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Dealing with acne as a teen is a rite of passage. But, dealing with it as an adult can be frustrating. What’s more, on an average, about 50 per cent of women, more than men, tend to suffer from adult acne. And the main cause for this tends to be hormonal.
“As women get older, their estrogen levels decrease triggering the growth of adult acne. This is why women experience more skin-related concerns, especially acne during periods, or menopause. These hormones can interfere with your skin health by producing more oily sebum,” says Dr Rinky Kapoor, consultant dermatologist at The Esthetics Clinics in Bengaluru.
How do we confirm whether the acne is hormonal in nature? “Hormonal acne can be painful and it will usually present itself in the lower part of your face— jawline and the neck area,” says Dr Agni Kumar Bose, a Mumbai-based dermatologist. The other symptoms that tend to accompany hormonal acne, according to Bose, include acanthosis nigricans or the darkening of underarms and the neck region, excess facial hair and decreased density of hair on the scalp. “This doesn’t mean that the person has PCOS (polycystic ovary syndrome), but they might fall under its spectrum, despite blood tests and sonogram being normal,” he explains.
To rule out hormonal acne, one can go for a basic hormone panel test that can detect levels of testosterone, 17-hydroxy progesterone, TSH, prolactin and cortisol – hormones known to induce acne. A dexamethasone suppression test can be done to know if the body is producing excess cortisol. The expert will also carry out an ultrasound to look for polycystic ovary syndrome (PCOS), which is a common hormone problem for women of childbearing age seen due to an imbalance of androgens. “This condition leads to symptoms such as irregular menstrual periods, hirsutism (facial hair) and uncomfortable acne. PCOS is more common in overweight or obese females. Allergy testing can be carried out as certain food allergies can cause hormonal imbalance and aggravate acne,” explains Dr Sneha Kothari, consultant endocrinologist at Gleneagles Hospitals, Mumbai.
Kothari says that women are more prone to adult acne due to hormonal fluctuations seen during menstrual cycle, pregnancy and menopause.
Hormonal imbalance causes higher sebum production and clogged pores causing unsettling breakouts, she says. “Since stress is also linked to acne flare-ups, women should de-stress themselves with yoga, meditation, pursuing hobbies, sleeping 7-8 hours per day and eating healthy. In addition, certain medications can also help to tackle acne,” Kothari adds.
Bose too feels that the process of eliminating hormonal acne is a holistic one and factors like what you eat, whether you exercise, and whether you are getting enough sleep— all of it matters. He also feels that stress management plays an important role when it comes to tackling hormonal acne. “It is important to understand what the problem underneath is and what is causing the stubborn acne, which tends to lead to discolouration,” he says. Bose also warns against using home remedies like turmeric and aloe vera for treating hormonal acne. “Turmeric if not used judiciously in a diluted format could burn your skin. Ensure to dilute it with milk or water before applying it to your skin,” he suggests.
Mumbai-based dietician Maithili Kelkar feels that to tackle and prevent hormonal acne, one should stay away from refined and processed foods that are high in synthetic sugar or trans fats. Instead, opt for whole grains and natural produce. “Swap your plastic cookware and storage dabbas with metallic ones as some plastics release xenoestrogen, which mimic estrogen functioning in our body,” she says before adding, “Include aloe vera juice in your diet and consume sources of Omega 3 fatty acids like seeds, nut, coconuts and peanuts.”
As for other DIY methods of tackling hormonal acne such as blood purification tonics, Kothari warns, “Medications should be taken as per the doctor’s direction. Opting for skincare products with ingredients like salicylic acid or benzoyl peroxide can be a good idea to control acne flare-ups.” When it comes to skin care in relation to hormonal acne, however, Bose leans towards the ‘less is more’ philosophy.
“Salicylic acid is one of the common skincare ingredients suggested by various dermatologists to reduce the visibility of acne scars without undergoing any cosmetic surgery. It treats mild and severe acne by decreasing the production of oil, reducing inflammation and unclogging pores,” says Kapoor. She also recommends benzoyl peroxide which works as a topical treatment by reducing acne-causing bacteria like Propionibacterium acnes (P. acnes). “Acne patches can also be used after consulting a dermatologist. Moreover, skin-lightening creams loaded with kojic acid, alpha arbutin and niacinamide can manage acne pigmentation scars,” she adds.
For scar-free skin Bose's advice is to avoid squeezing or popping the pimple. “Doing that makes it harder to treat,” he says. Kapoor recommends never sleeping with makeup on as it can clog your pores while trapping the dirt, bacteria, moisture, sweat, and oil on the skin. “It can significantly interfere with your collagen, increasing the risk of experiencing early signs of ageing like wrinkles and fine lines.” Her tips?
“Apply SPF regularly to safeguard your skin from harmful UV rays. These UV rays can damage the skin barrier and increase the risk of skin cancer. It is essential to apply sunscreen with an SPF 30 or more for better coverage and protection.”
As for scars caused by hormonal acne, Kapoor recommends treatments like laser therapy, laser resurfacing, dermabrasion, micro-needling, chemical peel, acne scar surgery and radiofrequency skin tightening. “When choosing skincare products look for ingredients like glycolic acid, salicylic acid, citric acid, retinol, vitamin C and niacinamide for better results. Try to use products recommended by an expert only,” she says.
Sumitra Nair is a journalist based in Kochi, Kerala.
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