Acne from gynecological perspective

Acne from gynecological perspective

Many think that acne is only treated by dermatologists, in this article we will reveal the role of a gynecologist in the treatment of acne.

Hormonal acne is usually linked to fluctuations or imbalances in female sex hormones (especially androgens which are male-type hormones that a woman’s body also produce).

Causes of hormonal acne:

• Increase in androgens
• Estrogen fluctuations
• Progesterone fluctuations
• Oil glands overstimulation
• Pores clogging

At what stages of life does hormonal acne appear or worsen?

• Puberty
• Premenstrual
• Pregnancy
• Postpartum
• Perimenopause
• Right after stopping birth control pills

What are the body parts that are most affected by hormonal acne?

• Chin
• Jawline
• Lower cheeks
• Neck

Characteristics of hormonal acne:

• Deep
• Painful
• Cystic
• Occurs in the same spot
• Worsens before menstruation

Gynecological causes of hormonal acne:

1. Polycystic ovary syndrome:

** irregular cycles

**hirsutism

**weight gain

**hair thinning

**infertility

In this syndrome the production of androgens is increased leading to more oil and cystic acne.

2. High androgen levels:

These women are more sensitive to androgens

3. Changes by birth control pills:

** starting or stopping them

** some OCPs treat acne (anti-androgenic characteristics)

** some OCPs have androgenic progesterone components leading to worsening of acne

4. Stress:

** it increases cortisol levels which leads to increased adrenal production of androgens

When should a lady with acne be referred to a gynecologist?

When she has:

• Irregular cycles
• Severe premenstrual syndrome symptoms
• Infertility
• Sudden severe acne
• Hirsutism
• Deepening of the voice

Assessment conducted by the gynecologist:

** total and free testosterone

**hormone produced by adrenal gland

**LH/FSH ratio

** prolactin level

** thyroid function tests

** pelvic ultrasound

How is hormonal acne treated?

• Lifestyle changes:

** low sugar diet

**weight loss

**get good sleep

**stress management

• Hormonal medications:

** combined oral contraceptive pills

**spironolactone

**metformin especially in insulin resistance

Treating hormonal acne is not only about cosmetic outcomes, it also means that the body is once again in equilibrium.

Dr Najeeb Layyous  F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist