Resolved question:
I am a 24-year-old Asian female who weight 112 lbs. I have noticeable facial hair and oily skin.
I have been on several acne medications for the past six years, from retinoids to antibiotics. The most effective combination was Ortho Tri-cyclen Lo and Spironolactone 100 mg for almost a year; my skin was completely clear, but it stopped working. This happened when I was unable to access the Ortho for 2 wks. I regained access and have been taking the two together for 6 months, but my skin has not improved to that of its former clear state. In fact, I find that the acne on my chin worsens and improves according to my menstrual cycle. My facial hair is less noticeable with the Spiro, but is still not as diminished as before my lapse.
My doctor said if Spiro and Ortho did not work, the next step would be Accutane. However, I feel that there are more important questions that needs to be answered: Why didn't my body react to the combination as well as it did the first time? What change occurred in my body to cause that?
Something that may also be important is that only once before in my six years of acne treatment did my skin become completely clear: when I switched from Ortho Tri-cyclen Lo (the first birth control I ever took) to Yaz (which caused me extreme weight gain). Not realizing the influence of Yaz, I stopped taking it and within three months began to experience very severe acne. I tried going back on Yaz, but unfortunately I didn't experience the same positive outcome. This makes me think that my acne has something to do with hormones and the way my body adjusts to prescription drugs, and I hope you can help me clear that up.
Thank you very much, and I look forward to your response.
Submitted:
4 Days
Category:
Dermatologist
Hi,
Excessive oil(sebum production ) is a prerequisite for the development of acne.This is regulated by androgens or male hormones.Androgen hormonal levels may be disturbed to some degree in female acne patients.However,this does not establish a causal link and at least a quarter of all cases remain unexplained.Sometimes, the hormonal levels may be abnormal,at other times ,levels are normal but the oil glands are hypersensitive to the hormones.Similarly,hair growth in a male pattern(thick hair on chin,beard area etc.)is also under the influence of male hormones.Androgen effects on the sebaceous glands are reasonably well characterised but the variability in response is not fully understood.Other factors may also be involved in determining this suscepibility and may be varying from time to time.This may be the reason for the good response to anti -androgen medications(OCP and spironolactone) initially and poor response thereafter.
Acne,excess facial hair and oiliness can occur as part of a syndrome called polycystic ovarian syndrome(PCOS). It is usually seen in young obese females with menstual irregularities.You can get your PCOS profile done(testosterone,SHBG,androstenedione,DHEA,Prolactin ,FSH,LH) and see if there is any gross abnormality in hormonal levels.
Other reasons for non responsiveness to anti acne mediations include antibiotic resistance,gram negative folliculitis etc.(your physician would be able to address these).Isotretinoin is definitely a good option for you.
Hope,I could clarify your doubts at least a little bit.If you have any more queries or require any more clarifications,feel free to get back to me.
Regards,
Dr.Veena Chandran