Friday, July 24, 2009

HORMONAL ACNE IN WOMEN

Adult Acne & Hormones

For millions of women, it happens like clockwork every month: cramping, bloating, mood swings, and acne. Experts know that acne is influenced by hormones, but research on the subject has been relatively limited — until now. A recent study conducted by dermatologist Alan Shalita, MD, confirmed that nearly half of all women experience acne flare-ups during the week preceding their period
.1

This particular kind of acnehormonal acne — may fail to respond to traditional therapies, such as topical retinoids and systemic or topical antibiotics. Several clues can help your doctor identify hormonally-influenced acne:

Adult-onset acne, or breakouts that appear for the first time in adults Acne flare-ups preceding the menstrual cycle • A history of irregular menstrual cycles • Increased facial oiliness • Hirsutism (excessive growth of hair, or hair in unusual places) • Elevated levels of certain androgens in the blood stream While hormonally influenced acne typically begins around age 20–25, it can strike teens and mature women as well, and is most persistent in women over the age of 30. These patients usually experience lesions on the lower face, especially the chin and the jaw line. While some may have breakouts on the chest and back, most have blemishes exclusively on the face. Hormonally-influenced acne is usually moderate and limited to inflammatory papules and small inflammatory nodules and occasional comedones. But how does it start?

Adult Hormonal Acne
- Puberty: Where it all begins.
Starting sometime before adolescence (around the age of nine or ten) the adrenal glands begin to produce dihydroepiandrosterone sulfate (DHEAS), an androgen. Other androgens — the "male" hormones at work in a woman's body — such as testosterone and dehydrotestosterone (DHT), join in at the onset of puberty. All of these hormones stimulate the sebaceous glands to secrete more of the skin's natural oil, or sebum. This is why oily skin and acne are so prevalent among teenagers. Naturally, since boys have more "male" hormones, teen acne tends to be more severe in males.
The treatment of acne in teenagers can be challenging, because their hormones are in a constant state of flux. They may initially respond very well to first-line treatments, such as topical retinoids and benzoyl peroxide, perhaps accompanied by an oral antibiotic. As their bodies develop, however, they may undergo severe hormonal shifts — and stop responding to the current medications. Courses of acne treatment may need to be adjusted more often with teenagers to accommodate these hormonal changes. More about teen acne.

Adult Hormonal Acne
- A vicious cycle.
Many women pass into adulthood without "outgrowing" their acne. Others may not develop it until their 20s or 30s, experiencing persistent breakouts the week before their period. Why? During the course of a normal menstrual cycle (if a woman is not taking any kind of hormonal birth control pill), estrogen levels peak at mid-cycle, then decline as she nears her period. After ovulation, the ovaries begin to produce progesterone, another hormone which stimulates the sebaceous glands. And with the extra oil comes acne. Hormones are also responsible for acne in a percentage of pregnant women, as well; the sebaceous glands go into high gear during the third trimester, causing oily skin and frequent breakouts. Some women even experience acne after menopause, when estrogen levels begin to taper off and testosterone becomes the dominant hormone.


Adult Hormonal Acne
- What can be done?
According to Dr. Shalita, the "wait and see" attitude is particularly ineffective for hormonal breakouts: "Acne that worsens during a woman's monthly cycle isn't something that women will grow out of as they get older. Seeing your dermatologist to determine the best treatment plan for acne flare-ups is recommended for the most successful result."1
Fortunately, there are many options available. It may be as simple as regulating a woman's cycle with oral contraceptives, or combining these medications with other topical or systemic treatments. More about treating hormonal acne.

1 Shalita A, “The Effect of the Menstrual Cycle on Acne,” Journal of the American Academy of Dermatology, December 2001.

SWEAT & YOUR SKIN

On the contrary! Moderate exercise is actually good for your skin — it helps you maintain a healthy body and manage your stress levels, too. If you find your acne is aggravated by regular exercise, then you may want to examine your routine. What do you wear? Where do you go? How hard do you work? Exercise-related acne is usually caused by something you put on your body rather something you do with it. Remove these outside factors, and you may put an end to your workout breakouts. Here are just a few things to watch for.

Acne & Exercise
- Make-up.
When exercising, wear as little make-up as possible. Even oil-free and non-comedogenic (non-pore-clogging) cosmetics can clog pores if worn during heavy exercise. When you’re done working out, wash as soon as possible.


Acne & Exercise
- Sunscreen.
If your regimen takes you outdoors, always wear sunscreen. While acne may improve slightly after brief periods in the sun, studies show that prolonged exposure actually promotes comedones (clogged pores) and, of course, sun damage. Some kinds of acne medication make skin more sensitive to the sun, so sunscreen is even more important. When choosing a sunscreen, look for products that are oil-free and have a protection factor of at least SPF 15 for both UVA and UVB rays. Like make-up, sunscreen can travel across the skin’s surface and lodge in the pores — so wash immediately after working out.


Acne & Exercise
- Clothing.
If you’re prone to body acne, avoid garments made exclusively with lycra or nylon. Why? Some synthetic fabrics can trap the heat and moisture against your skin, creating a fertile breeding ground for the bacteria that contribute to acne. For moderate exercise, your best bet is lightweight, loose-fitting cotton, or a lycra-cotton blend. Natural fabrics allow the skin to breathe, and loose garments are less likely to cause friction. If you’re exercising vigorously and working up a good sweat, however, you may want to try some of the new fabrics designed to wick moisture away from your skin.


Acne & Exercise
- Equipment.
Some people are more likely to get acne or have their lesions aggravated in the areas affected by sports equipment. The best defense against friction-related breakouts is a good fit — make sure your helmet doesn’t slide around on your forehead, or your wetsuit isn’t too tight under the arms. You can also curb equipment-triggered breakouts by lining your helmet with a layer of soft, washable cotton fabric; it's a great use for those old t-shirts, too. And no matter what the sport, it’s always a good idea to keep your equipment clean and dry when not in use.


Acne & Exercise
- Moisture.
Mom was right: You should get out of those wet clothes! No matter how you get your exercise — treadmill, trail, tennis court, or whatever — don’t sit around in your sweaty clothes or wet bathing suit when you’re done. If you can, shower off immediately and change into dry clothes before driving home. If this isn’t possible, change into dry clothes and wipe down as well as you can. When toweling sweat off your face, always use a clean towel, and blot gently rather than wipe. Vigorous wiping can irritate your skin, driving make-up and sunscreen deeper into the pores.


Acne & Exercise
- Showering.
Again, it’s best to shower immediately after working out. You may want to use a medicated exfoliant cleanser, but always be gentle with your skin. Scrubbing harder isn’t going to make you any cleaner, or make your acne go away — and it may actually irritate existing lesions or promote the development of new ones. If you can't shower right away, you can still curb breakouts by wiping down with medicated pads; keep a few in your gym bag just in case.
So keep up the good work! A healthy exercise program is an integral part of your overall health; and a healthy body is more likely to have healthy skin. Just keep an eye on the various factors that accompany your regimen, and try to remove the acne triggers — you’ll be on your way to breakout-free workouts.

COSMETICS & ACNE

Is your temporary solution part of the problem? For decades, dermatologists and cosmetologists alike have debated the effects of cosmetics on the skin, particularly in acne sufferers. Make-up has often been branded an “acne Catch-22” — you want something to cover the redness, but you’re told it may actually be causing your acne. Fortunately, this is only partly true. To understand how to approach the make-up issue, we should start with a discussion of “cosmetic acne.”




Cosmetic Acne & Skin Care - A mild-mannered cousin. Acne cosmetica, or acne that is caused by cosmetics, is a mild and fairly common form of acne. Because it is triggered by topical products rather than the complex process that creates true acne, it can strike anyone — even people who are not physiologically prone to the condition. Characterized by small, rashy pink bumps on the cheeks, chin and forehead, it typically develops over the course of a few weeks or months and may persist indefinitely. If you've recently started using a new skincare product and you're experiencing any of the symptoms listed above, discontinue use of the new product for a few days and see if your breakout subsides. NOTE: While studies have shown that make-up does not cause true acne, it can exacerbate the condition. So it’s helpful to be aware of common topical triggers, no matter what kind of acne you have.

Cosmetic Acne & Skin Care
- The culprit: Comedogenics.
Ever wonder where your make-up goes over the course of the day? Some of it is rubbed off by contact with your hands and your clothing, and some of it migrates across your skin, settling into your pores — much like rainwater collects wherever there are small holes in the ground. Some make-ups include ingredients that are considered comedogenic, or substances that are known to clog pores. Although these cosmetics may not cause true plugging of the follicle, certain ingredients may induce follicular irritation. The result? The small, persistent bumps known as “cosmetic acne.”


Cosmetic Acne & Skin Care - Seven rules for a clean beauty routine. With so many products making so many claims, it’s easy to be confused by clever marketing. Fortunately, just a bit of education can get you on the path to choosing the proper cosmetics and using them wisely. Here are seven good rules to follow for a healthy make-up regimen:

1.
Avoid penetrating oils. Contrary to popular belief, not all oils are comedogenic. Petroleum products, mineral oil and sunflower oil do not penetrate into the pore. Most cosmetic oils, however, can aggravate acne — so it’s best to avoid them. One of the most common acne triggers in skin products, especially lotions and sunscreens, is lanolin, a fatty acid extracted from sheep’s wool. Isopropyl Myristate, which promotes smooth, even application in many foundations, is such an aggressive penetrator that it’s the main ingredient in most rust-removers! In general, products labeled “oil-free” and "non-comedogenic" are less likely to clog your pores and trigger breakouts.

2. Steer clear of sweet smells. Fragrance is a major cause of allergic and irritant reactions on the face. Even products that claim to be "unscented" may include fragrances added to mask the smell of other ingredients. It’s best to stick with products labeled as “fragrance-free” or “hypo-allergenic.” Of course, reactions to fragrance differ dramatically, and you may find certain perfumes that don’t affect your skin. The most common offenders are fragrances in the ambrette, bergamot, cinnamate and musk families. If the derivatives of your favorite face cream or foundation’s scent are not easily determined from the product label, try a patch test on the skin behind your ear. If no irritation appears after three days of repeated application, you may continue usage on a larger area.

3.
Be smart about shadow and blush. The stuff that puts the sparkle in your eye shadow, face powder and blush is usually mica, a common mineral. The jagged, flaky shape of mica particles can cause irritation and/or clogging in the follicle, so it’s best to use products without too much shimmer. Likewise, many of the red dyes used to put a bloom in your cheeks are coal tar derivatives; not surprisingly, these substances are comedogenic, too. Check the labels for blushes that use carmine, which has been a natural, healthy cosmetic colorant since the time of the Aztecs. Also, cream blushes are more likely to have comedogenic ingredients, so stick to powder or gel blushes.

4.
Get wise to eye creams. Because of the delicacy of the skin around the eyes, creams created for this area are often thicker and greasier than regular facial moisturizers. Heavy eye creams and oily eye make-up removers can promote milia, tiny white cysts under the eyes. These kinds of products can also migrate to neighboring areas, creating acne on the cheeks, temples and forehead.

5.
Style your hair with care. Most hair products are full of the ingredients we’d like to keep away from our skin: alcohol, adhesives and oils. So if you’re prone to acne, use care when styling your hair — cover your skin when you spray, and try to keep oils, mousses, gels and pomades away from the skin at the hairline. And don’t use hair products when you exercise; perspiration from your scalp can carry styling products onto your skin, contributing to new breakouts.

6.
Wash after exercising. While we know that sweat doesn’t cause acne, it can promote it in those who are prone — and make-up can make matters worse. Even non-comedogenic products can cause clogging or irritation in the presence of heavy perspiration. As a rule, it’s best to wash immediately after exercising with a medicated exfoliating cleanser.

7. Use the right lip lube. If you have problems with pimples around the mouth area, you might want to reconsider the products you use on your lips. Lipsticks and glosses are greasy by nature, with high concentrations of petroleum, wax and other comedogenic substances. The greater the shine, the greater the potential for pore-clogging — so if you're breaking out, try going for a matte finish rather than a high gloss. In general, it’s fine to doll up! Just choose your cosmetics carefully — look for products that are oil-free and non-comedogenic. Read labels carefully to avoid common topical triggers. And of course, use your common sense; if a product that looks okay on the label is irritating your skin, discontinue usage right away.

5 STEPS TO SAFER SHAVING


The acne-like breakouts we know as "shaving bumps," or Pseudofolliculitis barbae, are the result of inflammation in the hair follicle brought on by shaving. As hairs begin to grow back after shaving, waxing or plucking, they get trapped inside the follicle, resulting in irritation and swelling. Anyone can get shaving bumps, but they're more common in people with curly hair. Fortunately, anyone can take steps to prevent them. By following a few simple steps, you can learn to "shave smart" for fewer breakouts.

Acne & Shaving
- Warm it up.
Before you begin shaving, prep the area with warm water. The hydration makes your skin more pliable; the heat will dilate your blood vessels, bringing blood flow to the area. Some people find that shaving in the shower brings better results.


Acne & Shaving
- Lather well.
Pseudofolliculitis barbae can also be diminished by using the right shaving cream. Thinner, more filmy shaving creams help the razor glide over the skin, reducing irritation.


Acne & Shaving
- Use the right razor.
If you can, use an electric razor. The shave won't be as close, but you probably won't break out. If you prefer blade shaving, use a new single-blade razor each time you shave. Why single? Double-and triple-edged blades lift the hair out of the follicle for a shave that is actually below the epidermis. As part of the skin's natural healing process, the epidermis grows over the opening of the follicle. Then, as the hair grows back, it has to fight to get out of the closed follicle — causing an inflammatory response.


Acne & Shaving
- Go with the grain.
The closer your shave, the more likely you are to get shaving bumps. So try to get into the habit of shaving with the grain — for both men and women, this usually means shaving down rather than up. This will cut down on irritation and may help with nicks and cuts, too.


Acne & Shaving
- Tone up.
When you're done, you may want to apply a mild alcohol-free toner (witch hazel is a gentle alternative) or antibacterial gel; this will kill bacteria before it gets into the open follicles — and help you stop Pseudofolliculitis barbae before it starts. Both benzoyl peroxide and salicylic acid are available in gel form as well.

For most people, these simple practices go a long way toward the prevention of Pseudofolliculitis barbae. If your shaving bumps persist, consult your dermatologist; he or she may be able to prescribe a more aggressive topical acne treatment.

LIFESTYLE, STRESS, & MANAGING YOUR ACNE

Is your lifestyle causing your acne? Certainly not. But the way you live affects your whole body, including its largest organ: the skin. The place you work, the hours you keep, the ways you play — all of these can take a toll on the epidermis, especially in those who are prone to acne. Following are a few everyday acne triggers you might not be aware of, and a few things you can do to avoid them.

Comedones on the job.
Since some part of your skin is always in contact with your environment, it’s important to pay attention to the substances with which you come into contact on a regular basis. You may be exposing yourself to comedogenic (pore-clogging) substances on the job without even knowing it; while these substances are not the cause of your acne, they can aggravate it. For example: the airborne grease in a fast-food restaurant can create an invisible film on your skin, clogging your pores. Most industrial oils — the kinds used in cars, in factories, on bicycles — are comedogenic as well.


Acne & Sleep
- Sleep and your skin.
The simplest good deed you can do for your skin may surprise you: sleep! Scientists and mothers around the world agree that a good night’s sleep — at least eight hours — can do wonders for your complexion. How? A healthy, well-rested body has the resources to build a strong immune system. While a robust immune system won’t prevent acne altogether, it can help fight infection so your lesions clear up more quickly. Luckily, your body isn’t picky; uninterrupted sleep in the daytime is just as beneficial. So if you work late, sleep late — and try to maintain a regular schedule.


Acne & Sun - Savvy sun worshipping. While it’s true that small amounts of sun exposure may initially improve acne, don’t be fooled; the benefit is temporary. Consistent sun bathing will dry your skin, causing your sebaceous glands to produce more oil. Also, skin that has been exposed to the sun has to slough old cells more frequently; when you combine the extra oil and extra dead cells, you create the ideal environment for comedones, or blocked pores. So if you work (or play) in the sun, it’s important to protect your skin with sunscreen. Look for oil-free products that provide at least an SPF 15 protection level from UVA and UVB rays.

Acne & Stress
- The stress connection.
Not surprisingly, stress often has a starring role in the ongoing acne drama. “Ninety percent of my patients complain about what stress does to their skin. It has a huge impact, and it’s becoming a bigger problem every day,” says Katie Rodan, MD, a clinical professor of dermatology at Stanford University.
How can stress — emotional anxiety caused by any number of factors in your life — show up on your face? The connection is purely chemical. When you become tense, your adrenal glands go work, flooding your bloodstream with the hormone cortisol. This triggers the sweat glands in your face to produce more oil. When your sebaceous glands go into high gear, there’s a higher probability that this excess oil will mix with dead skin cells and clog your pores, trapping bacteria inside. The result? More acne, primarily inflamed papules rather than blackheads or whiteheads.

What can you do?
Of course, you can't eliminate stress from your life — it's part of being human. But you can minimize its damage by leading a healthy lifestyle. A balanced diet and at least seven hours of sleep every night will help you build a stronger physical foundation; if you're well fed and well rested, you're less likely to feel irritated by the events of your day. Try to get some exercise every day, even if it's just a walk around the block at lunchtime. It's also important to take time out of every day to relax — read a book, take a bath, practice yoga, or do whatever makes you feel happy and calm. It's an important step towards overall good health, and therefore the health of your skin.

PHARMACOLOGICAL TRIGGERS: Are Your Prescription Drugs Causing Breakouts?

There are a number of prescription medications known to cause acne. If you routinely take any of the following drugs (or drugs like them) and have problems with acne breakouts, you may want to consult your physician to discuss an alternative treatment with fewer side affects. But try to keep it in perspective, your health comes first!

Anticonvulsants
(like Dilantin) are prescribed for the treatment of epilepsy and other kinds of seizures. Most medications in this family list acne as a common side-effect.


Corticosteroids
(like Prednisone) are often used to treat asthma and other chronic lung diseases. Like cortisol, a natural steroid produced by the body during times of intense stress, corticosteroids can stimulate sebum production and lead to blemishes.


Disulfuram
(or Antabuse) is prescribed to help chronic alcoholic patients who want to remain in a state of enforced sobriety. When mixed with alcohol, this drug causes a range of unpleasant symptoms intended to discourage further mixing. Unfortunately, regular use of Disulfuram (even when not drinking) can cause acne in some patients.


Immuran
.
Like other immunosuppressants, Immuran is used to suppress the immune system in patients awaiting an organ transplant. It can help prevent organ rejection; it can also suppress your body’s natural ability to fight the bacteria that cause acne.


INH
(or Isoniazid) is typically used to treat tuberculosis, or TB. Thought to be largely eradicated, TB experienced a resurgence in the late 1980s among the homeless population and in patients suffering from AIDS. It continues to be a problem today.


Quinine
is prescribed as a precaution against — or treatment for — malaria. If you’re traveling to a part of the world where malaria is a risk, be sure to ask your doctor about alternative solutions.


Thyroid preparations.
Some thyroid medications (such as Thiourea and Thiouracil) are known to trigger acne. These preparations are used to stimulate the thyroid gland in patients with low thyroid function. Large amounts of iodine, which also helps to regulate thyroid function, can also cause breakouts.

THE TRUTH ABOUT DIET & ACNE

Don’t eat that — you’ll get zits! We’ve all heard it; from parents, friends or even the family doctor. But the fact is, even after extensive study, scientists have not found a connection between diet and acne. Not chocolate. Not french fries. Not pizza. According to the American Academy of Dermatology, “A healthy diet is important for improving raw materials for healthy skin,” but they also note that greasy or sugary foods do not cause acne.1 Likewise, a study published in the Journal of the American Medical Association concurred, “Diet plays no role in acne treatment in most patients…even large amounts of certain foods have not clinically exacerbated acne.”1 Of course, that doesn’t mean you should make a habit of eating foods high in sugar or fat. The skin is the body’s largest organ, so what’s good for the rest of you will be good for your skin, too.

Acne Prevention & Diet
- Nutrients for healthy skin.
There are a number of nutrients found in everyday foods that are known to promote a healthy body — and therefore healthy skin. Get wise to these substances, and you’ll increase your chances of conquering your acne.


Acne Prevention & Diet
- Vitamin A.
Naturally occurring Vitamin A, or retinol, is found in fish oils, liver and dairy products. The Vitamin A produced by plants is known as Beta-carotene, and is found in yellow/orange fruits and vegetable such as carrots, yams, apricots and cantaloupe, as well as green vegetables like parsley, kale and spinach. Extremely high doses of Vitamin A are toxic, so don't overdo it.


Acne Prevention & Diet
- Vitamin B-2.
Stress has been known to aggravate existing cases of acne, and Vitamin B-2 is often helpful alleviating stress. Foods with a high concentration of B-2 include whole grains, fish, milk, eggs, meat and leafy green vegetables.

Acne Prevention & Diet - Vitamin B-3. Found in peanuts, eggs, avocados, liver and lean meats, Vitamin B-3 improves circulation, promoting healthy skin. It also reduces the cholesterol level in the blood and helps you metabolize protein, sugar & fat — increasing your energy through proper utilization of food.

Acne Prevention & Diet
- Vitamin E.
Vitamin E is found in almonds, peanuts, sunflower seeds, broccoli, wheat germ and vegetable oils. A powerful antioxidant, it protects your cells against the effects of free radicals, which are potentially damaging by-products of the body’s metabolism.


Acne Prevention & Diet
- Zinc.
Even in trace amounts, the antioxidant zinc is known to boost the immune system, improving overall health — which of course is reflected in the skin. Zinc can be found in eggs, whole grains, nuts and mushrooms.

Acne Prevention & Diet - Know your own triggers. Since acne is different for everyone, there may be certain foods that cause flare-ups in your skin. Clearly, these foods should be avoided. You may also want to check your vitamin supplements for their iodine content; while normal amounts of iodine have not been shown to affect skin, amounts greater than the RDA of 150 mcg may aggravate your acne. Overall, use your common sense. Drink lots of water and eat a healthy, balanced diet — but don’t be afraid to indulge your cravings every now and then.

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