As a “bread-and-butter” disease for dermatologists, acne is a frequent complaint for women who present to the clinic. Zoe Diana Draelos, MD, FAAD, an editorial advisory board member of The Dermatologist, shared some of her insights on how to treat acne vulgaris in the female patient.
Dr Draelos noted that dermatologists have a number of topical and oral medications in their arsenal, from isotretinoin to clindamycin/benzoyl peroxide. However, patients may attempt to use a number of other products or home remedies that can further exasperate the skin and cause acne to worsen instead of improve.
“It is important patients remove all food-obtained vegetable and animal oils from the face because these provide nutrients for Cutibacterium acnes. In addition, many women also wish to use skin care products that contain botanical oils. Oils obtained from plant sources can be used by C acnes to worsen the disease as well,” explained Dr Draelos.
In addition, she continued, facial cleansing is key. “Some of the newer silicone-based, sonicating cleansing devices are very helpful because they can clean both the superficial face and also the pore itself,” said Dr Draelos.
“Finally, probiotics are also entering the marketplace,” she continued. This is a new therapeutic focus, as evidence suggests that probiotics may modify pathophysiologic factors, such as improving the skin barrier, acting as an antimicrobial defense, and potentially providing an immunomodulatory effect on keratinocytes and epithelial cells. Dr Draelos explained that putting probiotic, dairy-based bacteria on the face may compete with C acnes for real estate on the skin surface such that the pathogenic organisms can no longer grow. This, in turn, can help reduce inflammation and allow the patient’s skin to heal.
Dr Draelos emphasized that the female patient with acne comes with unique challenges, particularly as acne can present all the way from puberty through menopause in women. “This is because acne is under hormonal control,” noted Dr Draelos. “Many women are using hormone-laden intrauterine devices that contain progesterone or are also using progesterone-based implants, or are taking birth control pills well beyond their 30s, or may also be using estrogen- and progesterone-containing hormonal supplementation or hormonal replacement therapy, and some women are being placed on testosterone for increased energy and other sexually related issues.” As hormones can play a key role in acne, and women see several different hormone states (adolescents, childbearing, postmenopausal) and may have hormonal supplement use, acne can be a little more challenging and difficult to control over the lifetime of a woman.