Cystic acne is a severe form of acne characterized by large, painful, pus-filled pimples and nodules that develop deep beneath the skin. These deep lesions can be tender to the touch and often lead to scarring if not properly managed. Many individuals experiencing this condition often wonder about its potential connection to hormonal birth control.
Hormones and Acne Development
Hormones play a significant role in the development of acne, particularly androgens. Androgens, such as testosterone, are present in both males and females and stimulate the sebaceous glands in the skin to produce sebum, an oily substance. An increase in androgen levels, common during puberty, leads to higher sebum production.
Excess sebum, when combined with dead skin cells, can clog hair follicles. This clogged environment creates a breeding ground for Cutibacterium acnes bacteria, triggering inflammation and leading to acne lesions. Hormonal fluctuations throughout a woman’s life, such as during menstruation, pregnancy, or menopause, can also influence androgen levels and contribute to acne breakouts.
Birth Control’s Impact on Acne
Combined hormonal birth control, which contains both estrogen and progestin, typically works to improve acne by influencing hormone levels. The estrogen component in these contraceptives increases the production of sex hormone-binding globulin (SHBG) in the liver. SHBG binds to free testosterone, making it less available to stimulate the oil glands in the skin.
This reduction in active testosterone leads to decreased sebum production, which helps prevent clogged pores and subsequent acne formation. While combined birth control generally has an anti-androgenic effect, some progestins can have slight androgenic properties. In certain cases, this might counteract the beneficial effects of estrogen or, for some individuals, even contribute to acne, though this is less common with formulations specifically designed for acne improvement.
Types of Hormonal Birth Control and Acne
Many combined oral contraceptives (COCs) are FDA-approved specifically for the treatment of acne. The specific type of progestin in a COC can influence its effect on acne, with some having more anti-androgenic properties than others. For instance, drospirenone, norgestimate, and desogestrel are progestins often found in COCs beneficial for acne.
In contrast, progestin-only birth control methods, such as the mini-pill, hormonal IUDs, or implants, generally do not contain estrogen. These methods typically have a neutral effect on acne, but in some instances, certain progestins used in these formulations can have androgenic activity, potentially worsening acne for some users.
Navigating Acne Concerns While Using Birth Control
If you are experiencing cystic acne while using birth control or are considering it for acne treatment, consulting a healthcare provider is important. A dermatologist or gynecologist can assess your specific situation and recommend the most appropriate course of action. Improvements in acne from hormonal birth control are not immediate and typically take several months, often between two to six months, to become noticeable.
Other acne treatments, including topical medications or oral antibiotics, can be used in conjunction with birth control for more comprehensive management. It is important not to discontinue birth control without medical advice, especially if it is also being used for contraception, as this could lead to unintended pregnancy or a rebound in acne symptoms.