Dr. Rayna Stoyanova, endocrinologist at Regina Life Clinic in Sofia, gave a lecture on “Acne as a Symptom of Endocrine Diseases” at the Acne Master Class organized by Beauty Woman magazine.
She directed the audience’s attention to an in-depth presentation of acne caused by hormonal changes, presented the hormones that increase sebum secretion from the sebaceous glands, and noted what provokes their imbalance. She gave guidance on what aestheticians can do in such cases and the importance of finding out the real cause of acne. Otherwise, it will reoccur regardless of cosmetic care.
When and why is acne a symptom of endocrine diseases?
The word “acne” was first used in the 6th century by Aetius Amidenus, a physician in Constantinople who called ionthos (or “acne”) the lesions appearing on the face during puberty. The disease occurs in about 79-95% of the adolescent population. It is expressed by comedones, papules, pustules and nodules. It appears in the sebaceous gland-rich areas of the face.
Although it is strictly a dermatological problem and does not threaten life directly, its social significance is great – it can worsen the quality of life, cause social isolation, mental disorders. It is most common for people aged between 10 and 20 years, but in recent years acne has also developed in adulthood in patients aged 30-40 years, in whom it can be very severe.
The forms of acne are: Acne Comodeonica – multiple open and closed comedones, located mainly in the forehead, cheeks, nose; Acne Papulopustulosa – most often the comedones are accompanied by inflammatory changes such as papules and pustules; Acne Conglobata – severe form, in which together with the comedones, papules and pustules, characteristic of ordinary acne, the skin develops various sizes of nodular and cystic changes.
The appearance of acne is influenced by internal and external factors. One of the internal factors is the change in hormonal balance. It is with hormones, and specifically those that provoke the production of sebum by the sebaceous glands, that endocrinology is concerned.
ACNE AND HORMONES
– Androgens (male hormones). In order to function properly and be healthy, the female body also produces androgens. The production of sebum by the sebaceous glands is controlled mostly by hormones – testosterone, androstenedione, androstenedione and DHEAS. Increased levels of these hormones lead to increased secretion of sebum and to the formation of comedones. Acne usually worsens in the luteal phase of the menstrual cycle (second phase) when progesterone levels rise. This is why some authors believe that it is this hormone with its androgenic effect that plays a role in the pilosebaceous unit. We as endocrinologists do laboratory tests on patients, used as a screening method to prove or exclude androgen overproduction. These include testing serum levels of total and/or free testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and 17-hydroxy-progesterone (to rule out late-onset congenital adrenal hyperplasia).
ACNE AND ESTROGENS
– Estrogens have a beneficial effect on the skin and its appendages, administered systemically as medications, they reduce the production of sebaceous secretion, since by suppressing ovulation, ovarian production of androgens is reduced.
– While in men hormones stabilize with years, in women they continue to fluctuate. Specifically, between the ages of 20 and 40, and then again during menopause, women are particularly prone to hormonally induced acne.
– The main three factors are menstrual cycle, pregnancy, menopause.
– The adrenal glands are a major site for the production of other steroid hormones vital to the human body – cortisol and gestagen.
– Cortisol, or the so-called stress hormone, is involved in the body’s adaptive responses to stressful situations. It controls water-salt balance in the body, carbohydrate metabolism, protein metabolism, bone metabolism, nervous system, immunity.
– Gestagen is a steroid hormone, an intermediate metabolite in the synthesis of adrenal cortex hormones.
THYROID HORMONES AND ACNE
T3 and T4 play a leading role in all body processes. Тhey contain iodine in their structure, and its inadvertent intake can change the function of the gland. Therefore, provoke the appearance of acne.
POLYCYSTIC OVARY SYNDROME
The clinical definition of PCOS has changed in recent years but now includes some of the basic criteria of the dermatological manifestations of hyperandrogenism, mainly acne vulgaris and androgenetic alopecia. Acanthosis nigricans, a cutaneous sign of hyperinsulinaemia, may also be present.
These dermatologic features can provide early clinical clues to recognize SPCJ, and treatment of these skin conditions can improve the patient’s quality of life and psychological well-being. Treatment modalities may include hormonal therapy designed to modulate the production and action of androgens, as well as non-hormonal therapies targeting specific dermatological conditions.
ACNE AND NUTRITION
There are foods and food products that are bad for our skin and cause it to secrete more sebum, which in turn clogs the pores and leads to the spread of pathogenic bacteria. Such foods are, for example, those with a high glycemic index (GI), that is refined carbohydrates and sugars. They cause a sharp rise in blood sugar in our body, from which more insulin is secreted by the pancreas. The insulin intensifies the action of the sebaceous glands and leads to the development of cells that clog the pores and lead to the so unpleasant acne.
In a study conducted in 2007, Austrian teenagers followed a carbohydrate-only low GI diet. They found that after 2 weeks their acne noticeably improved.
My recommendation to patients is: trust proven specialists and follow their recommendations, but don’t forget that lifestyle, stress, lack of sleep, lack of happiness in life have a huge impact on our skin condition.