If you thought the end of your teenage years would bring an end to your skin problems you might have been wrong!
Angie and Marti talked briefly about their experiences with skin problems on our show and we were overwhelmed by your emails so we decided to bring in Dr Scott Checketts.
About 12% of women have adult acne which is often worsened during their month cycle. There are more women out there struggling with this than one would think.
Most of my patients will describe their acne as deep, underground, painful lesions occurring mostly on the cheeks, chin, jaw-line and sometimes the neck with increased oiliness on the nose and forehead one week prior to menstruation. Some patients will also develop small acne pimples on the chest, back or shoulders. They often tell me that their acne is always present and worse now than when they were in high school. (This is probably pay-back from all those kids in high school who envied them for having perfect skin).
Many of my patients have tried every over the counter topical cream or lotion they could get their hands on and a lot have even tried several oral antibiotics, all to no avail. The topical products tend to just make the skin dry and the antibiotics often are the cause of yeast infections or other annoying side effects. Most patients do not want to try birth control pills for various reasons, (moodiness, potential weight gain, concern of other side effects). Needless to say they all tend to express a certain degree of frustration.
Adult female acne or androgenic acne is tied closely to the skin's sensitivity to the testosterone hormone in the system. Very few women will have any hormone abnormalities but a good screening for signs or symptoms of other conditions is important to identify any underlying problems that could contribute to the acne. Most of the time it just happens.
Each patient's presentation is different but usually a story consistent with hormonal acne. I often choose to treat my patients first with a medication call Spironolactone or aldactone. This is a pill that was designed as a diuretic or "water pill" to treat high blood pressure over 30 years ago. It was found to not work very well for this problem and is considered a quite weak diuretic. It is used still in patients with congestive heart failure if they begin to retain excess fluid in their ankles and legs. However, one of the side effects of this drug is that it will block or inhibit testosterone activity which is the reason we use it to treat adult female acne. This medication often effectively stops acne and facial hair growth in women because it works at the source. (It is not a medication given to men for acne as we do not want them to start talking in a high pitched voice).
Some of the side effects can include upset stomach, headache, rashes and may increase potassium levels in the blood. Some dietary cautions include no more than 1-2 bananas a day and normal portions of the dark leafy green vegetables, e.g. broccoli, spinach, Brussels sprouts, as these are good source of potassium. Younger patients under the age of 24 occasionally report a disruption of their monthly cycle. This is rarely seen in older patients. It will not lower the testosterone level in the blood but there are a few reports of decreased libido among by patients. Lastly I strongly encourage patients to not take this medication during pregnancy as it can interfere with the normal development of a male fetus. Little boy babies may be born looking like little girls. (This is not the way to get a daughter.) Most of my patients tolerate the medication very well and up to 70% experience marvelous results.
It will not cause the patient to gain weight, feel dry, worsen the acne, cause mood swings or yeast infections.
Sometimes a topical product will be added if there is a need for better control, but this rarely happens.
Dr. Scott R. Checketts, MD
www.tannerclinic.com2121 North 1700 West
Layton, UT 84041-8803
(801) 773-4840
