Hormonal acne on the rise in women

The prevalence of acne in females is on the rise, Dr. Renita Ahluwalia reported during her presentation at Skin Spectrum Summit in Toronto (875 words, 3.5-minute read)

For females with skin of colour and other skin types, hormonal acne is on the rise, according to Dr. Renita Ahluwalia, who reported on the topic in a presentation at Skin Spectrum Summit in Toronto.

“Fifty per cent of women in their 20s and 35 per cent of women in their thirties experience acne,” said Dr. Ahluwalia. “The main age of referral for women with acne has increased by eight years over the last decade, from 18.5 to 26.5.” 

During her talk, Dr. Ahluwalia emphasized the importance of considering hormonal factors when treating female patients with acne. “Up to 85 per cent of adult women complain that their acne flares a week before their period, with hormonal flares higher in women over age 30 compared to younger women.” 

When treating hormonal acne, it can be helpful to consider the etiology of the acne. Prior to a woman’s menstrual period, a woman experiences an increase in her progesterone and estrogen, which can stimulate the premenstrual acne flare. 

Dr. Ahulwalia talked about how a combination topical regimen of clindamycin phosphate 1.2%/tretinoin 0.025% [Biacna, Bausch Health] and topical dapsone 5% [Aczone, Bausch Health], along with an over-the-counter benzoyl peroxide cleanser and supported with the hormonal birth control spironolactone, was an effective treatment for a patient with severe hormonal acne. 

“What is really unique about the tretinoin in this [topical combination product] is that there are two forms of it: one that is immediately available and one that solubilizes slowly by going into the skin and into the follicle to increase penetration,” said Dr. Ahluwalia.

“Another key point about the tretinoin in this product is that it is not degraded by sunlight or benzoyl peroxide... The delayed release of the second form [of tretinoin] and its small particle size [allow] it to enter into the pilosebaceous unit and target those resistant P. acnes.” 

In a three-week head-to-head trial, patients treated with the clindamycin/tretinoin combination product had less stinging, scaling, and erythema compared to those receiving a combined product of adapalene and benzoyl peroxide. There was also a 50 to 60% decrease in both inflammatory and non-inflammatory lesions after 12 weeks. 

“[Topical dapsone 5%] works better in female patients,” said Dr. Ahluwalia. “Studies have shown that 48.6 per cent of women achieve clearer skin [compared to] 34.4 per cent of men.” Dr. Ahluwalia also stated that this product works on both inflammatory and non- inflammatory lesions and patients are sustaining treatment results for over a year.

A Canadian study on topical dapsone 5% treatment in 101 female patients showed very effective results. Using the global acne grading score as a measuring tool, 69 per cent of patients achieved success. 

After three months of the topical combination regimen, Dr. Ahluwalia's patients had noticeably improved skin but were not completely clear of acne. To further target the hormonal component of her patients’ acne, Dr. Ahluwalia prescribed 100 mg daily of spironolactone. 

The takeaway: “When there is a hormonal component, we have to address that,” said Dr. Ahluwalia 

Dr. Ahluwalia’s presentation was supported through an unrestricted educational grant from Bausch Health. 

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FROM THE LITERATURE ON FEMALE HORMONAL ACNE

A study comparing the clinical and hormonal profile of late-onset and persistent acne in adult females

  • Persistent acne patients were found to have signs of hyperandrogenism, polycystic ovary syndrome, and hormonal abnormalities at higher rates than patients with late-onset acne, according to a recent study that looked at 120 adult female acne patients. 

    From “Int. J. Dermatol”

Systematic review of the epidemiology of acne vulgaris

  • In a systematic literature review, researchers looked at the 35 published papers and found associations between family history, age, BMI, skin type, and hormonal factors that influence acne presentation. The investigators said that contraceptive use and the regularity of mensuration were not closely linked to acne rates, but pregnancy status was.

    From “Scientific Reports”

A prospective study examining trigger factors and hormonal abnormalities in adult female acne

  • In a recent study, researchers noted that stress, diet, cosmetics, and hormonal dysfunction as triggers for acne in adult female patients with acne. The investigators said that clinicians should consider discussing acne triggers with their adult female patients.

    From “Indian Dermatology Online Journal”

VIDEO: Seasonal changes in skin lipids may worsen acne in winter

AT THE INTERSECTION OF SKIN & SOCIETY

  • The disposable personal bandage is having a transformational year, according to a recent report from the television program, “CBS This Morning.” This year, which marks the 100th anniversary of the Band-aid brand, the manufacturer, Johnson & Johnson has expanded the spectrum of flesh-tone colours available. The movement to create more racially sensitive bandages is also being led by a new brand, Tru-Colour Bandages. “The bandage helps with healing, physically, but there is also an emotional, psychological aspect; just seeing that you are acknowledged for who you are and that there are options out there,” said Dr. Raymond Wurapa (pictured below), who helped to develop Tru-Colour bandages. View the full video report here.

This Week

Something to think about during the week ahead…

Next Week

Dr. Marissa Joseph discusses the different morphologic variants of atopic dermatitis in patients with skin of colour. Subscribe to Skin Spectrum Weekly and have each issue sent directly to your phone or inbox.

Thank you to our panelists and delegates for making Skin Spectrum Summit 2020 a great success. Conference highlights will soon be posted to the Skin Spectrum website. As always, we welcome your questions and comments on topics in Ethnodermatology.

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