Zits Aren't Just for Teens -- Hormonal Acne Strikes Later

March 9, 2001 (Washington) -- Who accounts for the fastest-growing section of the population affected by acne? Teenagers? Think again. It's adult women, according to a briefing presented at last week's annual meeting of the American Academy of Dermatology.

"Seventeen million Americans have acne, and at least half of adult women suffer from some degree of acne," presenter Diane Berson, MD, tells WebMD. "But half of women don't respond to traditional therapy," such as benzoyl peroxide, retinoids, and antibiotics.

Why don't they respond? Their acne may have strong hormonal triggers through excessive levels of the hormone androgen in their sebaceous, or sweat, glands.

So if you didn't have acne as a teenage girl, but are suffering in adulthood -- and not improving with standard treatments -- the odds may be that it's related to hormones.

Such acne often appears as premenstrual "flares," with acne breakouts on the lower face, neck, jaw, and chin.

The first-choice therapy for hormonal acne is low-dose birth control pills. Corticosteroids also can be effective, as can Aldactone, a steroidal antiandrogen agent. All three of these treatments decrease sweat production.

In most cases, Berson says, women with hormonal acne have normal serum levels of androgens. That means that the problem is related to high "local" production of androgens in their sweat glands.

Berson, an assistant professor of dermatology at New York University, says that there usually is no need for a full hormonal analysis. But a doctor should check for adrenal, ovarian, and pituitary abnormalities if these signs are evident: alopecia (hair loss), hirsutism (excessive hair growth on the body and face), irregular menstruation, obesity, infertility, and deepening of the voice.

If adult acne isn't hormone-related, stress can be an agent or can make existing acne worse, since stress stimulates the adrenal gland. And some cosmetics, especially foundations and sprays/gels, can be a culprit, as can some prescription drugs, such as seizure medications and lithium and other antidepressants.

According to Berson, it's OK for a dermatologist to prescribe the pill to a healthy patient for acne, as long as the patient tells her gynecologist. Berson says that a patient also should commit to an annual physical (including a pelvic exam) with her primary care doctor.

Besides its acne benefits, the pill can help against hirsutism, bone loss, and other problems, such as irregular periods, cramps, and PMS.

But some women should not take the pill, including those with high blood pressure, a history of blood clots, smokers over age 35, and those who've had breast or uterine cancer.

Women can suffer hormonal acne right into menopause. Menopausal women won't find the pill effective, but hormone replacement therapy is an option for them, Berson says.

Why are adult women the fastest-growing segment of the acne population? Berson credits increased awareness. "I think women are comfortable with the fact that they can seek help," she tells WebMD. "They don't have to feel embarrassed going to a doctor for acne because it is something that women get."

But Berson also tells WebMD she thinks there is a greater incidence of adult acne than 20 years ago, since "stress levels are higher."