CC BY
0HORMONAL CHANGES AND THEIR IMPACT ON ACNE DEVELOPMENT: WHAT TEENAGERS AND ADULTS NEED
TO KNOW
Pulatova S.Kh.
Tashkent Pediatric Medical Institute https://doi.org/10.5281/zenodo.13636718
Abstract. The article discusses the hormonal aspects of acne vulgaris pathogenesis in adolescents and adults. Particular attention is paid to the influence of sex hormones, such as androgens and progesterone, on the development and course of the disease. The clinical features of acne associated with hormonal changes, as well as various therapeutic approaches, including the use of topical and systemic drugs, hormonal contraceptives and antiandrogens are considered. Emphasis is placed on the needfor an integrated approach to treatment, including control of stress factors.
Keywords: acne, hormonal changes, androgens, progesterone, topical retinoids.
Acne (acne vulgaris) is often associated with hormonal changes and is characterized by hyperactivity of the sebaceous glands, hyperkeratinization of the follicular epithelium, and colonization by Propionibacterium acnes. In childhood, the sebaceous follicles are not yet developed and cannot cause acne, but during adolescence, the influence of androgens increases in both sexes.
Approaches for treating acne
The approach to treating acne in a particular patient is largely determined by the severity of the current stage of acne. Often, in order for acne to disappear, there are enough simple external products that eliminate acne and improve skin condition, as well as actions of a general health plan (healthy diet, hygiene, stress reduction, etc.). However, if acne is severe, or the above methods have been tried, but did not give the proper result, then an analysis is necessary. Only additional tests for acne help to find the root cause of acne.
When answering the question of what tests to take for acne, the following categories are usually indicated:
analysis of the skin for microbial flora and the presence of parasites
- blood chemistry;
Puberty is a critical period for the onset of acne. During this period, levels of androgens such as testosterone increase significantly, stimulating sebaceous gland hyperplasia and increased sebum secretion.
Androgens act through androgen receptors, which are located in the sebaceous glands and hair follicles. Increased sebum production and changes in its composition create conditions for the proliferation of Propionibacterium acnes bacteria, which leads to inflammatory reactions in the skin. Studies have shown that even minimal changes in testosterone levels can significantly affect sebum secretion and acne development.
In women, acne may be worsened during periods of hormonal fluctuations, such as the menstrual cycle, pregnancy, and menopause. Increased progesterone levels during the luteal phase of the cycle increase sebum production.
Hormonal contraceptives and antiandrogens, such as spironolactone, can be used to reduce the effect of androgens on the sebaceous glands. Studies have shown that combined oral contraceptives can reduce the number of androgens in the blood and thereby reduce acne.
In addition to sex hormones, stressful situations can also influence the development of acne by activating the hypothalamic-pituitary-adrenal axis. Levels of cortisol, a stress hormone, increase, which can stimulate sebum production and worsen inflammation. Stress can also affect the skin's immune response and worsen inflammation.
The clinical manifestations of acne can vary from mild forms, represented by comedones and superficial papules, to severe nodular and cystic forms. Hormonally induced acne is often characterized by deep, painful inflammatory lesions, especially on the lower face and along the jaw. Differential diagnosis includes exclusion of other dermatological diseases such as rosacea, perioral dermatitis and demodicosis, as well as systemic endocrine disorders such as polycystic ovary syndrome (PCOS) and hyperandrogenism.
Treatment for hormonal acne involves the use of topical and systemic medications. Topical retinoids, such as adapalene and tretinoin, help normalize keratinization and reduce comedone formation. Antibacterials, such as benzoyl peroxide and topical antibiotics, are effective in combating P. acnes and reducing inflammation. For women with hormonally induced acne, combination of oral contraceptives containing antiandrogen progestins or spironolactone, which blocks androgen receptors, may be recommended. In severe cases, systemic retinoids such as isotretinoin may be indicated, but their use requires strict monitoring due to the risk of teratogenicity and other side effects.
Hormonal changes play a key role in the pathogenesis of acne in adolescents and adults. Understanding these mechanisms is important for developing effective treatment and prevention strategies.
A comprehensive approach to acne treatment, including hormonal therapy, topical and systemic medications, and stress reduction measures, can significantly improve the quality of life of patients and help control this common skin disease.
REFERENCES
1. Brown R. Androgen Excess and Acne in Women: A Review of the Evidence. Dermatologic Clinics. 2018. 36(2), 177-186.
2. Smith L., Jones A. The Role of Hormones in Acne: A Comprehensive Review. Journal of Dermatological Science. 2020. 90(2), 145-156.
3. Thiboutot D., Del Rosso J.Q. Pathogenesis of Acne: Recent Research Advances. Advances in Dermatology. 2013. 29, 1-9.
4. Williams H.C., Dellavalle R.P. Acne Vulgaris: Diagnosis and Treatment. BMJ. 2016. 333(7555), 949-953.
5. Zaenglein A.L., Pathy A.L., Schlosser B.J., Alikhan A., Baldwin H.E., Berson D.S., Dreno B. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. 2016. 74(5), 945-973.
6. Zouboulis C.C. Acne and sebaceous gland function. Clinics in Dermatology. 2009. 22(5), 360-366.
7. Kalinina N.A., Kanauzova I.M., Medvedeva O.V. Differentiated approach to the treatment of acne and hirsutism in women with hyperandrogenism // Bulletin of dermatology and venereology. n 2004. - No. 3. n P. 30-32.
8. Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R. Bacterial community variation in human body habitats across space and time. Science. 2009;326:1694-7.
