block the follicle by producing too many skin cells
This is where it gets really interesting… We have DHT receptors in our hair follicle. Yep, the HQ of breakouts. Most people with acne, actually have an oversensitive receptor to a breakout type of hormone (Mr DHT and his crew) WITHIN the follicle!
And another fascinating fact is that the skin, especially the pilosebaceous unit (follicle), can actually be considered an endocrine organ. What does this mean to laymen?
Skin is not actually separate to our hormones. They are one and the same. What’s happening in the ovaries and the pituitary gland (hormone regulator), is affecting the skin. Combine that with the over-reactive receptor and it’s no wonder that hormones can make us breakout faster than you can say pilosebaceous unit overload.
So to recap on the Biochem…
- The pilosebaceous unit is a pumping factory for hormone production!
- You may have too many androgens swimming around in the blood
- Your oversensitive follicle will start freaking out
- The androgen receptor in your follicle (Mr DHT) will respond by producing oil, and the sticky icky kind etc.
Some of you are even more unfortunate, as you are genetically lacking the enzyme in your skin that helps to munch away at dead skin and excess sticky oil. Holy breakouts batman!
Remember how I mentioned that most adults presenting with hormonal acne have a lipid dry, sensitive skin? Well it this is super relevant. Skin that is lipid dry will produce more oil, in an attempt to hydrate the skin. Hello blockage. Skin that is lipid dry will have an issue with holding onto water (we call it transepidermal water loss). There are enzymes in our skin that work like little pac men to clear out the follicle on a regular basis. If there is NO free water, then the enzymes will be asleep. There will be no enzyme activity or exfoliation within the skin to stop the buildup in that follicle.
Yep there’s more…
Most people are deficient in a particular type of essential fatty acid that helps the skin to retain water. In the absence of water, the skin cannot exfoliate itself. This is called the omega 3-6 balance. Externally this is a really big deal. Internally it is a HUGE deal, as the delicate balance of the hormonal system relies on the correct balance.
How else is this balance super relevant?
Internally, the proper relationship between both omega-3 and omega-6 fatty acids also allow your body to produce a healthy immune response to invading bacteria. It also has a bucket load of implications for healthy skin and hormones. But that’s a whole other article.
The great news is that there is SO much we can do to help hormonally driven acne. And there are heaps of safe alternatives to synthetic hormones and medication. Hormonal acne isn’t a life sentence, it’s just another process of elimination on the way to clear skin.