The Role of Hormones In Cystic Acne: Best Treatment Options
While the majority of us have experienced the occasional pimple outbreak during our adolescent years—not of all us are lucky to have clear, flawless skin going into adulthood.
Acne is a common condition that can persist from adolescence into adulthood and is primarily influenced by genetics, hormonal fluctuations and lifestyle factors. Adult acne is confirmed to affect women more than men in all age groups—with 50% of women facing acne in their 20s.
Often, acne is a sign that something has gone out of balance in our body. Given that women face more hormonal fluctuations than men throughout their lifetime (think puberty, menstrual cycles, pregnancy and menopause), it’s no surprise to see women experiencing more breakouts in their 20s-50s.
So, why and how do hormones play a role in causing stubborn acne?
The role of hormones
Androgens (male hormones like testosterone) is the main reason for causing acne because they stimulate our sebaceous glands to produce more oil.
However, female hormones, namely estrogen and progesterone also have a role to play, i.e., to balance out the effects of testosterone and keep sebum production under control. While our hormones are typically able to regulate themselves and settle into a natural rhythm, factors such as our diet, skincare products, menstrual cycles and stress levels can all cause an imbalance.
Studies have shown that acne worsens during the premenstrual period in 60-70% of women due to the relative increase in androgens.
In short, it is the estrogen/androgen ratio that affects the overall activity of the sebaceous glands—when there is an imbalance that leans towards higher androgen levels, this is what results in the overproduction of sebum, which we know by now is the perfect breeding ground for the P.acnes bacteria and leads to clogged pores and inflammation.
Other hormones such as an increase in cortisol levels during periods of stress can also result in increased androgen activity and inflammation.
Although anyone can develop acne, a more serious and hard-to-treat condition is cystic acne, which tends to occur in people with oily skin and is more commonly seen in teens, women and adults with hormonal imbalances. While severe cases are more commonly seen in men, women often notice cysts focused on the lower half of their face.
As cystic acne is often characterized by large, red, painful and often pus-filled cysts under the skin that lingers and can also appear on the back, chest and shoulders—this is the reason why many patients end up seeking help from a dermatologist.
How to treat cystic acne
Topical treatments are the most widely used solution for those with mild-to-moderate acne symptoms or as a maintenance treatment. This includes the use of retinoids, benzoyl peroxide and azelaic acid—all of which targets a specific casual factor of acne.
However, since cystic acne is a condition that is found deeper within the skin that develops with more intense inflammation, this makes topical solutions simply ineffective and a waste of time.
Taking oral antibiotics can be helpful for more severe cases; however, relapse is often common after stopping treatment. Not to mention, the use of antibiotics is not recommended for long-term use due to side effects such as inhibiting fetal growth in pregnant ladies and developing bacterial resistance. Also, studies have shown that antibiotics aren’t as helpful for women facing hormonal imbalances.
Since the goal of treating cystic acne caused by hormonal fluctuations is to block androgen activity—one treatment worth mentioning is spironolactone, which given in lower doses, has demonstrated excellent results in treating adult acne in women. Hormonal therapy can also be helpful for women who frequently experience flareups during their menstrual cycle and can delay the need for isotretinoin.
Isotretinoin is by far the most effective solution for treating severe acne, although special precautions need to be taken to avoid adverse side effects. About 85% of people who take isotretinoin experience improvements within 4-6 months; however, may experience symptoms such as persistent headaches, skin inflammation, muscle and joint pain and even mood disorders like depression.
Prescription-strength solutions are your best bet for treating cystic acne and should be combined with in-clinic treatments including microdermabrasion, chemical peels and laser therapy to help keep acne within control and get rid of acne scars. In fact, there is now a promising approach to treat all types of acne and is one of the safest acne spot treatment for pregnant women: introducing Gold PTT.
Gold PTT Treatment @ The Clifford Clinic
Gold Photothermal Therapy (PTT) treatment is a solution that works by delivering gold nanoparticles into the oil glands and using a dermatology laser to convert light into heat energy to create a highly-targeted photothermal effect.
Gold nanoparticles are used due to their tunable optical properties, including high photothermal conversion efficiency, easy synthesis and low toxicity that makes it easy for our doctors to customize your treatment. As an acne treatment, it helps to modify the sebaceous pores responsible for causing acne by permanently reducing sebum production—thereby treating acne at the source.
The entire procedure takes roughly 30-45 minutes and involves 4 simple steps:
Step 1: Facial cleansing
Step 2: Application of Gold PTT nanoparticles and massaging of gold particles into the skin
Step 3: Application of Bellasonic Ultrasound to pulse the gold particles into the oil glands
Step 4: Laser treatment (using the 800nm diode laser and 1064nm long-pulsed laser) to excite the gold nanoparticles and help convert light energy to heat energy to work its magic on the sebaceous glands.
It will require 3 treatment sessions over a 1-week period where patients can expect improvements in their acne around 6 weeks after the last treatment. Studies have shown that gold nanoparticles can help effectively reduce the appearance of inflammatory acne lesions. Another recent study in 2020 also reported the treatment as valuable in diminishing facial pores!
As mentioned earlier, Gold PTT treatment is a powerful treatment for those facing mild to cystic acne. If you are facing recurrent acne that refuses to go away, you should also consider trying out this treatment.
The procedure is mostly comfortable (you might feel a slight tingly sensation) and it is okay to resume your daily routines immediately after treatment. You may also experience some redness, itching and discomfort at the treatment area which should resolve within a month.
Since acne-causing bacteria found in the pores are destroyed during the treatment, this treatment essentially alleviates existing acne symptoms and prevents future outbreaks!
At The Clifford Clinic, we are honoured to be the first clinic in Singapore to offer Gold PTT treatment and have experience in managing pregnancy and post-pregnancy related acne including acne scar treatment.
The importance of a combination treatment approach
When trying to treat any type of acne, especially cystic and recurrent acne, it is vital that you use a combination treatment approach that addresses the root cause of acne.
Cystic acne or acne that is caused by hormonal fluctuations can be tricky to treat since patients often deal with recurring outbreaks and more severe symptoms. Since they also come with deep inflammation that is a result of systemic causes, this requires a more clinical approach to treatment that starts from the inside out.
This is the reason why we have assembled a large collection of devices and over 10 different treatments to deliver a more comprehensive solution for our patients that includes facial treatments, acne laser treatment, localized acne treatment and topical and oral therapy. We are also the pioneers for both AGNES (a permanent cure for acne that also treats acne at its root) and Gold PTT treatments in Singapore and are able to come up with a safe and effective treatment plan that includes acne scar removal.
With more than 40 years of combined experience, our doctors focus first on understanding your concerns and goals before offering expert advice on what will work best for you.
Don’t underestimate how demoralizing and isolating acne of any severity can be. Seeking prompt treatment can help you to feel more confident and see better results—don’t hesitate to contact us to book your appointment today!