However, 60 percent of women either do not respond to standard acne treatments or build up a tolerance to frequently used medications. "I want to make an appeal to every woman who has not been able to control her acne through topical treatments or antibiotics to consult with a dermatologist soon," said Dr. Thiboutot. "There are so many different new therapy options to chose from now that most cases of persistent acne can be improved."
Acne in women is often related to her menstrual cycle. Women with premenstrual acne outbreaks, especially outbreaks on the lower face and neck, seem to respond particularly well to treatment with medications that either reduce or block androgen production. The androgen hormones create male traits in women such as a deepening of the voice, an increased libido or hirsutism that causes an excessive or abnormal growth of hair. They also stimulate the oil (sebaceous) glands, typically found in areas where acne is common such as the face, upper back and chest. The oil mixes with skin cells and bacteria, causing inflammation in the skin which appears as redness, swelling and pus -- commonly known as a pimple.
It is not yet known exactly what causes adult acne. It is important for patients to note that acne is not caused by dirt, nor is it related to the foods a person eats. Some types of liquid foundation and other make-up can clog pores and aggravate acne. In addition, hairspray, gels and other hair products that come in contact with the skin may worsen acne blemishes. While some patients try to conceal acne with a tan, the sun's harmful ultraviolet (UV) rays age the skin and can cause skin cancer, wrinkles and other dermatologic aging.
Before a dermatologist prescribes hormone therapy for a woman, the doctor may perform a standard screening work-up that includes two hormones -- testosterone and DHEAS (dehydroepiandrosterone sulfate). It is also important that the patient stop taking oral contraceptives for at least one month before any tests are performed because birth control pills can suppress androgens.
The basis of hormonal therapy is the birth control pill. The medications most effective in controlling acne contain a hormone called progestin with low androgenic activity (with generic pharmaceutical names such as norgestimate or desogestrel) in combination with 35 micrograms of ethinyl estradiol, an estrogen.
"As with any therapy, there are risks and rewards. The risks of hormonal therapy require regular breast and pelvic exams to guard against the increased risk of certain types of cancers. It is vitally important that dermatologists work with the patient's gynecologist to determine the most appropriate treatment and follow-up especially in women over the age of 40 or those who might be smokers," Dr. Thiboutot noted.
In addition to consulting on cases of acne in adult women, dermatologists and gynecologists often consult on cases of young women with acne. It is common for a dermatologist to be the first to consult with a teenage girl who comes into the office with acne that is actually a symptom of polycystic ovary disease. Both acne and polycystic ovary disease are caused by an imbalance in androgen hormones. It is important for dermatologists to work closely with the young patient's gynecologist to reduce the risks of infertility, cardiovascular disease and insulin-resistant diabetes. The identification of polycystic ovary disease is an important contribution to the long-term health of these young patients.
"Hormonal therapy is a good treatment for many teenage and adult women," Dr. Thiboutot said. "It is used less often than it could be because there are so many options to choose from. The patient should realize it is a good adjunct therapy."
Most acne treatments require prolonged care ranging from months to years depending upon the individual. Even after the acne is controlled, ongoing therapy is typically required to maintain the positive results.
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