Hormonal fluctuations are a key contributing factor to acne in all age groups.
Androgen hormones, including testosterone stimulate overproduction of oil secreted by sebaceous glands located in every hair follicle, leading to clogged pores and P-acne bacteria proliferation. To read “Acne, why and how it happens” click here.
Although androgen hormones are more dominant in men, women may experience also their acne-causing effects. As estrogen and progesterone levels fluctuate throughout the days, months and life, an imbalance of testosterone can take place, leading to more potential for breakouts.
During puberty (from age 9-14 in girls and 10-17 in boys) lots of biological and physical changes occurs together with changes to the skin. Because of its role that testosterone hormones have in the onset of acne, the condition is more severe in males during puberty. However it normally clears up or get much better by mid 20s and is not as reoccurring throughout life as in females.
About 45% of women suffer from menstrual cycle breakouts, because this 28 day process involves constant fluctuation of different hormones, which can improve or worsen the skin condition. During days 1 to7 of the cycle, estrogen hormone level increases clearing up the skin and during days 15-28 it begins to decline again which increase the potential of blemishes. In addition to a drop in estrogen, the progesterone level increases causing follicles to swell, compressing pores which in combination with the increased oil production create an ideal environment for acne.
Peri-menopause and menopause period begins when ovaries production of estrogen and progesterone slows down, while testosterone becomes more dominant, stimulating sebaceous glands produce more oil. In addition, surface hydration decreases with age (due to decreased surface lipids), trapping oil beneath the surface, this leads to a higher potential for breakouts. Menopause acne sufferers’ skin is considered water dry, not oily dry.
Another hormone cortisol (released in response to stress) stimulates sebum production and inflammation and thus contributing to severity of acne.
In summary even though acne pathology remains the same, adult acne is typically drier and similar to menopausal acne than teenager acne, due to decrease of surface lipids. To create an appropriate treatment plan both teenager and adult acne should seek advice from a professional
For my next article “Treatment plan to control teenager and adult acne”. (click here)
First of all, no matter what causing acne (hormones, genetics, stress, skin’s lipids abnormalities, faulty skin exfoliation and others) it is important to understand that acne is our body immune system respond. To understand it, I will explain on very simple model as to how and why it forms within the skin.
- Epidermis (top layer) of the skin mostly composed of dead cells (keratin filled). But those cells have not been dead for long. About every 5 days new cells are born in the lowest layer of epidermis and start their journey to the surface before they die, which takes about 28 to 40 days.
- Cells protect us by shifting from being water-filled to keratin filled giving the strength and integrity to the skin as they move up to surface. Ultimately, because of water loss these cells die and slough off in about a month.
- Dead cell together with oil, secreted by oil glands (sebaceous gland, located in every hair follicle) create skin barrier from external (like bacteria, weather changes) and internal (like dehydration, temperature changes) factors.
- But occasionally, things go wrong. Sometimes the cells don’t effectively move up and out of the follicle shaft that the oil glands are attached to, resulting in clogs composed of sticky cells, oils and the like, which can go on and form a black head or a white head .
- If the clog gets large enough it block excess air to follicle. Without oxygen P-acne bacteria (which live in all skin) starts developing and multiply, while matter forming in the clog (dead cells and oil) is feeding the bacteria.
- Now since that bacterium is no longer under control, our defense mechanism is activated and rushes to fight the bacteria, resulting in papule, pustule or cyst. Histamine (defensive hormone) is released that causes swelling and consequent pain from pressure on nerve ending. Capillaries are dilated to allow immune cells to arrive quickly causing redness and heat. And last, the pus is formed as a sign of the end of the battle.
Picking at pimples can give you immediate satisfaction but the infection can get worse, spread and cause permanent scaring along with post-inflammatory hyper pigmentation (brow or red spots).
Excessive washing of oily skin on the other hand, can be as detrimental as not washing enough, as is the use of overly drying products. Under each circumstance, the skin gets dehydrated, causing it to overproduce oil as it tries to seal in whatever water remains, which can lead to more clogged pores.
At this point very important to understand that your skin is not your enemy, it is as confused as you are and needs the help. It is time to change your habits and to start working together with your skin, not against it. It is the time to get professional advice with an appropriate treatment plan in office and at home.