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When It's More Than Acne

Other Conditions

There are some 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,” explains Schlosser.

Treating Hormonal Acne

Most women who have acne related to a hormonal condition like PCOS have probably found that more “standard” topical acne therapies, such as retinoid gels and creams, don’t meet their needs. “These people do best with hormonal therapy,” says Schlosser.

There are two primary options for hormonal management of acne:

  • Birth control pills (only certain formulations)
  • Spironolactone, a diuretic which also blocks the binding of androgen receptors, blunting the hormonal fluctuations that cause acne

Schlosser usually starts patients with acne related to a hormonal condition like PCOS on an oral contraceptive pill containing both 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 three months of use before you can judge its impact,” she says. “That’s the point at which studies found a notable difference between placebos and oral contraceptives. Many patients saw further improvement around the six-month mark.”

If oral contraceptives are not working, or only giving 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,” says Schlosser. 

Redmond usually starts his patients on 100 to 200 mg 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,” says Redmond. “The medications are often necessary for a few years. It’s mostly luck in how long it persists.”

Reviewed on April 20, 2011

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