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What role do hormones play on acne?

It is good to know that hormones (i.e. a chemical substance formed in one organ of our body that can be carried to another organ or tissue where it has a specific effect), specifically androgens and stress hormones do play a critical role in acne on many levels on us. However, we need to know that these hormones alone are not the sole cause of acne, many other factors are also involved in the process, for example bacterial overgrowth, the manner in which our skin cells differentiate and the stickiness of our skin cells.

There are two ways that these hormones affect acne, i.e. i) too much hormone is circulating in the blood that triggering acne and ii) an increased and inappropriate responsiveness of the pilosebaceous unit (i.e. the grouping containing the hair follicle and sebaceous gland) to a normal amount of circulating androgen. Hence, it is no surprised that even though all our blood tests on acne come back normal, our body, at the level of the sebaceous gland (i.e. oil-producing glands located in the deeper layers of our skin, and are attached to the hair follicle), when overly accepting hormones that are circulating in our blood will cause acne to occur.

When androgens levels increase in greater quantities in both boys and girls during puberty, this will cause the sebaceous glands to enlarge and increase in the production of sebum (i.e. oily substance produced that will end on the surface of our skin). In fact, the increased of sebum production because of androgens acting at the sebaceous follicle is always the prerequisite for acne even after our teenage years. This is the reason why acne is generally worse in areas where there is a higher density of sebaceous glands, i.e. the face and upper back, and generally absent in areas where we don't have any sebaceous glands in our elbows and feet.

Before the onset of puberty, i.e. between the ages of 7 and 8, the adrenal glands (i.e. small, hormone-producing organs that are found near the kidneys) of both boys and girls will produce increasing amounts of types of androgen called DHEAS (short for dehydroepiandrosterone sulfate) and testosterone (i.e. a male sex hormone), that can metabolize to more potent androgens in our skin and cause our sebaceous gland to enlarge and increase in sebum production. When girls mature, the ovaries take over this role from the adrenal glands, for the most part. We may want to know that our serum level of DHEAS correlates with the severity of comedonal acne (i.e. mostly blackheads and whiteheads. To know more about different types of acne, please click here) in prepubertal girls. In addition, acne severity increases with sexual maturity in both boys and girls along with the increased presence of androgens in their body.

Also, both boys and girls may have acne that is related to an increased sensitivity of the sebaceous gland to androgens. For girls and women, excess ovarian and adrenal production of androgens may also cause acne if it is persistent, or is associated with an increased hair growth on the face. In girls with acne caused by high circulating androgen levels, free testosterone and DHEAS in particular may be present. At the same time, low levels of a protein called sex hormone-binding globulin may also be observed. We may want to know that sex hormone binding globulin is attached to testosterone and will help keep it from affecting our skin; hence, a lack of this globulin will translate into greater amounts of androgen circulating in our blood and thereby affect our skin.

On the other hand, when our body is under stress, it releases a hormone called cortisol. This hormone actually helps us through whatever situation is at hand, however, cortisol also leads to suppression of our immune system (i.e. a collection of cells and structures in our body that fight disease or infection, for example, white blood cells, lymph nodes, and lymph vessels are the primary components of the immune system), which gives P. acnes (i.e. short for Propionibacterium acnes, a bacterium that grows and flourishes under certain condition and is the main culprit for inflammatory acne) an opportunity to flourish, leading to a flare of inflammatory acne in some people.

From the acne clear and acne care point of views, severe acne is usually a clue to a potentially serious hormonal influenced which should be diagnosed and treated early and appropriately both in terms of general health and for better results in treating our acne.

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