Does it seem as though your acne tends to flare up out of nowhere from time to time, even though you religiously maintain your skin care routine? It’s probably not your imagination. While clogged pores are the actual cause of acne, its severity is strongly influenced by your body’s natural hormonal fluctuations.
You can’t control your hormones the same way you do your diet or your skin care regimen, but that doesn’t mean you can’t take steps to deal with it.
Here’s a quick look at what’s behind hormonal acne and the steps you can take to overcome it.
- Relationship Between Hormones and Acne
- Hormonal Fluctuations
- Signs of Hormonal Acne
- Contraceptives for Treatment
- Affect of Glycemic Load & Insulin
- Reducing Simple Carbohydrate & Sugar Intake
- Dairy Products & Acne
- What Foods Should I Eat?
- Food Allergies & Hormonal Imbalances
- Stress Hormones & Cortisol
Relationship Between Hormones and Acne
Androgens, which are male hormones present in both males and females, contribute to acne flare-ups by over stimulating the oil-producing glands in your skin. Fluctuations in hormone levels that are brought on during puberty, pregnancy, menstruation, or menopause stimulate the overproduction of oil, called sebum, which impedes the development of cells lining the hair follicles in the skin. The combination of excess oil and reduced shedding of old skin cells can send acne into overdrive.
In females, inflammatory acne can be triggered by hormonal fluctuations that occur during the menstrual cycle. Testosterone, a steroid hormone produced in the ovaries and adrenal glands of women, plays an important role in how hormonal fluctuations effect women, especially those affected by acne.
A woman only produces a tenth (10%) of the testosterone that males produce, but the male sex hormone plays a significant role in anyone’s body, either male or female, increasing sexual desire, bone density, muscle mass and metabolic rate.
Not enough testosterone can leave you with low-energy, sluggishness and even depression, while too much testosterone can result in hair loss, unsightly facial hair and troubling acne. During a woman’s menstrual cycle, the male hormone testosterone remains at a fairly constant level(1). Estrogen and progesterone levels fall off in the second half of the cycle, resulting in higher relative testosterone levels that can trigger those troubling hormonal acne breakouts.
Signs of Hormonal Acne
The telltale sign of hormonal acne is an increase in breakouts leading up to your period and during ovulation. Blemishes tend to be the cystic type with red, tender and painful blemishes sitting more deeply within the affected areas. Breakouts are typically concentrated on the lower half of the face, particularly the jawline and chin but can also affect the cheekbones as well.
Contraceptives for Treatment
Dermatologists will often recommend oral contraception or another medication call spironolactone(2) for treating hormonal acne in women. Spironolactone is actually a diuretic that releases excess water, but it also blocks the receptors for male hormones, keeping them at a lower level.
Oral contraceptives (or birth control pills) contain hormones that, in addition to preventing pregnancy, slow the production of excess sebum in the skin, resulting in clearer skin and fewer acne problems. Combining estrogen, a female hormone, with progestin, a synthetic version of the male hormone progresterone, these medications can stabilize hormonal fluctuations and helps to treat acne. Oral contraceptives are not usually prescribed solely as an acne treatment though. Most often, dermatologists recommend using them alongside oral antibiotics but only after trying topical acne treatments first in treating the problem.
While oral contraceptives have proven to be very effective for hormonal acne treatment, studies have indicated that it takes time for them to work effectively – at least 3 months to see a noticeable difference and up to 6 months to see the biggest changes.
The FDA has approved three oral contraceptives for acne treatment in women, which include Estrostep, Ortho Tri-Cyclen and Drospirenone (Yaz) in women at least 15 years of age or older who have started menstruating and where topical treatments have been ineffective.
- Estrostep (Norethindrone Acetate and Ethinyl Estradiol). Estrostep is a so-called “combination” oral contraceptive that increases the level of sex hormone binding globulin (SHBG) and reducing testosterone levels in the body.
- YAZ (Drospirenone and ethinyl estradiol). Similar to Estrostrep, YAZ is another combination oral contraceptive that increases levels of SHBG, and decreases testosterone. YAZ is has been indicated as an effective acne treatment for women who have started their menstruation cycle, but only for those who want to use an oral contraceptive for birth control.*
- Ortho Tri-Cyclen (norgestimate and ethinyl estradiol). Ortho Tri-Cyclen affects hormones in the same way as the other two contraceptives. Studies have shown that it can be an effective treatment for acne vulgaris. It is indicated for the same women and reasons as Estrostep.
*Cautionary Note: The FDA issued a letter of warning to the makers of YAZ in September of 2009 stating that the company had “misleadingly overstated the efficacy of the drug” in their television advertising campaign. Make sure that you speak with your doctor and dermatologist at length about potential risks associated with YAZ or any other oral contraceptive before using.
Women with disorders such as polycystic ovarian syndrome (PCOS), adrenal disease and diabetes produce greater amounts of testosterone that can translate into hormonal acne problems as well.
Affect of Glycemic Load & Insulin
The health of your skin is highly correlated with your diet. Hormonal imbalances are tied directly to acne problems — and your diet influences the hormone balance in your body — including testosterone levels, IGF-1 (insulin-like growth hormone), and insulin levels, which can all be directly linked to acne.
The high glycemic load (referring to how quickly the food increases your blood sugar and insulin levels after ingestion) of Western diets has a disruptive impact on hormonal levels in the human body.
This high glycemic load triggers a spike in insulin production in your body, which boosts the production of oil glands in your skin, leading to the growth of pore-clogging cells. Rising insulin levels also promote an increase in testosterone production (particularly in women) as well as inflammation, which can trigger new acne or further aggravate an existing acne problem.
Reducing Simple Carbohydrate & Sugar Intake
The typical Western or American diet is heavily reliant on simple carbohydrates such as pasta, potatoes, white rice, and white bread, which are all foods with a very high glycemic index.
In the book The Clear Skin Diet, renowned dermatologists Val Treinar and Al Logan found that traditional indigenous cultures had very little acne, if any at all, but as soon as they started eating a Western diet, laden with simple carbohydrates and high glycemic foods, their incidence of acne increased dramatically.
Cutting out or reducing carbohydrate and sugar intake from high glycemic index food items will go a long way to reducing the hormonal impact that these foods can have on an existing or developing acne problems.
Dairy Products & Acne
Consumption of dairy products is also closely linked with acne, in part because of the saturated fats, but also because of the hormones (including growth hormone) that are contained within milk, cheese and other dairy-related products. Surprisingly, fat-free milk can aggravate hormonal acne due to greater amounts of sugar and higher concentrations of hormones in the milk itself.
What Foods Should I Eat?
At this point, you might be asking: what foods should I eat to help with hormonal acne? Eating omega-3 fats and fiber help to reduce testosterone levels and utilizing soy-based foods can help to moderate and reduce toxic testosterone levels in women can help to balance out hormone levels.
Additionally, people who eat more fruits and vegetables (containing more antioxidants and anti-inflammatory compounds that can also help to moderate hormone levels) tend to have far fewer acne problems as well.
Food items such as fish oil, turmeric, ginger, green tea, nuts, dark purple and red foods such as berries, green foods like dark green leafy vegetables, and eggs have all been linked to improvements in many of the underlying causes of acne.
Food Allergies & Hormonal Imbalances
Food allergies can lead to hormonal imbalances that contribute to acne problems. Food allergies actually come in two different forms, as either an immediate or a delayed food allergy. Allergic reactions most commonly occur from foods such as peanuts, soy, wheat, shellfish, fish, milk, eggs or tree nuts.
With an immediate food reaction, allergy sufferers experience symptoms that happen either immediately or can take as long as a few hours to develop. Symptoms can range from mild to severe and may include tightening of the throat, wheezing, coughing, nausea, abdominal cramps, or diarrhea. In severe cases, with allergies specifically to food items such as nuts, shellfish, or peanuts, anaphylaxis shock can occur.
Any food allergy will almost always provoke an immune response after the food is ingested, prompting the body to over produce what are called Immunoglobulin E antibodies, (IgE). Delayed food allergy symptoms, one of the most common but misunderstood causes of hormonal acne, can take up to 72 hours to appear and can be difficult to identify since we eat so many foods with many different ingredients.
Stress Hormones & Cortisol
Does stress cause acne flare-ups? Both physical and psychological stress causes a release of cortisol, which is the primary human stress hormone. Elevated levels of cortisol, particularly for prolonged periods, increase inflammation and oxidative stress, which is very destructive to the human body.
Higher cortisol levels increase blood sugar levels and insulin production, and deplete zinc, magnesium and selenium, which are all minerals that help to control acne. Combined with the inflammatory response triggered by the increase in cortisol, higher cortisol levels can contribute greatly to hormonal acne outbreaks.
Stress can also result in poor dietary choices that can contribute to acne problems. It’s very important to manage stress with physical exercise as well as meditation, yoga, massage, biofeedback, or aromatherapy practice.