The hormone factor
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If your acne is cystic and concentrated around your mouth, blame your hormones Because the pill stops the hormonal fluctuations that can bring on those breakouts, it’s often a solution. And if you started taking the pill in your teens or 20s, well, you may not even realise it’s helping keep your skin clear until you go off it and break out. Some women develop cystic acne for the first time only after they stop taking the pill, says dermatologist Dr Jill M Weinstein.
The link between other forms of birth control and breakouts, however, isn’t as clear-cut “There’s currently controversy around IUDS and acne,” says Dr William James, a professor of dermatology who has seen patients break out after switching from oral contraceptives to the semipermanent device. “Many IUDS output hormones, which could lead to acne flare-ups, but it’s such a small amount of hormones that we don’t know if those are causing acne or if it’s because you’re losing [the skin] benefits of oral contraceptives.”
Another pill with skin benefits is an oral blood pressure medication called spironolactone “It’s undergoing a renaissance for acne treatment,” says Dr James. “It blocks the effects of androgen hormones on oil glands.” But it’s not without potential side effects, such as irregular periods. So companies are researching ways to control excess oil production (a sign of hormonal acne) without influencing hormone levels. The most promising, DRM01, is a topical drug that shuts off the enzymes needed to make sebum. It could be available in as little as two years.
1Benzoyl peroxide It works in about 12 weeks by calming inflammation and killing the bacteria that cause acne. But there’s a good chance you’re using it the wrong way. “We used to think of benzoyl peroxide as a spot treatment,” says Dr James. “But since it kills acne bacteria, we now know to use it all over to prevent new breakouts.” A 2.5% or 5.5% formula works as well as a 10% one, without the flaky side effects. TRY La Roche-posay Effaclar H (R240) – it’s a dermatologist favourite.
2It’s in a lot of acne products, but because it works by removing excess oil and dead skin cells from the skin’s surface, it’s really ideal only for blackheads and whiteheads, not usually deeper pimples. If salicylic acid creams dry you out, Dr Zeichner suggests looking for the ingredient in a face wash. “Leave it on for as long as it takes you to sing the alphabet.”
3Retinoids “They’re like pipe cleaners for your skin,” says Dr Zeichner. “They minimise the stickiness of dead cells so they’re less likely to clog hair follicles and cause pimples.” Dr James adds, “Combining retinoids and benzoyl peroxide is also very effective, because the ingredients act in different ways.” Talk to your dermatologist about prescription-strength retinoids.
4AntibioticsIf your acne is cystic, persistent or severe (15-plus pimples at once, but who’s counting?), “Oral antibiotics can get it under control by decreasing inflammation and killing some of the acne on your skin,” says Dr Weinstein. But just last year, the guidelines for this treatment changed. “Research showed a significant portion of resistant bacteria was a result of long-term antibiotic use, which was common with acne patients,” says Dr Weinstein. “Now we prescribe oral antibiotics for only 12-14 weeks.”