The Many Faces of Acne

acne_faceI know that I have written many posts about acne in the past, but it is such an incredibly common problem that I am moved to write again on this topic.  Spoiler alert: Due the suggestion of several patients with acne that I have helped in the past, I will catalog all my professional knowledge, research and clinical experience into a book or books on acne in the next year.

Acne is a heartbreaking problem that can occur in both genders, many age groups, and all skin types.  Certainly, teenagers are more prone than other age groups, and women are more prone than men.  Hormones are the common bond that links these particular groups in regards to having more acne.

Changes in hormone levels are generally the driving force in the onset of acne.  The male hormones, collectively known as androgen, are the most potent in the cascade of hormones that affect acne.

androgen_acneSpecifically, androgen stimulates the oil or sebaceous glands to produce more oil or sebum.  As you know from previous posts, sebum mixed with dead skin cells and hair plugs up the skin pores and starts the inflammatory process of acne.

While we are talking about androgen as “male” hormones, it is important to note that women produce them as well.  Women produce androgen in their ovaries in small amounts and in their adrenal glands (a small gland that sits on top of your kidneys).

One common method for altering hormone levels and their fluctuation in women is to use oral contraceptives or birth control pills.  Certain types of oral contraceptives can reduce androgen production by almost 50%, and can reduce outbreaks of acne in some but not all women.

Obviously, birth control pills will not help the teenage boy with severe acne or the young lady who is concerned about taking hormones long term.  Another type of androgenic hormone that is not controlled by oral contraceptives, but can worsen acne, is called cortisol.

stressed_outCortisol is also commonly referred as a stress hormone.  It is triggered for release by the adrenal glands when your body is under stress.

This hormone is responsible for what is called the “fight or flight” response.  From an evolutionary point of view, this is part of our survival mechanism.

When early humans had to escape from the dangers of the hostile world, cortisol would surge from the adrenal glands into the bloodstream.  This surge resulted in a kick-start of heart rate, blood pressure and muscle tension to outrun the wild animal in pursuit.

While surges of cortisol are useful at times, especially for survival situations, these fluctuations occur even with emotional and intellectual stress.  Essentially, the stressors of everyday life in our modern society can trigger this hormone response which now causes molecular and cellular changes that results in acne.

That is why it is extremely common for me to hear that outbreaks occur with stressful job changes, school exams and relationship problems.  All are in agreement that breakouts often come at the worst times socially also: the prom, the job interview, or (God forbid) the wedding day!

At least now you know that it is not just bad luck or the stars.  Rather, it is stress and its hormonal consequences.

The next question is this: how can we control the stress hormones and their fluctuations?  Many of the following recommendations in this area will seem like common sense, but they are commonly ignored:

  1. Getting good quality and adequate amounts of sleep is important to help your body recover from the stressors of the day.  7-8 hours of sleep are needed and uninterrupted if possible.
  2. Stress-reducing activities such as meditation, yoga or prayer have been shown in studies to lower cortisol levels and lower the incidence of acne breakouts and even preventing age-related diseases.
  3. Lowering carbohydrates and sugars in your diet can lower fluctuations in blood sugar and insulin, which have been shown to affect cortisol levels as well.  This is bad news for the “junk food” junkies of the world, but explains why many teenagers see outbreaks when they eat the way they do.

In other posts (and in my forthcoming books), I will go into more detail about the specifics of dietary changes I would recommend.  Suffice it to say that hormones are contributors to acne flareups but there are definitely things we can do about it that do not require medication.

About Dr. John Burke

John Burke M.D. has practiced medicine for over 25 years, and is the founding partner of MidMaine Internal Medicine. He established Maine Laser Skin Care in 2004 after devoting years to learning the latest in laser and dermatologic technology. Dr. Burke has treated patients from all over the United States. He is one of Maine's busiest practitioners in laser treatments, and in the use of Botox for upper facial lines and excessive sweating.
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