How to banish hormonal acne? - Dr. Priya J Talageri

Hormonal treatment should be considered in female patients whose acne is refractory to conventional lines of treatment. Hyperandrogensim is a definitive indication for hormonal therapy, but in women who have clinical signs of hyperandrogenism but normal androgen levels in their blood reports still be considered for hormonal therapy. We basically have 4 major categories of drug in the treatment of hormonal acne. They are anti androgens, peripheral androgen metabolism blockers, insulin sensitizing against and combined oral contraceptive pills. Anti androgens will block the action of sebaceous gland and hence they will decrease the release of sebum and control the acne. So spironolactone is what we have is a very potent anti androgen. It can be given in a dose of 50 – 100 mg per day dosage and it is very effective compared to an OCP in an adult onset acne. He next drug which falls into anti androgen category is cyproteronacetate which is used in the dose of 2 – 100 mg per day and it is usually combined with an OCP formulation and which will exert anti androgenic effects. We also have a novel progestin which is termed drosperinone which is only US –FDA approved progestin so far to be combined with a low dose estrogen and it has again anti androgenic properties which will treat hormonal acne as well as hirsutism. Next category of drugs are combined oral contraceptives which is the combination of low dose estrogen with various progesterones. Here we have to very carefully chose the OCP for the hormonal acne because most of the progesterones, that is the synthetic progesterones are having inherent androgenic properties.SO we here have to carefully chose a progesterone which has very low inherent androgenic property like a drosperinone which is US-FDA approved would be very ideal here.. Next category of drugs are anti-inflammatory as well as anti androgenic antibiotics like limicycline, which is a second generation tetracycline and we sometimes do use roxithromycin which is a macrolide. Again it also has anti androgenic properties, though it is a antibiotic. Recently there is a report that Vitamin D deficiency has a role in menstrual irregularities. Hyperandrogenism, hirsuitism, as well as in hormonal acne. So a supplementation of Vitamin D would be ideal. Apart from the hormonal care, the good routine also helps in hormonal acne. So cut out on the processed food as much as possible. Avoid sugars, white flours and fats. Stick to the whole diet, also usage of broccoli and cabbage would help you and do not pick or pop or squeeze the acne. Be very gentle while cleansing your face. Use a very mild cleanser. Since the hormonal acne is very cycylical in nature, using some creams and topical and medications prior to the cycles will help you and supplementing the diet with fish oils and zinc would also help in hormonal acne. And if you are using a cosmetic product, please stick to a non oily product.