Increased stress and erroneous lifestyle choices have resulted in a significant change in the hormonal milieu in Indian women. Polycystic Ovaries is a genetic disorder that runs in families and can be passed down from either the mother or the father. With the rising prevalence of obesity in women and young girls, varying degrees of hormonal imbalance known as PCOS or PCOD have become fairly common. Although PCOD is a gynaecological condition characterised by irregular menstruation, it is most commonly diagnosed when patients visit a dermatologist for persistent acne, hirsutism, or hair loss.
So, when do I suspect PCOS or hormonal acne as a dermatologist?
When one or more of the following factors exist during a consultation, suspicion usually arises:
- Acne inflammatory with premenstrual aggravation
- Acne primarily affects the lower half of the face, jaw, and upper neck area.
- Hirsutism and/or hair loss may be present.
- Acne associated with irregular menstrual cycles or PCOS.
If none of the above factors are clear, acne that does not respond to conventional acne treatment such as topicals, antibiotics, and chemical peels is suspected to be hormonal acne.
How does a dermatologist know if the acne is hormonal?
This is a little tricky. A battery of blood tests is recommended. The results of the tests may reveal a clear deviation in hormonal status or they may be within normal limits. Normal test results do not rule out PCOD; in these cases, the ratios of various investigations are taken into account. Even if laboratory tests are inconclusive, the clinical diagnosis may be correct!
When will these hormonal tests be completed?
If the clinical diagnosis of hormonal acne is clear, tests are usually recommended during the consultation so that anti-androgen medications can be started. If the diagnosis is questioned, conventional acne treatment is initiated and the response is monitored. If the response is sufficient, the investigations may not be necessary. However, if the patient does not respond to 6-8 weeks of treatment, further investigation may be recommended.
Is hormonal treatment required for all cases of hormonal acne or PCOS acne patients?
No, not always. The medication is started at the beginning of the acne treatment for patients who require a quick response and are open to hormonal treatment. Topical and oral antibiotics/retinoids, as well as chemical peels, are started for patients who wish to avoid hormonal medication.
I typically use advanced chemical peels such as Agera, Obagi Blue peel Radiance, and Azelan to effectively control mild to moderate hormonal acne. If the patient's response is poor after 3-4 sessions, he or she is encouraged to begin the medication. If an adequate response is not obtained in 6-8 sessions, the patient is advised that oral anti-androgen medication is required if acne control is desired.
Acne is one of the dermatology lifestyle disorders that is completely treatable. Treatment time can range from 1-2 months for non-hormonal acne to 3-6 months for hormonal acne. Hormonal acne necessitates a more stringent maintenance regimen that includes carefully tailored skin care and monthly chemical peels.
Find a dermatologist you can rely on and be prepared for a long-term relationship. Hormonal acne patients frequently require a caring dermatologist who is committed to them for the rest of their lives.
Published by Dr Niketa Sonavane