Can taking the pill in your teens give you adult acne?
Imagine you are a teenage girl with acne. You have tried some topical treatments prescribed by your GP for your skin, but they haven’t done the trick. When talking about further options for your acne, you are offered the contraceptive pill as a good all-rounder. After all, your skin is all down to your hormones, right? You start taking it, and it really does help. Your skin improves, though you may carry on having some breakouts, but you chalk this up to “being a teenager”. In your late teens and early twenties, you carry on, needing the contraception too. There comes a point however, where either you need to stop taking the pill for health/personal reasons, or it doesn’t seem to work anymore. Suddenly you’ve become an adult with acne, when it was only supposed to stick around for your teenage years. What’s going on?
The pill is not a permanent cure for acne
The combined oral contraceptive pill (COCP), containing both oestrogen and progesterone, is often touted as a great treatment for acne prone skin. In fact, it often seems like the perfect two-in-one option in acne-prone, teenage girls who may soon be looking for reliable contraception.
Certain types of the COCP can be useful in acne, particularly those containing ethinyl estradiol as the oestrogen component. The oestrogen in the COCP has anti-androgen modes of action, including inhibition of ovulation, blockage of androgen receptors and reduction of circulating androgens. This anti-androgen effect results in a reduction in oil gland secretions, which is one of the driving forces behind acne. Reduction in oil production can therefore improve your skin and reduce breakouts.
As a result, some girls and young women with mild or moderate acne find that their skin can clear altogether when they are taking certain contraceptive pills. However in their late 20s and early 30s , they often come off the pill for a variety of reasons, such as changing their method of contraception to something more suitable, or even wanting to give their body a break before starting to try to conceive.
Coming off the pill is fine for some women, who were never destined to have acne as adults. However, an increasing proportion of adult women who stop the pill then come to the stark realisation that — horror of horrors — their acne has come back. In fact, it was never truly gone, it was simply being masked by years of hormonal contraception.
There’s nothing wrong with your hormones!
“Is it a problem with my hormones?”
This is invariably the question that my female acne patients ask me on their first consultation in clinic. The question is always lurking in the background, whether my patient is a teenage girl or an adult who has been through this typical pill experience. Quite frequently, the follow up question is whether blood tests, with an extensive hormonal profile, are needed to look for “something wrong”, something triggering their acne.
The bottom line is that abnormal hormone levels are rarely to blame for acne. In fact, doing a hormonal profile on every single woman with acne is most likely to reveal completely appropriate hormone levels. However, that doesn’t mean to say that hormones are totally blameless when it comes to acne. Confused? Read on.
Acne is a multifactorial medical condition, meaning that several factors are at play to create a “perfect storm”. Hormones can directly and indirectly affect these other factors, and they classically begin to surge in teenage years. Androgens, one of which being testosterone, are released by both men and women and can stimulate the oil glands, resulting in excess oil production in people with a tendency to acne. Rather than an excess of androgen production, it is thought that acne sufferers have skin androgen receptors which are highly sensitive to normal levels of androgens. Given that normal levels of hormones can result in significant acne in sensitive patients but not in others, it is no wonder that a blood test is likely to be fruitless in this situation.
The exception to that rule is women who present with other symptoms suggestive of increased androgen levels, the most common condition being polycystic ovarian syndrome. In that case, a blood test can help with the diagnosis, though treatment is often similar to patients without PCOS.
Lastly, the fluctuation of hormones during a woman’s cycle is natural and unavoidable, but it really is not the sole reason for acne in women, as other factors are needed to result in persistent problems with acne. Blaming the natural fluctuation of your hormones for your acne is probably not only counterproductive as it delays other medical treatment, but it can mean you are not being kind to yourself!
So, is the pill to blame for your adult acne?
Yes and no. In truth, while the pill can initially help and is unlikely to make your acne worse, it can often mask the problem by resulting in a modest improvement which tends to be neither sustainable nor permanent.
As dermatologists, we are seeing an increasing amount of female adult acne sufferers in clinic, more so than ever before, some of whom have been previous regular contraceptive pill takers in their teens and early adult years. While this may not necessarily be cause and effect, I often wonder if these women would have benefitted more from seeking a definitive acne-specific treatment earlier.
This is not to say that the contraceptive pill should never be used in the treatment of acne, as there may be several girls and young women with mild, short lasting acne that never reach a dermatologist’s office because of it. Spironolactone is another oral treatment which can be useful in the management of female adult acne due to its anti-androgen properties, though the need to combine this with topical treatments and continue with it long term, means other options may be more attractive or suitable.
Your hormones are working for you, not against you
It never ceases to amaze me how hormones are vilified when it comes to skin problems, and acne in particular. If you google “hormones and acne”, you will find all sorts of articles on how hormonal imbalance is to blame, and how “fixing” your hormones will “fix” your skin. In fact, sometimes there is nothing to fix.
Your hormones are instrumental in many important body functions, not only serving your reproductive health, but also protective of your bones and cardiovascular health. What women think of “hormonal imbalances” are quite often normal cyclical fluctuations, also observed in women without acne.
No matter where you sit on the “hormone fence”, it is important to know that there are acne treatments out there that can work for you. Getting a detailed assessment of your acne as it relates to your skin and individual circumstances is the first step. A dermatologist can determine whether there is a need for a hormonal profile to be done, discuss skin-friendly pill options, and offer you sound advice on what the next steps to your path to clear skin could look like. If you are ready to take that leap, have a look at my article on 5 Steps to Clear Skin.
I am a consultant dermatologist and founder of Dr Pratsou Dermatology, a private medical practice focusing on all things skin. In my 10 years as a dermatologist, I have treated over 25,000 patients. I am passionate about promoting skin confidence without filters. Visit my website for more information on acne and specific treatment options.
