Opportunity for a Successful Combination Therapy for Adult Hormonal Acne

Opportunity for a Successful Combination Therapy for Adult Hormonal Acne

Understanding Acne

When trying to understand the etiology (causes) of acne, hormonal imbalance is often cited as one of the most prevailing factors responsible for acne. Fluctuations in hormone levels can result in over production of sebum (skin oil) by the sebaceous glands residing in the skin. This extra sebum tends to clog the pores of the skin the first step in the acne cascade.. It is important to understand that androgens, the male hormones are very potent in stimulating the sebaceous glands.

Both, women and men produce all three sex hormones: estrogen, testosterone and progesterone. Of course, depending if you are a woman or a man - your glands produce more estrogen or testosterone.  If a woman produces too much testosterone (androgens), this physiologic “over-dose” may result in symptoms such as: acne, too much facial or body hair (hirsutism), patterned female baldness and sometimes changes in menstruation cycle or in rare cases even infertility. 

When a woman’s acne is thought to be caused by increased levels of androgens (testosterone) produced primarily by the adrenal gland this condition is termed “Androgenal acne” or “androgen induced acne”.   The increased levels of androgens cause the sebaceous glands to make excess sebum (skin oil) which can clog pores leading to the accumulation of dead skin cells and the growth of bacteria (P. acnes).  This condition appears on the face as white heads and black heads (comedones).  In certain situations, a local inflammatory response can lead to pustules and papules.  If the inflammatory cascade reaches beyond the hair follicle where it originated, cysts are formed, which are painful and can lead to more severe damage of the skin which can lead to scarring.   Understanding that androgens play a pivotal role in the development of acne has led some physicians to prescribe spironolactone (Aldactone) for acne treatment in women with suspected androgen induced acne.

Why Spirinolactone?

Spirinolactone (brand name, Aldactone) was originally developed in the 1960’s as a diuretic for the treatment of hypertension (high blood pressure) and edema in patients with congestive heart failure.  A unique characteristic of spirinolactone was that unlike other diuretics approved at the time, patients did not lose potassium, and it was therefore labeled a “potassium sparing” diuretic.  Aldactone’s mechanism of action involved the effect on the adrenal gland and a hormone called aldosterone.  Aldosterone when released by the adrenal gland inhibits (decreases) the formation of urine and “preserves” water in the body.  Aldactone being an aldosterone antagonist (opposite) increases urine formation helping those with high blood pressure or edema to eliminate water from their body.

How does spironolactone impact acne?

Observations were made in women with hair loss, or increased facial hair (hirsutism) that treatment with spirinolactone resulted in an improvement in both conditions, which were known to be associated with androgens.  Further research revealed that spirinolactone has dual effects on androgens. Spirinolactone acts as an androgen receptor blocker (it blocks the influence of androgens on target organs like the sebaceous glands), and it also decreases the production of androgens in the adrenal glands. As a result, Aldactone (spirinolactone) can reduce symptoms resulting from over production of androgens including androgen induced acne in women.  It is important to note that the use of spirinolactone is restricted to women since longer term use in men results in feminization due to decreases in circulating testosterone levels. It is also important to remember that in women who are pregnant or anticipate becoming pregnant special care and attention needs to be paid since spirinolactone has been associated with teratogenesis (possible changes in a fetus). 

From an acne treatment perspective, the goal for the use of spirinolactone is to reduce the impact of adrenal androgens on sebaceous gland secretions.   Spirinolactone is therefore not recommended for women with acne associated with fluctuations in female sex hormones (estrogen and progesterone).  Fluctuations in female sex hormones is common during puberty, the menstrual cycle, before and after child birth and lastly at the menopause.  For certain individuals these fluctuations in hormone levels also seem to be associated with the appearance of acne.

It is important to understand that spironolactone is Not effective if androgens are not the cause of acne and here is why.  Spirinolactone is  actually known as a “partial agonist” of the androgen receptor, this means that in the absence of androgens like testosterone and DHT spironolactone will have a mild positive effect (stimulate) on the androgen receptor.  It is only under conditions when there is excess androgens available in the blood that spironolactone by blocking testosterone or DHT from binding to their receptor has a clinical benefit.  This means that women need to understand whether their acne is actually caused by elevated levels of androgens.  Certain symptoms like thinning hair or hair loss, development of facial hair in combination with resistant acne are signs you have androgenal acne.  Of course yur physician can also perform a blood test to confirm you have elevated testosterone or DHT levels.

AcnEase for Prevention and Treatment of Acne &  Use of  Spirinolactone

Acnease- a unique all botanical acne treatment and spirolactone represent rare complimentary treatment opportunity for androgenal acne sufferers.  We may even say- they represent a combination therapy that may help many adult women with severe hormonal/androgenal acne

AcnEase® is an all-natural, proprietary, herbal based medicine specifically developed to treat and prevent acne.  The ingredients in AcnEase® do not change hormone levels, but rather diminish their impact on sebaceous gland secretions.  In addition, the ingredients present in AcnEase® also have mild antibacterial and anti-inflammatory properties, which also help in the treatment of acne.  The safety profile for AcnEase® is extraordinary with the only reported mild side effect being a “food type” allergy to one of the ingredients in AcnEase in a limited number of cases.  Clinical testing in Asia has reported >90% efficacy in reducing the formation of new pimples.  Historical data also supports the clinical utility of AcnEase in the treatment of androgen associated acne.  However, in women with resistant acne and taking spironolactone, AcnEase can provide a nice compliment to gaining greater overall effectiveness. Similarly if a woman elects to take AcnEase for androgen induced acne and is not seeing 100% improvement addition of spironolactone for a short duration may do the trick. AcnEase® in addition to helping women with androgen induced acne has also been shown to be effective in women with acne attributed to fluctuating hormone levels, especially those who are often taking oral contraceptives as a part of their acne treatment paradigm. 

AcnEase® can be viewed as having a dual acne treatment utility:

As a stand-alone treatment for acne, the appropriate regimen and dose for AcnEase varies upon the nature, location (face and/or torso) and duration of acne.

In addition, it is important to note that AcnEase can be used in conjunction with either spirinolactone and/or oral contraceptives (OC) as AcnEase does NOT directly affects hormones levels. If however an individual decides to stop taking either OCs or spirinolactone, we recommend that you do not abruptly stop either medication but choose to wean yourself off over the period of a week or two to prevent a worsening of acne symptoms.