Acne before periods

[mayarose]

Hi,
Every month I get acne problem on face just few days before my period not after period not in between. I eat more fruits and veg near my periods to keep bloating away so expect that there shouldn't be any skin problems but it is a kind of ongoing problem now. Please advise.

[Dr Anjali Mahto]

Dear MayaRose,

Many thanks for your question. I have answered a similar question elsewhere in this clinic and i hope you don't mind me reposting it here:

Rather annoyingly, a break out of acne or spots is very common in women on a monthly basis. This occurs in very close synchrony with the menstrual cycle and often spots start to get worse 7-10 days before the start of your period. It can affect nearly two-thirds of women that are prone to acne.

This type of acne occurs due to hormonal changes during your cycle. Though women have female hormones circulating through their bodies throughout their menstrual cycle (oestrogen predominating in the first half of the month, and progesterone in the second half), the androgen (male hormone) testosterone is also present - albeit in smaller quantities - at all times. Shortly before the onset of menstrual bleeding, the female hormones reach their lowest levels; the level of testosterone, however, remains fairly constant at all times and so its proportion is relatively higher at these points. The relatively higher proportion of testosterone is thought to be one of the contributory factors in hormonal acne.

Getting your skincare right is important. There is no doubt that breakouts can leave you looking and feeling miserable. Whilst most people think of acne as a problem for teenage skin, over the past decade, doctors are increasingly seeing rising rates of acne in adults. This can either be acne that persists past teenage years or acne that first develops in adulthood.

These tips may help reduce the hormonal acne you describe:

1. Cleansing:
It is important to cleanse your skin twice a day - morning and evening. This can be in the form of a rinse off cleanser or micellar water. Choose a cleanser specially formulated for acne - these products often contain salicylic acid or benzoyl peroxide.

After cleansing, use a light gel-based moisturiser that is “non-comedogenic” i.e. prevents the formation of blackheads. Even oily skin needs moisturising as oils do not equate to hydration. Moisturising the skin will maintain the integrity of the barrier function of the skin and is vital for good skin health.

Don’t pick or squeeze your spots as your skin will take longer to clear and you may end up with acne scars.

2. Exfoliation
It is a good idea to gently exfoliate once a week if you have oily skin. This will immediately remove dead skin cells from the skin surface resulting in a brighter appearance. Longer term, it will reduce the development of blackheads. Be careful not to overdo this otherwise you will end up irritating the skin and making things worse not better.

3. Choose the right make-up products and sunscreen
It is important to choose the right products for oily, blemish prone skin. If you wear make-up, then opt for an oil-free foundation or BB cream.

It is vitally important to wear sunscreen to reduce the aging effects of the sun and the risk of skin cancer. Many people with oily skin find that sunscreens can block their pores resulting in spots. Choose a mattifying sunscreen designed specifically for oily or combination skin.

4. Healthy diet and lifestyle
Having healthy skin is part of maintaining a healthy life style. There is emerging scientific evidence that dairy products and foods rich in carbohydrates with a high glycaemic index (GI) may aggravate acne. Follow a nutritional diet with plenty of whole grains, vegetables and pulses. Stress can anecdotally also play a part in aggravating inflammatory skin conditions such as acne. Learn to de-stress and make sure you get enough sleep and exercise. Participate in activities such as yoga and mediation if this works for you.

Despite these measures, if hormonal acne remains a problem or starts to affect your self-esteem then seek help early from your family doctor or dermatologist before any scarring of the skin develops. Dermatologists area able to offer a wide range of treatments including creams, antibiotics, hormonal treatments (spironolactone, cyproterone), lasers, chemical peels, and isotretinoin. They may also do some additional tests including blood tests to measure hormone levels or an ultrasound scan to exclude an underlying disorder such as polycystic ovarian syndrome, which may be driving hormonal acne.

I hope that helps and my very best wishes,

Anjali