Acne occurs due to excess activation of sebaceous gland in the skin. These are nothing but glands with ducts which produce sebum or skin oil. The purpose of skin oil is to keep the skin smooth and lubricated. For individuals who have acne, these sebaceous gland get overactive and produce excess sebum, and the exit of these sebaceous gland can get blocked due to proliferation. The sebum which gets trapped in the duct can become infected and then inflamed. Sebaceous gland activity is intrinsically controlled by several circulating factors, one of them is androgen. Acne does not occur in individuals who have androgen insensitivity showing the vital importance of androgens in the occurrence and progression of acne.
Acne, while being a skin condition, improves very well with therapy directed at suppressing androgen levels. In some women acne can be chronic and can persist into 30s and even 40s. In those women who have chronic acne, anti-androgenic treatment becomes necessary in the form of spironolactone or an oral contraceptive. In some women acne may be due to rare endocrine disorders, like adrenal or ovarian tumor or severe insulin resistance.
We work closely with several dermatologists to improve results for patients with acne. A careful evaluation is done by taking an examination to identify any signs of rare endocrine disorders. The patients are then tested for androgen levels and other endocrine problems before treatment with androgen lowering therapies is initiated.
Hormonal therapy is indeed very safe and effective for those women who are struggling with acne. There is a wide misconception that hormonal therapy is either unsafe or ineffective in acne. The non-hormonal therapy for acne is isotretinoin which can be given only up to a particular cumulative dose. Many patients continue to have acne despite taking the full cumulative dose of isotretinoin. In these patients anti androgenic treatment becomes necessary and people take Anti androgenic medication for decades, if not years. We usually monitor patients on acne therapy once or twice a year to see if the therapy is progressing on expected lines.
Hormonal therapy for acne consists of two varieties:
Both oral contraceptive pills (OCP) and spironolactone are highly effective for acne. Many randomized controlled trials have shown that more than 80% of patients with acne do see some form of improvement with this line of therapy.Typically, improvements in acne are seen very quickly after initiation of antiandrogenic therapy within a fortnight, also making this highly suitable for many patients who require quick improvement in acne condition.