Many acne-prone women will have found that acne can break out or worsen on a monthly basis. This occurs in close synchrony with their menstrual cycle, with the flare-up typically occurring a week to ten days before the start of their period. This is known as menstrual, or hormonal, acne. It is quite common, with about two thirds of acne-prone women suffering from it regularly.
Hormonal acne occurs due to cyclical changes in the composition of a woman's hormones. Though women have female hormones circulating through their bodies throughout their menstrual cycle (oestrogen predominating in the first half of the month, and progesterone in the second half), the androgen (male hormone) testosterone is also present - albeit in smaller quantities - at all times. Shortly before the onset of menstrual bleeding, the female hormones reach their lowest levels; the level of testosterone, however, remains fairly constant at all times and so its proportion is relatively higher at these points. Such higher proportions of testosterone in turn, are known to cause the changes in the skin's complexion that bring about acne.
Acne affecting the lower half of the face has often been linked to hormonal changes, particularly in women that develop spots at a later age (adult onset acne). This can often manifest as deep, red painful cysts under the skin rather than blackheads or whiteheads. Not all data backs this finding, however, and this type of acne may also be present in those without any underlying detectable hormone imbalance.
Getting your skincare right if you suffer with acne is absolutely vital. There is no doubt that breakouts can leave you looking and feeling miserable. Whilst most people think of acne as a problem for teenage skin, over the past decade, doctors are increasingly seeing rising rates of acne in adults. This can either be acne that persists past teenage years or acne that first develops in adulthood.
Acne is probably one of the most common problems I deal with in my dermatology clinics. So, here I've put together a list of the questions I am most frequently asked.
How should I be looking after my skin to minimize blemishes?
It is important to cleanse your skin twice a day - morning and evening. This can be in the form of a rinse off cleanser or micellar water. Choose a cleanser specially formulated for acne - these products often contain salicylic acid or benzoyl peroxide.
After cleansing, use a light gel-based moisturiser that is "non-comedogenic" i.e. prevents the formation of blackheads. Even oily skin needs moisturising as oils do not equate to hydration. Moisturising the skin will maintain the integrity of the barrier function of the skin and is vital for good skin health.
Don't pick or squeeze your spots as your skin will take longer to clear and you may end up with acne scars.
Should I exfoliate?
It is a good idea to gently exfoliate once a week if you have oily skin. This will immediately remove dead skin cells from the skin surface resulting in a brighter appearance. Longer term, it will reduce the development of blackheads. Be careful not to overdo this otherwise you will end up irritating the skin and making things worse not better.
Will wearing make up make my acne worse?
It is important to choose the right products for oily, blemish prone skin. If you wear make-up, then opt for an oil-free foundation or BB cream.
I'm going on holiday and sunscreen makes my skin break out - what shall I do?
It is vitally important to wear sunscreen to reduce the aging effects of the sun and the risk of skin cancer. Many people with oily skin find that sunscreens can block their pores resulting in spots. Choose a mattifying sunscreen designed specifically for oily or combination skin.
Skin care and products aside, do you have any other advice to reduce spots?
Having healthy skin is part of maintaining a healthy life style. There is emerging scientific evidence that dairy products and foods rich in carbohydrates with a high glycaemic index (GI) may aggravate acne. Follow a nutritional diet with plenty of whole grains, vegetables and pulses. Stress can anecdotally also play a part in aggravating inflammatory skin conditions such as acne. Learn to de-stress and make sure you get enough sleep and exercise. Participate in activities such as yoga and mediation if this works for you.
Despite these measures, if hormonal acne remains a problem or starts to affect your self-esteem then seek help early from your family doctor or dermatologist before any scarring of the skin develops. Dermatologists area able to offer a wide range of treatments including creams, antibiotics, hormonal treatments (spironolactone, cyproterone), lasers, chemical peels, and isotretinoin. They may also do some additional tests including blood tests to measure hormone levels or an ultrasound scan to exclude an underlying disorder such as polycystic ovarian syndrome, which may be driving hormonal acne.