hormones and Acne

acne hormone1.JPG

Male-like hormones such as progesterone and testosterone can play a role in acne

Hormone are a factor in the development of acne and sometimes an endocrinolgist can help evaluate hormonal acne.  The issue is either a sensitivity to your own natural fluctuations in the male-like hormones or an excess of these hormones.  Birth control pills can change the fluctuations in these hormones but cannot be used in pregnancy. Spironolactone which is a blood pressure lowering medication can change your sensitivity to these male hormone fluctuations but also cannot be used in patients that are of child bearing age. 

Acne treatment is altered when pregnant. It may be important to understand pregnancy drug ratings.  The use of of topical retinoids is not recommended in pregnancy. Tazarotene is a pregnancy category X.  Systematic reviews did not show a significant increase in the risk for major congenital abnormalities in the first trimester with topical retinoid exposure. This is reassuring for patients who did not realize they were pregnant while on those medications. However that study was not sufficiently powered to conclude that topical retinoid use is safe in pregnancy. There are case reports of fetal malformations in infants of women who were exposed to topical retinoid use during their pregnancies. 

In deciding whether to treat acne during pregnancy there should be careful consideration of the degree of acne, the patient's risk tolerance, and the preferences of the OB Gyn. Reasonable options include oral or topical erythromycin, tropical clindamycin, and topical azelaic acid all of which are pregnancy category B. Benzoyl peroxide is pregnancy category C.