When It's More Than Acne
There are other hormonal disorders whose symptoms can include acne, but these are much more unusual. For example, people affected by a group of inherited disorders known collectively as congenital adrenal hyperplasia often produce either too much or too little of certain sex hormones, including testosterone.
"People with these disorders have a problem with the adrenal glands, which produce and metabolize hormones," Schlosser says.
Treating Hormonal Acne
Most women who have acne related to a hormonal condition like PCOS have probably found that standard topical acne therapies, such as retinoid gels and creams, don't meet their needs.
"These people do best with hormonal therapy," Schlosser says.
There are two main ways to manage hormone issues that are linked to your acne outbreaks:
Schlosser usually starts patients on a birth control pill that has estrogen and progesterone. Estrostep, Ortho Tri-Cyclen, and Yaz are the three brands approved by the FDA for acne treatment.
It's not an overnight process. "You have to give this approach at least 3 months of use before you can judge its impact," Schlosser says. "That's the point at which studies found a notable difference between placebos [dummy pills] and oral contraceptives. Many patients saw further improvement around the 6-month mark."
If birth control pills aren't working or give only partial relief from your acne, your dermatologist may recommend spironolactone. It may also be the first treatment of choice for hormone-related acne if you smoke or have other risk factors that make hormonal contraceptives undesirable. "Many of my patients get significant added improvement with this drug," Schlosser says.
Redmond usually starts his patients on 100 to 200 milligrams of spironolactone per day. "Most people tolerate it fairly well. Since it is a diuretic [meaning that it causes you to urinate more often], you'll need to keep up your water intake. But as long as you do that, you shouldn't have too many problems."
"For women, spironolactone works in a very high percentage of cases," Redmond says. "For men, it's not optimal because it blocks testosterone."
So how long will you need to take these medications? That's hard to say. "Eventually, the tendency to have acne goes away for most people, but it's hard to know when," Redmond says. "The medications are often necessary for a few years. It's mostly luck in how long it persists."